Medical schools in North Carolina are touting the high numbers of students they graduate who go on to primary care specialties. But those numbers aren’t the whole story.
By Rose Hoban
As usual, the scene a couple weeks ago at medical schools across the state was one of nervous anticipation, happiness and some disappointment: in short, a typical “Match Day.”
Match Day, every March 15, is when fourth-year medical students around the country learn where they will be “matched” for the post-graduate residencies that turn them from newly graduated medical students into experienced doctors.
And with the nation facing health care reform that will supposedly favor primary care specialties – pediatrics, family medicine, obstetrics/gynecology and internal medicine – medical schools everywhere are touting how many of their students are headed into primary care.
But the numbers aren’t what they seem, said Andrew Morris-Singer, a primary care doctor and the founder of Primary Care Progress, an organization that’s working to increase the number of physicians and others practicing primary care medicine.
“We are literally hemorrhaging people from the primary care pipeline,” Morris-Singer said. “In the past, 40 percent of students went into primary care, but that number has dropped precipitously.”
In North Carolina, numbers released by the state’s four medical schools claim that from each, upwards of 42 percent of students will be headed into primary care. But Morris-Singer said matching for primary care doesn’t mean those doctors will practice in primary care. He said that by the end of their residencies, at least half of those people will have moved into a specialty.
“Medical school deans are quoting a number that’s not actually the number that will end up in primary care,” Morris-Singer said. “It’s an over-exaggeration we call the ‘dean’s lie.’”
Research published in the Journal of the American Medical Association in December showed that upwards 80 percent of graduates who choose the “primary care” track of internal medicine end up specializing within three years of leaving medical school.
The UNC-Chapel Hill School of Medicine’s Robert Gwyther, M.D. admits UNC’s primary care numbers are more aspirational than actual.
“About 10 years ago, our legislature passed a bill saying medical schools have to put 50 percent of people into primary care,” said Gwyther, who advises students. “They count internal medicine and pediatrics and obstetrics as primary care, and it’s still a challenge for UNC to get the 50 percent.”
“And we know that 95 percent of the interns will end up practicing in a specialty,” he said.
The American Academy of Family Practitioners has stated that the U.S. needs to put at least 25 percent of students into family medicine in order to avoid a primary care shortage.
“Across the country, we’ve never come close,” Gwyther said.
Even though overall enrollment in medical schools is up around the country, the number of students matching to primary care residencies has stayed about flat.
“This year’s Match numbers are proof that increasing enrollment in our medical schools did not translate into an increase in the percentage of U.S. seniors entering family medicine,” wrote AAFP president Jeff Cain, M.D. in a press release.
Reasons for the exodus
Morris-Singer and others point to several factors that compel medical students to abandon primary care, even if it was the reason they entered medical school. The first, and most obvious, is money.
“When a student decides to go into primary care, he or she is walking away from $3.5 million of lifetime revenue while carrying $160,000 to $200,000 in debt,” Morris-Singer said.
Recent changes to reimbursement due to the Affordable Care Act are intended to increase reimbursement to primary care physicians.
“For family docs practicing independently, like they did in the old days, it’s 75 percent overhead to stay in business these days; only about 25 percent stays in your pocket,” said UNC’s Gwyther. “The rest is going to rent and staff and insurance billing people. Whereas if you work in the hospital as a doctor, 90-plus percent stays in your pocket. The rest is picked up by the hospital.
The article was published at Medical Schools Tout High Numbers of Primary Care Grads, But the Numbers Tell a Different Story