Medical student interest in primary care continued its gradual slip, according to the latest data from the National Resident Matching Program.
In the 2009 resident match, the percentage of U.S. medical school seniors choosing residencies dropped slightly in both internal medicine and family medicine.
This year, 4,922 internal medicine residencies were offered and 98.6% were filled. Of those, 53.5% were filled by U.S. medical graduates. Last year, 97.8% of the 4,858 positions were filled, with 54.8% filled by U.S. medical graduates. This is the third consecutive year in which interest in internal medicine has dipped among graduates of U.S. medical schools.
Family medicine residency programs experienced a similar trend: Of the 2,535 family medicine residencies that were offered, 91.2% were filled, with 42.2% of those filled by U.S. medical graduates. Last year, 90.6% of total positions were filled, with 43.9% going to U.S. medical graduates. Family medicine experienced a small increase in U.S. seniors matching to its residency programs last year, but dropped back down this year.
In raw numbers, only 2,632 U.S. seniors matched to an internal medicine residency program this year, compared with 3,884 in 1985, according to the American College of Physicians. The decline is compounded, the ACP said, because currently only 20%–25% of internal medicine residents ultimately choose to practice general internal medicine, compared with more than 50% in 1998.
“We are witnessing a generational shift from medical careers that specialize in preventive care, diagnostic evaluation, and long-term treatment of complex and chronic diseases, to specialties and subspecialties that provide specific procedures or a very limited focus of care,” said Dr. Steven E. Weinberger, senior vice president for medical education and publishing at the ACP.
The problem for society as a whole, Dr. Weinberger said, is that this shift is happening at the same time that demand for primary care physicians is growing rapidly with the aging of the U.S. population. But Dr. Weinberger added that he is “cautiously optimistic” that efforts to enact comprehensive health reform in the coming years could help make primary care more attractive to medical students.
Match Day data show that interest continues to be strong in medical specialties with a heavy procedural focus, such as dermatology, neurologic surgery, orthopedic surgery, and otolaryngology.
Overall, this was the largest Match Day in history, with 29,890 participants, up 1,153 from last year and up more than 4,500 positions from 5 years ago, according to the National Resident Matching Program (NRMP). The increase included 400 more U.S. medical school seniors and 570 more international medical graduates. In addition, more students with osteopathic degrees participated in this year's match, as did more physicians who had graduated from medical school prior to this year.
“We saw an across-the-board increase in match applicants this year, particularly among U.S. medical school seniors,” said Mona M. Signer, NRMP executive director. “This is likely the result of medical school expansion across the nation in anticipation of a future physician shortage. Existing medical schools have increased their class sizes and new medical schools are in development.”
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