Med students like internal medicine, but fewer are choosing primary care

More medical school students see the field of internal medicine as a potentially meaningful career track than they did 20 years ago, yet fewer are choosing to become primary care physicians.

According to a study published Monday by the Archives of Internal Medicine, the percentage of students planning to practice general internal medicine dropped from 9 percent to 2 percent from 1990 to 2007. That occurred even though medical students were happier with their internal medicine rotations and said the specialty seemed more meaningful.

Mark Schwartz, lead author of the study and an internist at the New York University School of Medicine, said in the 1990s more schools started having students work in family doctors offices and community clinics, rather than just hospitals. The aim was to give students a better idea of what internists do and help attract students to the specialty.

It worked in some ways, Schwartz said. Students in 2007 regarded internal medicine with higher esteem than students in 1990, and they were less turned off by the work. But they were no more likely to choose internal medicine, and were less likely to choose primary care, citing the workload and stress.

“We’ve succeeded to some degree in ways in which medical schools can attract students toward internal medicine,” Schwartz said. “But bolder action is needed at the public policy level to enhance what students understand as the payment and practice of internal medicine,” which is beyond what medical schools can do.

Michael Yannes, a second-year medical student at Temple, said he is seriously considering a career in internal medicine, but primary care as a specialty is not at the top of his list.

“Unfortunately, primary care just isn’t having enough compensation these days to really make it financially feasible for a lot of students coming out of school,” Yannes said.

Dr. Valerie Weber, chairwoman of the Department of Clinical Services at the new Commonwealth Medical College in Scranton, Pa., said her school pairs students with primary care physicians for three-year stints, hoping lasting relationships will draw students to the specialty. She said more medical schools could adopt long-term projects like Commonwealth Medical, but only so much can be done at the educational level to entice students into primary care.

“Students need to see that there’s a doable lifestyle,” Weber said, “That it’s something that they need to spend their lives doing, and that pay needs to be on par.”