Primary Care is Unappealing to Many Medical Students

Huge salary disparities and onerous student loans appear to be dampening the enthusiasm of medical school students for primary care. The 2010 National Resident Matching Program shows that the number of U.S. medical students choosing internal medicine residencies grew slightly from 2009, but not enough to impact the shortage of primary care physicians.

The NRMP data show that 2,722 seniors at U.S. medical schools enrolled in an internal medicine residency program, a 3.4% increase from 2,632 in 2009. Those enrollment numbers are similar to 2008 (2,660), 2007 (2,680), and 2006 (2,668). In comparison, 3,884 U.S. medical school graduates chose internal medicine residency programs in 1985, the American College of Physicians reported.

The 2010 match numbers include students who will ultimately enter a subspecialty of internal medicine, such as cardiology or gastroenterology. About 20% to 25% of internal medicine residents eventually choose to specialize in general internal medicine, compared with 54% in 1998, ACP said.

"Because it takes a minimum of three years of residency after four years of medical school to train an internist, it is critical to begin making careers in internal medicine attractive to young physicians," said Steven Weinberger, MD, an executive with ACP. "As America's aging population increases and more people gain access to affordable coverage, the demand for general internists and other primary care doctors will drastically outpace the primary care physician supply."

The 2009 Review of Physicians Recruiting Incentives from physician recruiters Merritt Hawkins shows that huge salary disparities continue to exist between primary care physicians and subspecialties. The average salary offered to family physicians in the Merritt Hawkins study was $173,000, the lowest of any specialty. By comparison, cardiologists were guaranteed average base salaries of $419,000 a year, and orthopedic surgeons were guaranteed $481,000.

Those compensation figures are consistent with other studies, such as the Medical Group Management Association's recently released Physician Placement Starting Salary Survey: 2009 Report Based on 2008 Data. The MGMA study found that median starting salaries for all primary care physicians grew by 7.4% between 2005-2008, to $150,000, while the median starting salaries for all specialists grew by 25% for the same period, to $275,000.

The ACP has called for increasing primary care physicians' Medicaid and Medicare payments, expanding pilot testing and implementation of patient-centered medical homes, and increasing support for primary care training programs as ways to increase the number of primary care physicians.

Weinberger said the rising cost of medical education and the financial burden on physicians is pushing many young doctors toward more lucrative subspecialties.