Primary care gains on Match Day
Fourth-year medical students chose primary care today in somewhat larger numbers than in recent years on the day future MDs across the country learned where they will spend the next phase of their medical training.
In Massachusetts, the percentage of students who picked primary care -- which includes family practice and pediatrics -- stayed about the same or grew at Boston University School of Medicine, Tufts University School of Medicine, and University of Massachusetts Medical School. At Harvard Medical School the percentage dipped slightly, part of an up-and-down pattern over the past 10 years.
Here are the primary care numbers for this year (and last):
BU: 26 percent of 105 students (17 percent last year)
Harvard: 10 percent of 165 students (12 percent last year)
Tufts: 18 percent percent of 104 students (17 percent last year)
UMass: 39 percent of 100 students (35 percent last year)
Some students who were matched to internal medicine residencies may later enter primary care, so there may be more primary care doctors in the pipeline than it would appear.
Primary care has been losing ground for many years to more lucrative specialties, including dermatology and surgery. As shortages of primary care doctors have deepened, physicians have faulted a healthcare system that pays more for procedures than for care that primary care doctors provide.
At Harvard, 8 percent of fourth-year students picked dermatology, up from 3 percent last year but the same as in 2003. That puts dermatology ahead of the 7 percent of students entering residencies in pediatrics this year, but the opposite was true for the last nine years. Pediatrics and internal medicine have been the top two choices since 2000.
"My students keep picking what are claimed to be the lowest-paid specialties: internal medicine and pediatrics," said Dr. Nancy Oriol, dean of students at Harvard Medical School. "I have a hard time seeing anything having an impact on their choices."
Students applied to programs in July, before the current economic downturn that began last fall. But the money owed for student loans has been a concern for the last several years, said Dr. Amy Kuhlik, dean of student affairs Tufts.
"We know debt level impacts student choices," she said, citing national surveys. "About 30 percent of students say it impacts their choice of field. But generally speaking I think they feel secure in the fact they are going into residency and secure they will have jobs when they get out."
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BU: 26 percent of 105 students (17 percent)
Tufts: 18 percent percent of 104 students (17 percent)
UMass: 39 percent of 100 students (35 percent)
Double percents, doesn't make sense.
Veronica, the numbers in parentheses refer to last year, as the sentence before said.
Elizabeth Cooney
White Coat Notes
As a primary care internist, I think some of these deans are congratulating themselves rather prematurely since every single one of those students choosing "primary care" may indeed choose a subspecialty of either medicine or pediatrics at the end of their residency. So what appears to be a coup for primary care remains to be seen 3 years hence.
Dr. MAS
hmm two stories about this on BDC and both of them show non white woman, are us white males really becoming this extinct......or is there a trophication of sporting non white males....you decide.!
Give me all the slack you want, im still gloating in my truths.
Wow. You should fire your editing team.
"At Harvard, 8 percent of fourth-year students picked dermatology..."
Harvard students and administrators need to be congratulated for the new crop of future leaders in healthcare who are dedicated to selfless practice of medicine for the greater good. And all the people with skin blemishes can rejoice that there will be enough docs to take care of their botox injections. However, I conjecture that all the dermatology applicants wrote about curing melanoma in their applications....
The internal medicine matches will mostly subspecialize in the future and will be lost to primary care. Won't solve the access problem we have now, nor the one we will shortly have with the Baby Boom hitting 65 and the 47 million uninsured suddenly with a new government health plan.
Actually, the way these numbers were tabulated does not make sense at all. The only students who will definitely be doing primary care are those who matched to Family Practice or to an Internal Medicine Primary Care Track program. Among students going into the specialties of Pediatrics, Internal Medicine, Medicine/Pediatrics, Psychiatry, and Obstetrics/Gynecology, some of them will remain generalists -- and they, too, are considered primary care doctors. Some, though, in each of these 5 specialties will go on to do subspecialty fellowships (e.g. pediatric cardiology, reproductive endocrinology), which are not considered primary care. So the calculation of the percentages of students going into primary care should either have included only the first two residencies (with the stipulation that this is a gross underestimate), or else all seven specialties (with the stipulation that this is a gross overestimate).
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