How Many, As Of Now, Are Intending To Go Into Primary Care

[CorpuSpongiosum]

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[Punchap]

I have no idea which specialty I want to go into. The only certainty is that I don't want to go into primary care. And I'm not the only one...apparently, only 2% of graduating medical students plan on primary care.

See here: http://www.newsday.com/services/newspaper/printedition/wednesday/health/ny-hsinte0910,0,53178.story


Politicians take heed.

 

[CorpuSpongiosum]

I have no idea which specialty I want to go into. The only certainty is that I don't want to go into primary care. And I'm not the only one...apparently, only 2% of graduating medical students plan on primary care.

See here: http://www.newsday.com/services/newspaper/printedition/wednesday/health/ny-hsinte0910,0,53178.story


Politicians take heed.

that's why i started this poll, interested to see if it were any higher for DO's.

 

[Terpskins99]

I have no idea which specialty I want to go into. The only certainty is that I don't want to go into primary care. And I'm not the only one...apparently, only 2% of graduating medical students plan on primary care.

See here: http://www.newsday.com/services/newspaper/printedition/wednesday/health/ny-hsinte0910,0,53178.story


Politicians take heed.

The system brought this onto themselves. Medicare and HMO's keep finding ways to screw doctors out of their paychecks. What incentive is there for any doctor to pursue primary care? (Though, I know for a fact that way more than 2% of my classmates intend to pursue PCP. Especially if you include hospitalists/internists that run clinics part-time.) Besides, my feeling is that the nurses and PA's can handle primary care just fine. If they want it, they can have it.

 

[rddoms]

It has been said that one should only take X dollars out for student loans if you can make the same amount in one year as an attending. I don't know about the rest of you, but Tuition + living expenses at a private school is not cheap. Plus I like the knife!

 

[DannMann99]

It has been said that one should only take X dollars out for student loans if you can make the same amount in one year as an attending

Look's like i'll have to specialize... lol

(alittle over 200 🙁 )

 

[Cp22kjer]

Look's like i'll have to specialize... lol

(alittle over 200 🙁 )

This was touched on another thread. If the incentives were right I think many people would consider primary care. But its completely logical to rule that out with 300K in loans.

We really need forgiveness plans and better salaries. On top of that its scary to think that NP's and PA's are taking over many of these jobs.....it seems that physicians are almost being nudged into specialties nowadays.

 

[Terpskins99]

This was touched on another thread. If the incentives were right I think many people would consider primary care. But its completely logical to rule that out with 300K in loans.

We really need forgiveness plans and better salaries. On top of that its scary to think that NP's and PA's are taking over many of these jobs.....it seems that physicians are almost being nudged into specialties nowadays.

Not at all true. In medical school you'll find that everyone (faculty, staff, attendings) seems to be screaming at you to pursue primary care.

I think the first thing that needs to be addressed is tuition. The rate that it is rising these days is ridiculous. The only rationale medical schools use to explain their rise in tuition is "we're not raising it any more than anyone else". Uh... and that justifies it how exactly?

 

[andexterouss]

That poll might be true for US MD students. I'm guessing the number of DOs entering primary care should be anywhere from 30% to 40% just based on the 2007-2008 match list. In fact, i'm thinking that in the next 10 years majority of primary care docs are going to be DOs despite our small number compared to MDs. Also lets not forget that Carib schools are producing a massive amount of students each year and a lot of them go into primary care if for no other reason than the fact that they couldn't match other specialties. The problem I see is that most major cities may be saturated with PCPs while rural areas might be short stiffed.

 

[Chocolate Bear]

Not at all true. In medical school you'll find that everyone (faculty, staff, attendings) seems to be screaming at you to pursue primary care.

Cp22kjer was addressing the poor outlook for PCPs due to widening scope of NPs and PAs, not a lack of encouragement--before and during med school--to pursue primary care. The latter is blatant.

 

[scpod]

....In fact, i'm thinking that in the next 10 years majority of primary care docs are going to be DOs despite our small number compared to MDs....

No way. Keep in mind that primary care includes Family Medicine, Internal Medicine, Pediatrics and OB/Gyn. Do you have any idea how many residency spots per year there are for those residencies? Lots of MDs will be filling those for years to come.

Plus, there are more MDs practicing Family Medicine alone right now than there are total practicing DOs.

 

[Terpskins99]

No way. Keep in mind that primary care includes Family Medicine, Internal Medicine, Pediatrics and OB/Gyn. Do you have any idea how many residency spots per year there are for those residencies? Lots of MDs will be filling those for years to come.

Plus, there are more MDs practicing Family Medicine alone right now than there are total practicing DOs.

Since when did ob/gyn be considered primary care?

 

[Old_Mil]

Besides, my feeling is that the nurses and PA's can handle primary care just fine. If they want it, they can have it.

That's the irony of it all. Primary care is not only well adult/child care and preventive medicine (which midlevels are capable of handling), but the triage of symptoms (which requires the greatest amount of intellectual horsepower in all the house of medicine, which is why it should be wholly owned by Physicians). Unfortunately, the way medicine has developed, insurance doesn't reimburse people to think...

...and so primary care falls by the wayside as more and more doctors spend their postgraduate years training as technicians to do procedures that do reimburse.

 

[schrute]

That's the irony of it all. Primary care is not only well adult/child care and preventive medicine (which midlevels are capable of handling), but the triage of symptoms (which requires the greatest amount of intellectual horsepower in all the house of medicine, which is why it should be wholly owned by Physicians). Unfortunately, the way medicine has developed, insurance doesn't reimburse people to think...

...and so primary care falls by the wayside as more and more doctors spend their postgraduate years training as technicians to do procedures that do reimburse.

I agree with you, but I think it would be MUCH harder to reverse the forward motion of physician employment than to expand the role of mid-level care providers (mainly PAs & NPs), to whom the role of general practitioners has already been delegated. Not to knock on FP, but it really doesn't take a rocket scientist with 8 yrs of school & post-grad training to be a PCP. Granted, most of that mentality is due to PCPs having chunks of their practice-scope gradually annexed by specialists, but that's a reaction to our litigious society and evidence-based medicine.


I'm not saying the answer is to just GIVE family practice to PAs and NPs, but physicians shouldn't be scolded for NOT entering the field when it's slowly been dissected by societal demands, cost restraints, and the overall problems with our system. With people graduating with $200k of debt, it's a GAMBLE to invest your time, money and sanity in a field that has slowly been auctioned off to the highest & lowest bidders (specialists & mid-levels, respectively).


And I know just-out-of-training it takes a wider breadth of knowledge to deal with the complexity of problems physicians encounter than what PAs and NPs receive in training, but PAs with a few years of experience can handle the overwhelming majority of the stuff that comes through the ER / clinic. My dad was a PA and worked in the ER / clinic for 17 years in a rural community...90% of the time, there was no attending physician.

Much of primary care is not THINKING and applying intellectual tenets from medical school, it's REACTING and applying cookbook medicine.

 

[andexterouss]

No way. Keep in mind that primary care includes Family Medicine, Internal Medicine, Pediatrics and OB/Gyn. Do you have any idea how many residency spots per year there are for those residencies? Lots of MDs will be filling those for years to come.

Plus, there are more MDs practicing Family Medicine alone right now than there are total practicing DOs.

I was actually comparing US MDs and DOs. Majority of the PC slots you are referring to are filled by FMG/IMGs and DOs according to NRMP.So , yes, technically more "MDs" will be represented in primary care but thats due to massive overcompensation from FMG/IMGs.

Right now, 65% of practicing DOs are in primary care.If only 2% of US MDs keep going into primary care and DOs maintain their current rate, i think we'll be the majority of US grads in primary care. May be not in 10 years but it could happen.

 

[scpod]

....If only 2% of US MDs keep going into primary care and DOs maintain their current rate, i think we'll be the majority of US grads in primary care. May be not in 10 years but it could happen.

Except that's not true. A lot more than 2% are going into it. You can read that Newsday article that surveyed some students but the truth is in the match numbers. Counting only US MD grads in the 2008 match, about 9% (1303 of 15242) applied for Family Medicine spots alone. And, a whole bunch of Internal Medicine residents must be planning on primary care too, since less than 1800 US MD's applied for fellowships after IM in 2008.

 

[UnderdogMD]

Medical schools across the US are increasing enrollment. New schools are being built. BUT, the residency spots for specialties aren't really increasing that much. Things are going to become even more competitive. FMG's/IMG's will be the first to be displaced. It is way for them to force doctors into primary care.

Edit: Actually, just ran across this post by law2doc that is saying the exact same thing in a better way than I am

Not really a "problem". What folks choose is irrelevant. There are a fixed number of non-primary care residencies. As medical school ranks increase each year while residency numbers are pretty stable, some percentage of those that don't choose primary care paths will still end up there as the other stuff fills up, and folks end up in their backups or scramble for an open position. At present, we are filling our overflow with the offshore educated crowd, and as more and more US residents are generated, we will increasingly fill those slots with US students, whether it is their first choice or not.

 

[peppy]

With people graduating with $200k of debt, it's a GAMBLE to invest your time, money and sanity in a field that has slowly been auctioned off to the highest & lowest bidders (specialists & mid-levels, respectively)

I totally agree. I think this is why so many students come into med school claiming they love primary care and end up changing their minds once they're in. It's not that they were just lying to get in. It's that the IDEAL world version of family medicine is different than the unfortunate real-world trends in the field.
I love the idea of family medicine in theory. If you truly got to see a little bit of everything, it would be a very rewarding and intellectually specialty. But it seems like in the real world, you end up with an identity crisis where the simple stuff goes to NPs/PAs and the complicated stuff goes to specialists.
Very unfortunate, because I don't think an NP or PA is any substitute for a good PCP.

 

[Lokhtar]

Much of primary care is not THINKING and applying intellectual tenets from medical school, it's REACTING and applying cookbook medicine.

From what specialists tell me about their field, it's pretty much like that for them too. Especially a couple I know that run their practices around certain procedures/diseases. But I don't think that it means the training was unnecessary. Because I'll tell you what, this PA that works with him could take over and no one would notice 90% of the time, just like in PCP. But its that 10% or less that doctors get paid for and that training helps.