Not it! — Doctor Style
A recent study in JAMA (JAMA.2008;300(10):1154-1164) found that fewer medical students are interested in internal medicine, the kind of primary care that deals only with adults. It doesn’t surprise me, but it’s an interesting phenomenon. My institution is an anomaly in that the majority of students choose to do primary care, but nationwide, primary care is going out of vogue for a number of reasons.
Medical students know how to crunch the numbers. The average debt for a graduating medical student is more than $100,000, and then after graduation, working as a resident doesn’t pay much for the time invested. Lifestyle specialties like radiology, ophthalmology, anesthesiology, and dermatology (ROAD) yield much higher salaries than the primary care specialties, so one would make more money not doing primary care. As a result, one could pay off debts sooner and have more money for leisure.
The non-monetary reason is time/effort. Primary care can be tedious dealing with lots of patients, and with that comes lots and lots of paperwork. The hours can be extensive, and the residency is time-intensive too. If you’re in a ROAD specialty, though, you don’t have to see as many patients, and the hours aren’t too bad.
If you combine the hassle with the lower income potential, it can be easy to see why so many med students are turned off by primary care, but does it have to be this way? I think part of it is attributed to the values of our healthcare system. The things that “pay” for a hospital in terms of reimbursement are procedures and use of technology. Prevention in this system is just one of those things that is beneficial on a quality level but not on a profit level. As such, the primary care doctors who are more low tech and do things like screening and counseling have to spin their gears more to stay successful financially, and though medicine overall is a highly valued profession, primary care just isn’t as glamorous as radiology.
Financial incentives like loan repayment, etc. can help improve the enthusiasm for primary care, but the problem is more of a cultural one. We need more positive exposure to how fulfilling primary care can be as opposed to the traumatic depictions of the field. If the atmosphere in the institution is enthusiastic towards primary care, the students will be more receptive to it as well. Medicine is naturally a long road, but it’s also a rewarding one. Primary care doctors are the backbone to the healthcare system in all that they do. For more flavoring of internal medicine, here’s a blog I enjoy reading, which is hosted by the American College of Physicians: ACP Internist.