Saturday, March 30, 2013

Stop The Internal Medicine Residency Charade

I received some interesting news from my medical school alma mater regarding the recent Match Day. Of course they patted themselves on their backs for how well the students matched. In particular, they touted that 43% of the graduating class will be going into a primary care field and nearly 30% of the class had chosen to go into internal medicine.

The National Resident Matching Program also highlighted the great number of students who intend to train in internal medicine. According to the NRMP press release, "This year 1,000 more internal medicine positions were placed in The Match," as compared to last year. In total 3,135 U.S. seniors matched to internal medicine. That's sounds just dandy since for years we've all been getting pounded with warnings about the dire shortage of internists who will be taking care of our growing elderly population.

However, Match Day results do not predict the number of doctors who will practice in a certain field. Residents often change their minds and decide they want to do something else. This is particularly true in internal medicine. One study showed that only a fifth of all IM residents will stay in the field. The rest will move on to a more lucrative subspecialty like cardiology or gastroenterology. Therefore of the 3,135 U.S. seniors who matched in IM this year, only a little over 600 of them will likely end up as an internist. So much for replenishing the dwindling supply of internists who are retiring or quitting at an increasing rate.

We should stop this charade of promoting the importance of internal medicine to the medical students. It's obvious that for most of them IM is just a stepping stone to a more monied career. The real primary care doctors are the ones who matched in family medicine, which only 1,355 U.S. seniors did this year. The NRMP should reclassify IM as a transitional step to the real interests of students. Like surgery residents who work transitional years before going into their urology or plastic surgery residencies, I think students should match into GI, cardiology, pulmonary, or any of the other medicine subspecialties on Match Day. They can then list separately the transitional programs in internal medicine the students will go to first before going into their real careers. This will clearly show how badly we are preparing for the upcoming primary care shortage. Then we can put more emphasis on family medicine if we are serious about training more primary doctors.

Incidentally, my alma mater said that nearly ten percent of the graduating class have decided to go into anesthesiology. That's twice the national average. Smart class they are.

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