General physician shortage becoming acute

Medical students are shying away from careers in general internal medicine, which could exacerbate the U.S. doctor shortage expected by the time the youngest baby boomers head into their senior years, researchers report today.

Only 2 percent of 1,177 respondents to a survey of students at 11 U.S. medical schools said they planned to pursue careers in general internal medicine, according to the new study.

General internists provide a large portion of care for older and chronically ill patients, the authors write in the Journal of the American Medical Association. Yet, the rate of medical students opting for general internal medicine is declining as the number of older adults rises, they write.

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According to one estimate, the United States will have 200,000 fewer doctors overall than it needs by 2020, according to the new report. Meanwhile, the number of older Americans is expected to almost double from 2005 to 2030.

Many medical students are turned off by the thought of caring for chronically ill patients and the amount of paperwork general internists must deal with, says lead author Karen Hauer, a general internist on the faculty of University of California - San Francisco.

"They rated the intellectual aspects of the field highly, and they rated continuity of care appealing," Hauer said. "When you put the whole package together, it's too hard."

The trend of declining medical student numbers in general internal medicine and family medicine has been occurring for five to 10 years at Sanford School of Medicine at the University of South Dakota, said Janet Lindemann, dean of medical student education, on Tuesday. While the overall number of internal medicine graduates has remained level the past three years, more are opting for specialties, she said.

Pay is an estimated two to five times higher for a surgeon or anesthesiologist compared to a family physician or general internist, Lindemann said. The average medical school graduate's debt is $125,000, so students also choose specialties to help them pay off their debts, she said.

"They're choosing these specialties because in some cases, they offer a better lifestyle, better hours ... and pay," she said.

A "research letter" in the same issue of JAMA as Hauer's study ranked internal medicine as one of the lowest-paid medical specialties.

Members of the medical school class of 2007 graduated with an average debt of $140,000, writes Mark Ebell, a family practice doctor at the University of Georgia.

That's $5,000 higher than the average starting salary of internists that year, according to Ebell.

Their amount of debt didn't seem to influence the medical students' choice of specialty in her survey, Hauer says. Rather, students focused more on quality-of-life factors such as income and work hours, which did steer them away from general internal medicine.

Dr. Tom Braithwaite, medical director for Sanford USD Medical Center's hospitalist program, works in internal medicine. He noted that insurers and Medicare reimburse specialists' procedures more than an internist, who determines whether patients are taking their medications and deduces their medical problems.

"Cognitive skills are not as valued as technical skills," he said. "People who perform surgeries, put you to sleep or remove a mole are far more better paid than a primary-care physician."

While a shortage exists for all doctors, the deficiency is more noticeable in internal medicine and family medicine because that is the first line of care for many patients, especially in a rural state, Lindemann said. At the same time, the medical school fares well because it emphasizes family medicine.

"Compared to a lot of schools, we graduate more primary-care doctors, but it's less than half of our class," she said.

Lindemann cited making physician salaries more equitable, lowering students' debt and giving students a better understanding of the rewards of being a primary-care physician as ways to counter the shortage, as well as increasing the medical school class size.