Medical students (still) shun internal medicine, study finds

Study after study has shown that as the U.S. population ages and suffers more obesity-related health problems, there may not be enough primary care doctors to treat patients needing care.

A new study in the Archives of Internal Medicine suggests that the situation isn’t likely to improve anytime soon.

Researchers led by Dr. Mark D. Schwartz of the New York University School of Medicine compared results from a 1990 survey of medical school seniors with results from a similar survey in 2007. By and large, the students in 2007 reported better experiences with internal medicine during their medical school training -- 78% said they were highly satisfied with their internal medicine rotation, versus just 38% in 1990 -- and also said that the career provided more “opportunities for meaningful work” in larger numbers (58%, versus 42% in 1990).

But that didn’t translate into more students going into the field, the study reported. Twenty-four percent of respondents in 1990 reported they were planning careers in internal medicine (including subspecialties and pediatrics); 23% did in 2007. And there was a big drop in the percentage of students who said they go through general internal medicine training -- from 9% in 1990 to just 2% in 2007.

Students said they were pushed away from careers in internal medicine because they didn’t want to work with the types of patients cared for by internists and because time commitments and workloads in the field seemed burdensome. Higher student loan burdens may have been a factor, too, though their influence is probably “complex,” the researchers reported. The 2007 students had greater educational debt than the 1990 group (on average, $101,000 versus $63,000 in 2007 dollars). At the same time, the income gap between generalist and specialty physicians has grown threefold.

The authors wrote that their results suggested that increasing the numbers of generalists in the U.S. medical workforce depended not just on improving students’ experiences in medical school but also on “bolder reforms” designed to reduce pay gaps and address the difficult work conditions that primary care physicians often face.