Author Insights: Internal Medicine Residents Are Reluctant to Pursue Primary Care Careers

Colin P. West, MD, PhD, Mayo Clinic in Rochester, Minn, and a colleague found a large percentage of residents training in internal medicine programs plan to pursue a career in a subspecialty rather than in primary care. (Image: Mayo Clinic)

Colin P. West, MD, PhD, Mayo Clinic in Rochester, Minn, and a colleague found a large percentage of residents training in internal medicine programs plan to pursue a career in a subspecialty rather than in primary care. (Image: Mayo Clinic)

A large majority of internal medicine residents, including a majority of residents in primary care programs specifically designed to promote general medicine careers, are planning to enter subspecialty careers rather than become general internists. The findings, appearing today in JAMA, are based on data from an annual survey linked to the Internal Medicine In-Training Examination taken in October of 2009-2011.

Of the 16 781 graduating third-year residents surveyed, only 21.5% reported planning a general internal medicine career. For graduating third-year residents enrolled in primary care programs, only 39.6% were considering such a livelihood. Women and US medical school graduates were more likely to report general internal medicine career plans than men and international medical graduates.

The study was conducted by Colin P. West, MD, PhD, and Denise M. Dupras, MD, PhD, of the Mayo Clinic in Rochester, Minn. Dr West discusses their findings:

news@JAMA: Why did you do the study?

Dr West: There’s been quite a bit of talk, particularly in the last decade or so, about an impending physician shortage, and there’s quite a bit of debate about whether that affects general medicine providers, subspecialists, or both. With that as the background, we wanted to learn how internal medicine residents now see their future careers.

news@JAMA: So why are so few internal medicine residents intent on pursuing a primary care career?

Dr West: There are 2 main factors. One is some of these residents weren’t ever planning on a primary care career; they were taking the training where they could get it. The other is that during the program, they see something negative about a primary care career or enticing about a subspecialty career.

news@JAMA: What images are associated with a primary care career that become factors that influence residents’ career plans?

Dr West: They see, on the positive side, that they can develop wonderful relationships with patients over time. But they also learn that primary care is associated with a heavy bureaucratic burden, paperwork, and regulatory requirements, which on the surface seem greater than for subspecialties. And, although I’m not suggesting that primary care physicians are necessarily underpaid to a great degree, the gap in income compared with subspecialty care gives people pause.

news@JAMA: Would increasing the number of residency slots for internal medicine ultimately increase the number of primary care physicians?

Dr West: Our findings suggest that if we simply increase the number of medical colleges and primary care residency slots without doing something to make primary care more attractive, we’ll just increase the number of subspecialists. And if we cap subspecialist slots, we’ll produce more physicians practicing primary care who would rather be doing something else. We want primary care physicians who love what they do and take care of their patients with joy in their careers. We don’t want primary care physicians who feel they are stuck in that career.



Categories: Medical Education, Medical Practice, Primary Care/Family Medicine

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