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Medical grads turning away from primary care, study shows
(Sept. 9, 2003)
Fewer graduating medical students are choosing primary care residencies, according to a study co-written by a professor at the Brody School of Medicine at East Carolina University and published in the Sept. 3 issue of the Journal of the American Medical Association.
Dr. Dale Newton, a pediatrician at ECU, and longtime research colleague Dr. Martha S. Grayson of New York Medical College in Valhalla, N.Y., published "Trends in Career Choice by U.S. Medical School Graduates" in JAMA.
"The primary message that we point out in our article is that there is a decrease of 10 percent from 1998 to now," Newton said. The authors suggest that the decrease might be explained because of the increase in mid-level practitioners, decreased career satisfaction of primary care physicians, declining income, and the widening gap in reimbursement between subspecialists and primary care physicians.
In their article, Newton and Grayson document the recent decrease in the number of medical students choosing primary care specialties: internal medicine, family medicine and pediatrics. In 1987, 49.2 percent of all medical school graduates matched to a generalist residency in internal medicine, family medicine to a lesser extent, the study says. This percentage decreased to 43.1 percent by 1991, but climbed to 53.2 percent by 1998. But by last year, the number had fallen again, to 44.2 percent. The decrease has been in internal medicine, family medicine and to a lesser extent in pediatrics, Newton and Grayson report.
The downward trend has implications. According to Newton, a future shortage of primary care doctors will create other problems for the health care system. He cited studies that show states with more primary care physicians per capita have lower mortality rates from heart disease and cancer and fewer incidents of low birth weight.
"We can only hypothesize that (the reduction is) because of lifestyle, income or prestige changes," he said. "In general, we've noticed that practicing pediatricians in surveys say that they are satisfied and that may be why pediatrics has seen a much smaller decrease in medical student interest. Lower levels of career satisfaction were reported in general internal medicine and family practice physicians."
Newton said the Brody School of Medicine has not yet seen a significant decrease in medical students choosing primary care. "We have somehow managed to avoid it," he said. "Or maybe we are just trailing the national level. As a nation, we'll be facing a shortage of primary care providers."
Newton has been researching medical student specialty choices since joining the ECU faculty in 1991. He and Grayson over the years have surveyed medical students to understand the "why" of the decreasing interest in primary care trend. Their JAMA article was based on three national databases, not just their individual school data.
"Students are also more motivated by what they see as the future lifestyles and are more likely to choose specialties with better hours and few interruptions of free time," Newton said. "Students pick up on the issue of long hours, lower pay and harassment, so they start making these choices. I still think primary care is an extremely rewarding career," said Newton, who has been an internist-pediatrician in eastern North Carolina for more than 26 years, including 14 years in private practice.
Also in the Sept. 3 issue of JAMA is an article titled, "Influence of Controllable Lifestyle on Recent Trends in Specialty Choice by U.S. Medical Students," which Newton said dovetails with his and Grayson's research.