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“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Thursday, March 27, 2003
    Primary Care Providers: An Endangered Species?

    This week the national internists' association, the American College of Physicians, reports the following sad news regarding residency matches: primary care continues to decrease in popularity as a career choice among medical students.

    For the sixth year in a row, fewer U.S. medical school seniors chose primary care residencies in the Match.

    According to results posted last week by the National Resident Matching Program, 3,040 U.S. seniors matched to categorical, primary and medicine-pediatrics internal medicine programs. That represents a drop of 194 medical students over last year, or a one-year decline of 6%.

    Since 1999, the number of U.S. seniors matching to the three internal medicine tracks has declined by a total of 14.5%.

    That's not good news. Most people receive most of their care from primary care doctors; more worrisome still, many specialists have to complete an internal medicine residency before going on to do a fellowship in the specialty of their choice (think cardiology, gastroenterology, infectious disease and nephrology to name a few), which means we'll likely be facing shortages of specialists in these internal medicine-based fields. Meanwhile, the residency positions in ophthalmology, dermatology and radiology are no doubt filling up. Which is all well and good, if that's what you want to go into... one's quality of life and economic bottom line are probably better in those fields, to be honest.

    But people need doctors. Primary care doctors. With proper training and educational background. Where are we going to get them? What's going to happen to our aging population in the next decade as more docs retire and there are fewer to take their place? Probably more and more of us are going to settle for seeing physicians' assistants or nurse practitioners. I know some excellent and dedicated PAs and NPs, but I feel that primary care docs provide better care for complicated patients with multiple medical problems - our training is focused on this very issue.

    Two factors in this problem, of course, are time and money. Providing primary care takes more time - and we are reimbursed less - than the specialist who does procedure after procedure all day. Read DB's Medical Rants for more on this topic. (She also has a lovely post about me.)



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