The there are currently few reports of this in the mainstream press, the AMA news announced "Residency Match sees continued growth in primary care." The American College of Physicians reports on their web site states "Residency Match Results Encouraging for Adults Needing Primary Care." Kevin Pho of KevinMD appropriately wonders whether this increase is enough to save primary care in his post "Match Day 2011: Family medicine grows, but enough to save primary care?" based on the assumption that this year's match meant good news for primary care.
Don't believe the hype.
This was not a good match for primary care or our health care system in general. These positive reports are based on the press release from the National Resident Matching Program or NRMP which is the group that runs the match. They stated that
"The number of U.S. seniors matched to family medicine positions rose by 11 percent over 2010 . Among primary care specialties, family medicine programs continued to experience the strongest growth in the number of positions filled by U.S. seniors. In this year’s Match, U.S. seniors filled nearly half of the 2,708 family medicine residency slots. Family medicine also offered 100 more positions this year.
The two other primary care specialties that increased in popularity among U.S. seniors were pediatrics and internal medicine. U.S. seniors matched to 1,768 of the 2,482 pediatric positions offered, a 3 percent increase over 2010. In internal medicine, U.S. seniors filled 2, 940 of 5,121 positions, an 8 percent increase over last year."
At first glance, this seems like good news for primary care. However, their use of statistics is misleading. They are not taking into account that there were almost 500 more US medical students in the match this year. This is equivalent to a drug company telling you that their medication reduces hearts attacks by 30% (from 50 to 35), but forgets to tell you that there were 1000 patients in each group, so that the real reduction in heart attacks is only 1.5%.
What you need to look at is the percent of US medical students that matched into that speciality and whether or not it changed from last year to this year. If you go to the NRMP web site, you can get the actual raw numbers. For Pediatrics, though more US seniors matched into Pediatric residencies (remember there was about 500 more students this year than last), the percent of US seniors matching into Pediatrics was unchanged. For Family Medicine, there was a slight bump, but compared to last year, only about 1/2 of a percent more of US seniors chose to go into Family Medicine (far less impressive than the relative increase of 11%). The real big bump was in Internal Medicine, where almost 1% more US seniors matched into Internal Medicine. However, we know from previous studies, that only 2% of seniors that choose Internal Medicine plan to go into primary care. (See here for previous post).
What is also in the NRMP press release (that some are paying less attention to)
"Dermatology, orthopaedic surgery, otolaryngology, plastic surgery, radiation oncology, thoracic surgery, and vascular surgery were the most competitive fields for applicants. At least 90 percent of those positions were filled by U.S. medical school seniors.
The number of U.S. medical school seniors in emergency medicine increased by 7 percent and grew for the sixth year in a row, as they filled 1,268 of the 1,607 first-year positions available. Anesthesiology offered 44 more positions and matched 45 more U.S. seniors who filled 671 positions of the 841 offered "
Essentially, though there are more medical students this year than last, and thus more doctors available to society when they are done with their residencies, the same low numbers of students are choosing residencies that will lead to careers in primary care. This small increase will not make up for the many patients in the US who lack a primary care physicians and certainly won't even begin to fill the gap when many of our now close to 50 million uninsured patients suddenly gain insurance under health care reform. Rather, despite the clear need for more primary care physicians, our students continue to choose the more lucrative subspecialties.
America, this is a crisis. Many of the few primary care docs we have are retiring, leaving practice, or going cash only or retainer. Our students see this and continue to choose other specialties. If something is not done to increase the value, reimbursement, and job satisfaction of our primary care doctors; we will have no one left to care for our sick and aging population. (And before you post a comment about NP's and PA's filling this gap, those students aren't going into primary care either. A surgical PA makes more money than a primary care MD).
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6 comments:
A very thoughtful article Dr.Mintz.
I am from India and we face the same problem here.
Yes, the percentages are largely unchanged.
But - when it comes to finding family physicians for a workforce - I would argue absolute numbers are important too. In case, there will indeed be 11% more US seniors looking for a family practice job in 3 years.
Just because there may also be 10% more people also looking for a surgery job as well doesn't entirely take that away.
Yes, the percentages are largely unchanged.
But - when it comes to finding family physicians for a workforce - I would argue absolute numbers are important too. In case, there will indeed be 11% more US seniors looking for a family practice job in 3 years.
Just because there may also be 10% more people also looking for a surgery job as well doesn't entirely take that away.
Anonymous,
Don't get me wrong. I am happy that we will have more US students graduating this year that are choosing Family Medicine. This will mean that in 3 years we will have an increased number of Family Practice docs.
My point is that the headlines in the media give a sense of reassurance that we are seeing a real improvement, that the tide is shifting, that a new generation of soon to be physicians believes that health care reform will work out well for Primary Care and are now more likely to choose Primary Care as a field. This is just simply not true. We have a major problem. Even before the Affordable Health Care Act, the stimulus package increased loan repayment opportunities for students choosing primary care. These opportunities increased with the Affordable Health Care Act. Yet, the percent of US Seniors choosing primary care fields reached an all time low last year and hasn't change that much this year.
In other words, it's great if the absolute number of primary care physicians increases. However, this is no time to celebrate.
Don't forget, we also have DO students primarily match into primary care every year.
Well, lose no hope, students from across the world keep on filling each and every available us residency position. infact, more thn 17000 of us compete for less than 4-5000 open positions. And they're not that bad too, i know that most of only the cream of my class applied.. i personally ranked in the 99th percentile of USMLE takers and still am going into primary care. Your educational system is among the best in the world, and so are the people. dont berate yourself too much... i think America underestimates itself.
One thing that is important is however that you are sqeezing medicare funding for residency positions... all that does is fix the total supply of doctors, just that Internationals reduce and americans relatively increase... but there no changes in numbers.
Well.. hope my comment adds some perspective to the debate. Good luck and god bless america.
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