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Med Students Say No To Internal Medicine

Posted by Jane Akre
Wednesday, September 10, 2008 11:43 AM EST
Category: Major Medical, Protecting Your Family
Tags: Doctors, Doctor, Internal Medicine, JAMA, FDA and Prescription Drugs, Health Care, Managed Care and Insurance Companies

Most medical students are not choosing internal medicine instead choosing the more lucrative specialty fields.



IMAGE SOURCE: ©iStockphoto/ doctor charting notes/ author: imagepointphoto


A Journal of the American Medical Association (JAMA) survey of 1,177 medical students finds that when it comes to making a specialty choice in medicine, internal medicine comes in last.

The survey found only 2 percent plan to pursue the field of primary care internists. 12 percent are going into pediatrics and five percent are choosing family medicine, both also primary-care fields. 

Nearly twenty years ago, nine percent said they planned to pursue internal medicine.

Why?  Money seems to be one concern.

When they graduate, the average medical student owes $140,000 in student loans. Primary care doctors make the least among doctors who choose to specialize.

“It’s getting increasingly difficult to find a (family medicine) doctor especially in rural areas. It’s a tenuous situation as students look to careers that are financially rewarding because they have a lot of debt and they’re looking away from primary care,” Dr. Mark H. Ebell, the study’s author and a primary care doctor at the University of Georgia.

Caring for the chronically ill, the elderly, the long hours and low pay, and increasing amounts of paperwork do not bode well for a balanced family life, the researchers find.

The authors write:

“Current students recognize the increasing demands on internists, particularly primary care physicians, to accomplish large numbers of preventive and therapeutic interventions during short visits with chronically ill patients while also managing increasing administrative expectations.” 

And all of this does not bode well for the number of doctors in the future. By 2020 the U.S. will have 200,000 fewer doctors than it needs to serve a population that is expected to double between 2005 and 2030.

“The United Stated is confronting a potential crisis in health care for older adults. Unfortunately, students were discouraged by the challenge of caring for the types of patients in internal medicine,” Dr. Karen Hauer of the University of California, San Francisco, who was involved in the study, said.

Expect many mid-level providers, physician assistants and nurses to fill the gap but doctors argue that physicians are needed to oversee the work of mid-level employees.

The authors conclude that increasing the salary of primary care physicians will help narrow the pay gap among physicians and may help reform the students’ concerns. 

The Physician Executive who claims to be an MD who blogs anonymously reports that:

“Many of US doctors feel that primary care is the choice of students with no other choice. Even Canada's social conscience cannot mask the prejudice entirely. I was once recruited by a cardiovascular surgeon who said I was too good to settle for family practice.”

My personal value system is to give the generalist at least as much respect as the boring old, extreme and arcane specialist, to provide the poor as well as the rich and to try and love people who are hard to love as much as people who's company everyone seems to enjoy.”

A third year medical student writes in Running A Hospital blog that he too is on the fence about pursuing internal medicine. # 

1 Comment

Anonymous User
Posted by J
Monday, September 15, 2008 12:20 PM EST

As predicted in "Code Blue, Health Care in Crisis" (Annis, Regnery Press, 1993)

Comments for this article are closed.

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