Most U.S. internists don't stay in primary care: study

Tue Dec 4, 2012 7:38pm EST

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Dec 5 (Reuters) - Less than a quarter of new U.S. doctors finishing an internal medicine training program planned to become a primary care physician instead of a specialist - a move that could worsen the primary care doctor shortage in some parts of the country.

More people may need primary care doctors in the future due to health care reform that gives more people insurance, said authors of the study, which appeared in the Journal of the American Medical Association.

Researchers at the Mayo Clinic in Rochester, Minnesota analyzed surveys of close to 17,000 young doctors in the final year of an internal medicine residency program. Just under 22 percent said they would become a primary care physician.

Another 64 percent wanted to be a specialist, most often a heart or lung doctor or an oncologist. The rest hoped to work in a hospital, or were undecided about their future.

Compared to responses by the same residents two years earlier, changes in career plan into, or away from, general internal medicine were both common.

"There have been recent estimates that in the next decade or so, we may be as much as 50,000 primary care physicians short in the United States," said Colin West, one of the authors.

That's due to a combination of factors, such as older doctors retiring and more people getting insurance through health care reform and needing a general doctor.

"Our study suggests that current numbers of graduates planning general medicine careers won't come anywhere near meeting that shortage," he added.

Some young doctors may graduate from medical school hoping to be a primary care physician, but realize during residency that it's much more lucrative to get into a speciality such as cardiology or ophthalmology, said Amitabh Chandra, an economist and health policy researcher at Harvard University.

Others might plan to be a specialist all along, but find it easier to get into an internal medicine residency program than a competitive speciality one.

Thus, training more internal medicine residents might not be the answer to doctor shortages, researchers said. But Chandra said another strategy could be to find ways to get current primary care doctors into specific areas of the country that are underserved - and to pay them slightly more to see more patients and work longer hours.

"Ultimately... we just have to start to pay much more to general internal medical physicians," he said.

Others have suggested that nurse practitioners and physician assistants could fill the gap.

West said righting the primary care doctor shortage may require system-wide changes.

"We really need to put much more attention into revitalizing internal medicine and primary care as viable career options," he said. SOURCE: bit.ly/MvXYT6 (Reporting from New York by Genevra Pittman at Reuters Health; editing by Elaine Lies)

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