Boomers may see doctor shortage; Medical students shun careers caring for older patients

by Rita Rubin 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% of 1,177 respondents to a survey of students at 11 U.S. medical schools said they planned to go into general internal medicine. 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 choosing that specialty is declining as the number of older adults rises, they write. According to one estimate, the USA will have 200,000 fewer doctors overall than it needs by 2020, the authors write. Meanwhile, the number of older Americans is expected to nearly double between 2005 and 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 the University of California-San Francisco. “They rated the intellectual aspects of the field highly, and they rated continuity of care appealing,” Hauer says. “When you put the whole package together, it’s too hard.” On top of the workload, a letter to the editor in the same issue of JAMA as Hauer’s study ranks 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 internists’ average starting pay that year, says Ebell, who didn’t separate the more lucrative internal medicine sub-specialties, such as cardiology and gastroenterology, from general internal medicine. Radiologists topped Ebell’s list, with a starting salary of $350,000, not to mention, Hauer notes, more regular hours than general internists. Their amount of debt didn’t seem to influence medical students’ choice of specialty in her survey, Hauer says. Instead, students focused more on quality-of-life factors such as income and work hours, which did steer them away from general internal medicine. Perhaps only 1% or 2% of doctors who finish internal residency programs go on to practice general internal medicine, says Richard Deichmann, associate medical director of primary care at the Ochsner Medical Center in New Orleans. About half of the rest become “hospitalists” who care only for hospitalized patients, and the other half become sub-specialists. “I don’t dispute anything that they found in that study,” Deichmann says. “There is more and more non-patient-related care that takes up our time.” As a result, Dartmouth University’s David Goodman notes in an editorial, patients can’t find internists or other primary-care doctors willing to accept new patients.