Harold C. Sox, MD, Editor
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Sox H.; Career Changes in Medicine: Part II. Ann Intern Med. 2006;145:782-783. doi: 10.7326/0003-4819-145-10-200611210-00012
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Published: Ann Intern Med. 2006;145(10):782-783.
We have known for some time that fewer medical students (1) and internal medicine residents (2) are deciding on careers in primary care. Of the several factors contributing to this trend, experiences during medical school and residency are probably important, but we have a limited understanding of which experiences are decisive. Experiences in practice also contribute. Earlier this year, Annals of Internal Medicine published an article showing that many board-certified internists were leaving general internal medicine (GIM) (3-4). As we try to transform primary care into a desirable career choice, we need to know more about when students and residents make their decisions and why they choose primary care (or why they do not). An article in this issue by West and colleagues (5) helps fill this important gap. It allows us to follow the career preferences of a large cohort of residents in each of the 3 years of residency. The findings suggest to me that GIM starts at a disadvantage but competes well over the 3 years of residency training.
Steven D Grant
December 10, 2006
The Decline of Primary Care
In the editorial Career Changes in Medicine:II (21 November2006/Volume 145 Issue 10/ Pages 782-783), Dr. Sox asks where is the lesion? This is referring to the fact that only 19% of first year residents plan to become general internists. He looks at the numbers in the article by West and his colleagues, and wonders if the problem lies in the medical school experience or the internal medicine residency.
As the President and CEO of the largest independent physician organization in southeast Michigan, and a clinical assistant professor at Wayne State University Medical School, I have been watching this trend for several years. I continue to practice general internal medicine, and, regularly, have third and fourth year students rotate through my office. These students confirm what I have believed for years. It is the money, stupid. The supposed experts can pontificate about the possible causes, but they will continue to miss the mark.
Although a certain percentage of medical students will become general internists because they truly like the field, until the income issue is solved the ranks of the primary care physicians will continue to dwindle. As long as pcp`s make a fraction of what most specialists make, there will be a major problem.
I do not have the answer, but I do know that a medical home or a 5% increase in the E/M codes are just bandaids. A bolder solution is needed. Unfortunately, there is nothing on the horizon.
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