In the January 2012 issue of the journal Family Medicine [full text available here], a survey of medical students’ attitudes toward primary care and specialties reveals some sobering information about primary care and the overall practice of medicine.
At three medical schools, Michigan, Michigan State and Brown, 1533 students were sent surveys during the years 2006-2008, with 983 [64%] responding, an excellent rate of return for a survey. My theory about exposure to primary care may be wrong because third and fourth year students were significantly more inclined to choose primary care as a career than first or second year students. But the overall percentage of students who said they would opt for primary care was only 14.8%. This is consistent with matching program data, which indicate that 14% of US medical graduates match in primary care.
The students had negative opinions about the work life of all physicians, but they were particularly down on primary care. Senior students were more negative about primary care than juniors [maybe my theory about exposing them to a primary care clerkship is right] and more positive about the work life of specialists. Despite the increased negativity of senior students, the clerkship in primary care did not really have much of an impact on the students’ career choices.
The paper has some limitations, most notably that the students were only polled once. It is well-known that many change their minds as they progress through school. Also, this study involved students from only three medical schools.
The authors conclude: “Our learners’ negativity about their future work lives reflects and portends a pessimistic culture of medicine. Student views of primary care work life are particularly negative, but some students indicate an interest in primary care despite negative perceptions.”
The authors feel that to attract more students into primary care, the work life of primary care doctors needs to be improved. However, they did not offer any suggestions on how this could be done. And the website FierceHealthcare reports that the government is trying to lure students into primary care. Other than mentioning a $877,000 grant to The University of Maryland Medical School for development of a “primary care track,” which to me seems somewhat short of innovative, the article does not describe any “lures.” They might have been better off giving the money directly to the students as a bribe.
Of even more concern is that the surveyed students perceived the work life of all physicians, primary care MDs and specialists alike, negatively. As I have stated before, I agree with the authors that the future of medicine is not bright.
9 comments:
Are you aware of any studies of this kind from 20 or 30 years ago? Is medical student perception changing in a negative direction, or does it just look like that because we don't have information from the past? Certainly medical student life is quite different from private practice, so I wonder how accurate their perceptions of the future, and thus their reactions to it, are. Perhaps what seems to me to be the increasing resistance to long-term commitment of any kind is showing up in this survey. It seems that fewer and fewer are responding to medicine, or perhaps anything, as a 'calling' the way some of us did in an earlier era.
I am MS II, and get annoyed at my fellow medical students who complain about the working conditions that await them. They knew what they were in for when they applied and they actively chose to go into medicine anyway. But the situation is not entirely the fault of the students. An important contributing factor is that medical schools are choosing the wrong candidates. Part of the selection process focuses on ensuring that selected students will successfully complete the training. But much of the selection process focuses on something else, and that something else doesn’t appear to be selecting for students that want to do primary care work. Instead, programs are choosing the “best” applicants, where “best” appears to be defined more by achievement and ambition than anything else. This naturally skews your population and selects for/against certain attributes. There are many medical school applicants who would make competent physicians AND want to do the work that awaits them (including primary care work) but never get the chance.
I’m curious if you see any parallels between your work as a residency director and the work of medical school admission committees. If so, did you learn any lessons that they should heed?
Thanks for the comments.
Robert-I don't know of any studies like this from years ago. I don't think it's a calling any longer. See the link in the last paragraph of my blog above.
Anonymous-I have blogged that med students don't really know what medicine is like. The same holds true for applicants to med school. Choosing residents was always a crap-shoot for me. I never figured out how to pick good ones. Also, the match often dictates who you get.
Some rumblings from a few nursing students a year or so away from graduation jumping ship into premed. Some young second degreers with undergrad biochem or engineering backgrounds, wanting to be nurses are going premed now as well. Reason? To be able to find a job after graduating. Nursing is leaving too many without work. What kind of medicine do they intend to practice? We'll see. I bet a few want primary care as the original choice of nursing vs medicine was to be one on one with patients. We'll see what the future brings.
-SCRN
SCRN-Good points. I hope someone tracks those nurses and finds out if they succumb to the lure of a specialty.
The way to get people into family medicine is to disband it as a specialty. Every medical graduate should be able to practice general medicine upon graduation. Many would opt to do so to pay off the debts and would apply to residency afterward if they chose.
The dentists do it this way. Are doctors dumber than dentists? Is medical school nothing more than a rubber-stamp exercise? Are the academic family docs too attached to their pseudo-prestigious positions to even entertain the possibility of returning to a general license model?
Anon, interesting. It will never happen.
Skeptical Scalpel, why do you think it will never happen? Just curious. I am married to a Brazilian, whose entire family is basically doctors. The way med school is set up in Brazil, graduates are able to practice as generalists. The graduates end up with about 6,000 hours of clinical experience, which surely is enough to practice safely, isn't it? Do you think generalists (a.k.a., family medicine docs) really need the 20 something thousand hours (or however much it is family med residents end up acquiring) of experience to practice safely/competently? The Brazilian docs seem to do just fine. Why do you think the U.S. could never adopt this model?
For one thing--politics. I don't thing the family medicine board would agree to it. Then there's the issue of a lack of interest in general medicine on the part of many med school grads. The fourth year of med school would have to be changed completely to enable students to get enough hours. There's already and issue with the number of training sites available. See http://skepticalscalpel.blogspot.com/2017/12/chronic-shortage-of-training-sites.html
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