Medical School Students Shun Primary Care as Demand Rises

More than three-quarters of U.S. medical students continue to shun primary care for higher-paying specialties, setting the stage for a shortage of doctors as the population ages and health care expands, a study found.

Among medical residents who aren’t planning a career in surgery or pediatrics, 22 percent said they expect to go into internal medicine or primary care with the rest planning on fields like cardiology or dermatology, a study published today in the Journal of the American Medical Association found.

About 20 to 25 percent of students have chosen primary care in the past 10 years, down from about 50 percent in the early 1990s, said Colin West, co-author of the study. If the trend continues, the U.S. could be short 52,000 primary care doctors in 12 years as an aging population requires more complex care and more people get coverage under the health-care law, a study published last month in the Annals of Family Medicine found.

“The concern many of us have is that as the baby boomers get older and demand continues to increase, it is going to become progressively more difficult for these patients to find physicians,” said West, who practices internal medicine at the Mayo Clinic in Rochester, Minnesota. “This could be a barrier to achieving the main goal of health reform of creating greater access to health care.”

Ignoring Incentives

Under the 2010 Affordable Care Act, an additional 30 million Americans are expected to get health insurance through an expansion of states’ Medicaid programs and newly created health insurance exchanges. The law has tried to address the increase in demand by boosting reimbursement rates to primary care doctors. Still, those incentives haven’t been enough to entice most medical students, West said.

Salary disparities between primary care doctors and specialists are a major reason for the gap, West said. The average annual pay for a doctor practicing internal medicine is about $219,500 compared to $415,900 for a gastroenterologist, $422,900 for cardiologists, and $386,000 for a dermatologist, according to a 2011 report by the American Medical Group Association, based in Alexandria, Virginia.

The study today looked at survey results from 16,781 third-year medical residents who were on track to go into non-surgical, adult medicine. Of those, about 3,605 said they plan to pursue a career in general internal medicine or primary care. Even among students who were in a residency program focused on primary care, less than half said they planned to continue studying primary care medicine in their training fellowship.

The survey also showed that women were more likely than men to go into general medicine.

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