Wednesday, April 06, 2005

More on Primary Care -- Who' is Going into FP Residencies?

As a follow-up to the post below, there are several interesting discussions regarding primary care in the US today. In particular, a simple review of the NRMP match data demonstrates that of the 2,761 slots available, 82.4% filled --- but only 49% were filled with US medical school applicants. That means that 51% of the family practice residency slots were filled by non-US medical school applicants. The percentages would have even been worse if the number of slots offered was as high as it was in 2001 (total of 3,074 slots).

This interesting statistic, in line with trends over the past several years, belies the constant drumbeat heard in our medical schools and from public health officials that "primary care is good, specialist training is bad." Take a group of young, highly motivated, intelligent people (many, like me, fairly "type A"), and give them a range of options for careers in medicine......surprise! They choose those fields which are most interesting, exciting, and monetarily rewarding to them. With the average medical student graduating over $100,000 in debt already, a career in a lower paying specialty looks like a quick trip into financial hardship. I would even argue that medical schools are not even attracting many of the same types of applicants that were commonplace in the past --- yesteryear's hard-charging and well-compensated cardiac surgeon is today's investment banker.

Many involved in this process point fingers at specialists, saying that we take too much money out of the pie for doing too little, etc. I don't want to get into that type of arguement, but would invite any grumbling primary care provider to spend a week with me in the hospital. We all choose our specialties for a variety of reasons. It would be more appropriate to work towards a better system of reimbursement, something that our specialty societies blatantly ignore (mine included).

Lots of (better written) thoughts about the meaning of the match results from Kevin, M.D., A Chance to Cut is a Chance to Cure, GruntDoc, and Blogborygmi.