Are US Medical Graduates Turning to Primary Care?

Robert Centor, an internist and an Associate Dean at UAB School of Medicine, publishes a blog on internal medicine, american health care and health education called db's Medical Rants.  This week he posted on the results of the US medical graduate match.  For those unfamiliar, the match is run by the National Residency Matching Program, and functions frighteningly similarly to the undergraduate sorority matching system, but replacing ice-water teas with interviews and "squeal day" with match day.  After a lengthy application and interview process, residents-to-be list out programs in order of their preference, and programs rank the applicants, and then a computer (not quite so sophisticated as Watson) runs the numbers and determines who will be placed where and for which specialty training.  For instance, I had friends match nearby at UAB in fields from internal medicine to radiation oncology, and as far away as Portland, Maine, and Portland, Oregon in emergency medicine and otolaryngology.  Anyway, recent trends have shown increases in the number of US medical school graduates filling residency spots in specialties considered to be primary care, including pediatrics, family medicine and internal medicine.  For years, these have been among the least attractive fields for US seniors (in terms of percentage of spots filled) due to a variety of factors, including lower earning potential and what is perceived to be a more stressful working environment.


Centor is encouraged that this year's preliminary results show an increase in the number of US medical seniors choosing primary care specialties.  However, I disagree with his analysis of the data.  In fact, the results are nothing more than a numbers game.  In the last decade, most medical schools expanded class size by about 10%, and a few new schools popped up.  As he Centor points out, there has been no correlating expansion in residency spots.  The only place for the excess US grads to go is into less competitive specialties – those where US graduate matching rates are below 60%, like internal and family medicine.  An important point to remember is that US medical grads are not the only applicants competing for spots - osteopathic medical school graduates can also apply to those spots, as can international medical graduates (including US citizens trained at off-shore medical schools).  I don't believe the results reflect a growing appeal of primary care so much as necessary spillover.  Students are still overwhelmed by the weight of debt with which they graduate, and they are still drawn to specialties that assure "good" compensation.  So long as dermatologists make half again a pediatrician's salary without working on Fridays, rest assured that the specialty will remain that much more competitive.  You also make a excellent point that the number of primary care physicians cannot grow until residency training spots increase.  All in all, the results are good PR for medical schools and residency programs, but lacking in real substance.