Match Day 2013 - Interest in primary care up, but demand still greater

Medical student interest in primary care seems to be increasing, but more is needed to address the needs of the healthcare system, say organizational leaders.

Graduating medical students increasingly appear to be interested in careers in family medicine and internal medicine, but the number of students going into primary care is not enough to meet the demands of the healthcare system, according to medical organization leaders commenting on the results of this year's National Resident Matching Program.

This year, the total number of U.S. medical students choosing family medicine residencies was 1,374, up 39% from 2012. The trend indicates students’ awareness of family physicians’ importance in patient care and a greater appreciation for the role they will play in a reformed healthcare system that includes models of care such as the Patient-Centered Medical Home, says Jeffrey Cain, MD, president of the American Academy of Family Physicians.

But the growth in interest in family medicine has slowed, Cain notes. “If we’re going to successfully rebalance the healthcare workforce on primary care medicine, we need to build the number of U.S. medical school graduates choosing family medicine," he says. Interest can be stoked through healthcare education and workforce policies and continued support for programs such as the National Health Service Corps and primary care health professions grants under Title VII of the Public Health Services Act, Cain adds.

This year's Match Day results also showed a continued increase of U.S. medical graduates who chose residencies in internal medicine-primary care (200 in 2013, 186 in 2012, and 166 in 2011).

Steven Weinberger, MD, FACP, executive vice president and chief executive officer of the American College of Physicians (ACP), says that although the organization is pleased that more graduating U.S. medical students are choosing residencies in internal medicine, the “ACP remains concerned about the need to increase the nation’s general internal medicine physician workforce to meet the needs of an aging population requiring care for chronic and complex illnesses and the increased number of individuals who will be receiving coverage through the Affordable Care Act.”

The 2013 match numbers for internal medicine are still well below the 3,884 U.S. medical school graduates who chose internal medicine residency programs in 1985, the ACP notes. Most current internal medicine residents ultimately will enter a subspecialty of internal medicine, such as cardiology or gastroenterology. Only about 20% to 25% of internal medicine residents eventually choose to specialize in general internal medicine, compared with 54% in 1998, according to the organization.

Weinberger cites problematic payment models and the exorbitant cost of medical education with the resulting financial burden on medical students and residents as barriers to a career in general internal medicine.

Anticipated physician shortages are not limited to primary care, says Jeremy A. Lazarus, MD, president of the American Medical Association. “Workforce experts predict that the United States will face a shortage of 130,000 physicians across all specialties by 2025," he says. "This shortage will be exacerbated by the increased demand on our healthcare delivery system as more seniors enroll in Medicare and newly insured Americans seek access to care."

The AMA supports legislation introduted by Senators Bill Nelson, Chuck Schumer, and Harry Reid, and Representatives Aaron Schock and Allyson Schwartz, to address physician shortages and create additional graduate medical education positions to ensure patient access to care, Lazarus adds, vowing to continue to work with Congress on the issue.