2009 Match Results Disappointing

[deleted87716]

Countless studies have demonstrated that a strong primary care workforce is essential to a high-quality, cost-effective health care system. But the latest Match numbers are out of step with that premise. Instead, they show a disappointing dip in the number of students choosing family medicine.

The number of positions filled by family medicine residency programs decreased 3.2 percent this year to 2,329 positions, according to preliminary information from the 2009 National Resident Matching Program. The number of family medicine positions filled by U.S. seniors decreased 7.4 percent, to 1,083 positions.

AAFP President Ted Epperly, MD, had this to say: "This decline has nothing to do with the value of primary care and everything to do with a system that claims to support primary care but fails to actually act on its pronouncements."

He added, "Research has demonstrated unequivocally that the world’s successful health care systems depend on primary care. With a ratio of 70 percent subspecialists to 30 percent primary care physicians, the American health care system is upside down. No health care reform can succeed unless we bring both financial and actual access to the primary care physicians that provide more than 80 percent of all health care services Americans need."

A 2006 AAFP workforce report indicated the United States would need 139,531 family physicians by 2020, which means it must graduate 4,439 family physicians each year. "In our current environment, the nation is attracting only half the number of future family physicians that we will need," said Epperly.

Here's how several other specialties fared in the Match:

Internal medicine-primary filled 18 fewer positions (-7.6%),
Pediatrics-primary filled one more position (1.3%),
Internal medicine-pediatrics filled 13 more positions (3.7%),
Anesthesiology filled 44 more positions (6.1%),
Diagnostic radiology filled six fewer positions (-4.0%),
Emergency medicine filled 89 more positions (6.1%),
Obstetrics-gynecology filled 28 more positions (2.4%).

Source: http://blogs.aafp.org/fpm/noteworthy/entry/the_2009_match_results_are

---

Members don't see this ad.

 

[FMstudent]

Blue Dog,

As a 4th year american grad who "intentionally" went FM, I'll give my thoughts.

I questioned my choice so many many times before submitting my rank list.

I like FM. I like the variety. I like the office procedures. I like that I can make my practice into whatever I want to.

But for the last 4 years , I've heard other physicians telling me not to go FM. That there is no money, and that I will work like a dog trying to make 200k. I hate to say that the majority of FM doctors themselves told me to go into anesthesia, or rads.

And I am one of the students that Jet was trying to convince with his "why make 150 when 450 is out there". I have 200k in loans (at 6.8 % fixed).

How are US seniors , the supposed "cream of the crop", logically going to pick a specialty that everyone pushes them away from.

Now obviously I am not bashing FM, because I chose it. But the only reason that I chose it was because a select few FM docs (maybe 2-3 out of 20) told me that you can do well, and that I can be happy.

I guess I feel as though the FM docs that are doing well in FM don't speak up enough. They don't show students that 150k a year is not a given.

I hope that those few docs were right. I hope someday I'll make 250K in FM with a great lifestyle. If I do..... I am going to tell as many students as I can that it can be done.

I am realistic. I know that not everyone in FM is going to do well. There will always be those without loans to payback , or those that are purely altruistic ...and they will be fine with 150K. But if you want to convince US seniors to go into FM, you have to give them some bit of hope that they can do well in FM...and I see little effort to do such...

 

[andwhat]

Blue Dog,

As a 4th year american grad who "intentionally" went FM, I'll give my thoughts.

I questioned my choice so many many times before submitting my rank list.

I like FM. I like the variety. I like the office procedures. I like that I can make my practice into whatever I want to.

But for the last 4 years , I've heard other physicians telling me not to go FM. That there is no money, and that I will work like a dog trying to make 200k. I hate to say that the majority of FM doctors themselves told me to go into anesthesia, or rads.

And I am one of the students that Jet was trying to convince with his "why make 150 when 450 is out there". I have 200k in loans (at 6.8 % fixed).

How are US seniors , the supposed "cream of the crop", logically going to pick a specialty that everyone pushes them away from.

Now obviously I am not bashing FM, because I chose it. But the only reason that I chose it was because a select few FM docs (maybe 2-3 out of 20) told me that you can do well, and that I can be happy.

I guess I feel as though the FM docs that are doing well in FM don't speak up enough. They don't show students that 150k a year is not a given.

I hope that those few docs were right. I hope someday I'll make 250K in FM with a great lifestyle. If I do..... I am going to tell as many students as I can that it can be done.

I am realistic. I know that not everyone in FM is going to do well. There will always be those without loans to payback , or those that are purely altruistic ...and they will be fine with 150K. But if you want to convince US seniors to go into FM, you have to give them some bit of hope that they can do well in FM...and I see little effort to do such...

where is the end to all of this??? nowhere in sight. overvalue specialists, throw away primary care-- this is the attitude, only likely to get worse and much worse. the incentives are vanishing for primary care rapidly.
I hate how difficult it is lately, to refer patients to a new Primary Care doctor after Hospitalization. It is sad, and pathetic, that either the answer is 'no' or the wait time is 2-3 months. How in the h+ll can the patient wait 2-3 months, when they need to be seen next week????????
Be selfish, and understand that its something that I can ignore.
This is the only other option, which is just to ignore the situation. Yes of course, things will fix themselves. This is a pathetic and sad situation honestly.
Sorry cannot be encouraging, how about realistic though.
Realistically speaking, this is not good at all.

 

[FMstudent]

not exactly the encouragement i was looking for ...

but an honest opinion at least.

 

[Bluemirage]

not exactly the encouragement i was looking for ...

but an honest opinion at least.

Don't worry change is coming. We had a lunch lecture given by a former national president of the association for a procedural specialty (trying to be vague to keep anonymity). He said that the powers to be in government are discussing a redistribution of reimbursement, taking salaries from procedural specialties and high cost specialties like Radiology and giving it to primary care specialties in order to alleviate the current PCP crisis. When PCP's start averaging over 200k working 50 hours/week, more students will start to applying to primary care again.

 

[deleted87716]

I can make my practice into whatever I want to.

That's the key. Don't let anyone tell you otherwise. Most of the FPs who are miserable are trapped in cages that they built themselves. You don't have to be like them.

But for the last 4 years , I've heard other physicians telling me not to go FM.

Big shocker there. They've been saying that for twenty years, at least.

That there is no money, and that I will work like a dog trying to make 200k.

Most of the people I work with earn more than that working four days a week.

How are US seniors , the supposed "cream of the crop", logically going to pick a specialty that everyone pushes them away from.

We're working on it, trust me. Anyone who says that we aren't trying isn't involved and isn't paying attention.

 

[deleted87716]

He said that the powers to be in government are discussing a redistribution of reimbursement, taking salaries from procedural specialties and high cost specialties like Radiology and giving it to primary care specialties in order to alleviate the current PCP crisis.

Of course they are. This is the Obama administration, after all. "Redistribution of wealth" was practically a campaign promise. For primary care, there's nowhere to go but up. For everyone else...look out.

 

[stonewall22]

That's great...government needs to be bigger and control everything. Hopefully next week they can start choosing what I wear.

 

[medicienne]

Blue Dog,

As a 4th year american grad who "intentionally" went FM, I'll give my thoughts.

I questioned my choice so many many times before submitting my rank list.

I like FM. I like the variety. I like the office procedures. I like that I can make my practice into whatever I want to.

But for the last 4 years , I've heard other physicians telling me not to go FM. That there is no money, and that I will work like a dog trying to make 200k. I hate to say that the majority of FM doctors themselves told me to go into anesthesia, or rads.

And I am one of the students that Jet was trying to convince with his "why make 150 when 450 is out there". I have 200k in loans (at 6.8 % fixed).

How are US seniors , the supposed "cream of the crop", logically going to pick a specialty that everyone pushes them away from.

Now obviously I am not bashing FM, because I chose it. But the only reason that I chose it was because a select few FM docs (maybe 2-3 out of 20) told me that you can do well, and that I can be happy.

I guess I feel as though the FM docs that are doing well in FM don't speak up enough. They don't show students that 150k a year is not a given.

I hope that those few docs were right. I hope someday I'll make 250K in FM with a great lifestyle. If I do..... I am going to tell as many students as I can that it can be done.

I am realistic. I know that not everyone in FM is going to do well. There will always be those without loans to payback , or those that are purely altruistic ...and they will be fine with 150K. But if you want to convince US seniors to go into FM, you have to give them some bit of hope that they can do well in FM...and I see little effort to do such...

I totally agree with you. I was very disappointed when so many attendings tried to discourage me from my choice of specialty, or assumed that I 'bombed' my boards, or I am a desperate IMG, etc.
I am glad I fought through all of that and matched into my favourite specialty- FM

 

[thethom]

First, 200k at 40 hours a week is entirely possible, and not difficult. My preceptor and I (from a fammed elective) spoke business (he offered me a job after residency), and I can honestly say that making good money is not a problem in ANY medical specialty. During my interviews I spoke to residents about earning potentials. The chiefs were all offered jobs right out of residency around 200k, and vouched that the attendings were up at 300k+...this is in NC mind you...

Second, if fewer go into fammed residency, fewer will finish each year, and that makes YOU much more in demand...

 

[aparecida]

That's great...government needs to be bigger and control everything. Hopefully next week they can start choosing what I wear.

I don't think you understand why current reimbursement works the way it does. It isn't market-driven. It's Medicare/Medicaid-driven. The government decided, and continues to decide, what rates it will reimburse: for a CT read, for a sick office visit, for a heart cath, for a prostatectomy, for a for a diabetes follow-up. Private insurers take their cues from Medicare and Medicaid.

These reimbursement rates determine the incomes of the various specialties. Thus, "the government" has been "controlling" physician salaries for decades.

The existing reimbursement rates were influenced by committees which were composed heavily of subspecialists in procedurally-oriented fields. I, for one, would be thrilled to see those reimbursement rates adjusted to give better compensation to primary care, encouraging more students, and more top students, to choose it.

I don't believe the overall physician-pay pie is going to get any larger. Granting a larger share of it to primary care means it will have to come at someone's expense. My vote there is for the ROAD specialties, which I think are grossly, unsustainably overpaid.

 

[Bluemirage]

I don't believe the overall physician-pay pie is going to get any larger. Granting a larger share of it to primary care means it will have to come at someone's expense. My vote there is for the ROAD specialties, which I think are grossly, unsustainably overpaid.

This was what the speaker at my school was referring to when he discussed the "redistribution of reimbursement." He stated that the government cannot afford to increase the overall reimbursement pool. The increase in PCP salaries will be at the direct expense of the salaries of high cost specialties.

 

[JaggerPlate]

Don't worry change is coming. We had a lunch lecture given by a former national president of the association for a procedural specialty (trying to be vague to keep anonymity). He said that the powers to be in government are discussing a redistribution of reimbursement, taking salaries from procedural specialties and high cost specialties like Radiology and giving it to primary care specialties in order to alleviate the current PCP crisis. When PCP's start averaging over 200k working 50 hours/week, more students will start to applying to primary care again.

I'm all for more money to PC fields ... but isn't this called communism??? Take from those who earn, distribute it so that everyone is equal??? Can't they find a way to make PC fields more appealing without taking money away from other fields?? Isn't this why PC fields fell apart in the first place?? Also, won't this just create more tension and disagreement in an already poorly unified field??

 

[deleted87716]

I'm all for more money to PC fields ... but isn't this called communism???

More like socialism.

 

[JaggerPlate]

More like socialism.

Both seem quite unAmerican. Isn't there a way to get money and incentives back into the field without taking it from other physicians???

 

[deleted87716]

Both seem quite unAmerican. Isn't there a way to get money and incentives back into the field without taking it from other physicians???

I vote we take it from professional athletes, actors, and rock stars. Give some to the soldiers, cops, and teachers, while we're at it.

Who's with me?

 

[danzman]

I vote we take it from professional athletes, actors, and rock stars. Give some to the soldiers, cops, and teachers, while we're at it.

Who's with me?

Nah. Just tax the hell out of them and give soldiers, cops, etc NO taxes. You support the social system as a job, you should have to pay NO tax back into it.

 

[JaggerPlate]

I vote we take it from professional athletes, actors, and rock stars. Give some to the soldiers, cops, and teachers, while we're at it.

Who's with me?

Definitely more to the teachers.

 

[deleted87716]

See? Socialism ain't so bad, as long as you're on the receiving end of it.

 

[aparecida]

I'm all for more money to PC fields ... but isn't this called communism??? Take from those who earn, distribute it so that everyone is equal???

It would be socialist if the earnings were coming from a nongovernmental source and were being taken, and redistributed, by the government. But in this case, the high pay rates for specialists and low pay rates for PCPs are already coming from the government, by way of Medicare and Medicaid setting the standards.

It is not socialist for the government to adjust its OWN reimbursement rates.

 

[deleted87716]

It would be socialist if the earnings were coming from a nongovernmental source and were being taken, and redistributed, by the government. But in this case, the high pay rates for specialists and low pay rates for PCPs are already coming from the government, by way of Medicare and Medicaid setting the standards.

It is not socialist for the government to adjust its OWN reimbursement rates.

Um...actually, governmental control of the production and distribution of goods and services is pretty much the textbook definition of socialism.

 

[danzman]

Definitely more to the teachers.

Im on the fence about teachers. They seem to have a pretty sweet gig. How many other jobs can you think of that will get you thirty grand (or more in places like Texas) for working 8 months a year (x-mas break, spring break, and summer off), in at 7am, done by 4, an hour of lunch, and an hour a day for "planning" (whatever that means), and you get to hang out with little kids all day? My friends from high school who became teachers love it. They all work side jobs in the summer and do pretty well for themselves. No stress, and most of the parents really love them. Maybe id be for giving more cash to high school teachers, but middle school? come on, thats a sweet gig! Last time I checked a lot of fresh law school grads were making 40 grand, working like crazy, hating their lives and owing a hundred grand in loans. Seems like majoring in teaching couldn't be that hard...

 

[JaggerPlate]

Im on the fence about teachers. They seem to have a pretty sweet gig. How many other jobs can you think of that will get you thirty grand (or more in places like Texas) for working 8 months a year (x-mas break, spring break, and summer off), in at 7am, done by 4, an hour of lunch, and an hour a day for "planning" (whatever that means), and you get to hang out with little kids all day? My friends from high school who became teachers love it. They all work side jobs in the summer and do pretty well for themselves. No stress, and most of the parents really love them. Maybe id be for giving more cash to high school teachers, but middle school? come on, thats a sweet gig! Last time I checked a lot of fresh law school grads were making 40 grand, working like crazy, hating their lives and owing a hundred grand in loans. Seems like majoring in teaching couldn't be that hard...

Here's my issue with the argument ... in five years, those law school guys will be making 100k, but the teacher will still be making 30 grand, burned out, and now tenured ... ergo doesn't care and won't try. Also, my mom is a teacher and I can assure you that they may be at WORK from 7am-4pm, but she grades papers, makes lessons plans, grades tests etc ... much longer after hours. Plus there is a ton of politics in it, and you're always a slave to pathetic budgets and poor test scores because kids dismiss state exams, which leads to months of bureaucratic BS from every level of decaying administration that now needs you to do more for the kids with even less money. Plus, happy teachers = better education all around = more likely to go to college, be successful etc. I really can't see the harm in bettering education.

Not trying to stir any pots ... I just have a lot of educators in my family, and have witnessed this crap first hand. The US education system probably needs more of a reworking than the healthcare system.

 

[Consigliere]

Don't worry change is coming. We had a lunch lecture given by a former national president of the association for a procedural specialty (trying to be vague to keep anonymity). He said that the powers to be in government are discussing a redistribution of reimbursement, taking salaries from procedural specialties and high cost specialties like Radiology and giving it to primary care specialties in order to alleviate the current PCP crisis. When PCP's start averaging over 200k working 50 hours/week, more students will start to applying to primary care again.

Boy are you naive.

 

[danzman]

Here's my issue with the argument ... in five years, those law school guys will be making 100k, but the teacher will still be making 30 grand, burned out, and now tenured ... ergo doesn't care and won't try. Also, my mom is a teacher and I can assure you that they may be at WORK from 7am-4pm, but she grades papers, makes lessons plans, grades tests etc ... much longer after hours. Plus there is a ton of politics in it, and you're always a slave to pathetic budgets and poor test scores because kids dismiss state exams, which leads to months of bureaucratic BS from every level of decaying administration that now needs you to do more for the kids with even less money. Plus, happy teachers = better education all around = more likely to go to college, be successful etc. I really can't see the harm in bettering education.

Not trying to stir any pots ... I just have a lot of educators in my family, and have witnessed this crap first hand. The US education system probably needs more of a reworking than the healthcare system.

Maybe you are correct; I only know a few teachers and they are all new to the job. But most of the law grads will never see 100K, and they have at least three more years of education. I only picked the law because it was easy, you could say the same about most degrees, it just seems that compared to all other jobs that pay in the 30-40K range (average sallary) teachers have it pretty good. Again, insurance adjusters work their tails off for 35K. I am certainly not putting them down, in fact I think it would be a solid job. But how much would you increase their pay? Again, n=1, but at my undergraduate college, elementary ed was one of the most popular degrees. Seems like they have loads of people wanting to do it. Kinda messes up that supply and demand thing.

 

[danzman]

This was what the speaker at my school was referring to when he discussed the "redistribution of reimbursement." He stated that the government cannot afford to increase the overall reimbursement pool. The increase in PCP salaries will be at the direct expense of the salaries of high cost specialties.

This will not happen. All that will ever happen are specialists will make less, PCPs will make less, NPs will pick up slack. If anything, you will see crummy loan pay-back programs that are a waste of time. There is simply no reason to take money from one group and give it to another when you can just take money from one group and keep it. I do agree that some specialties will make less in the future, but this will be due to Medicare just not paying for things that are not supported by data, like half of all cardio stuff, and a big chunk of neurosurgery and ortho. They can still do them for out-of-pocket, but the gov will stop paying for them. The current problem with primary care not being attractive is not that they only make 150K, its that rads make 500K. If rads made 155K along with everyone else, we would not be having this conversation. Rather, it would be about student loans...

 

[tony montana]

This will not happen. All that will ever happen are specialists will make less, PCPs will make less, NPs will pick up slack. If anything, you will see crummy loan pay-back programs that are a waste of time.

Any hard evidence to support this statement or is it just your opinion/conjecture/etc?

 

[danzman]

Any hard evidence to support this statement or is it just your opinion/conjecture/etc?

Absolutely not. No one has any evidence/proof of anything, its all just speculation. However, with the state of the economy, I can’t see anyone who depends on government reimbursements getting any more (Medicare/aid), thus insurance reimbursements will follow. Even if it was possible to lobby congress to change the reimbursement structure in the next five years (which again, I don’t think will happen due to a crappy economy), all you would see was less money across the board, especially less to the top earners, and maybe some loan repayment programs for those who work in rural Kansas. Then PCPs would get what, 5 percent more? Its peanuts if you still have all the crap that PCP medicine entails and still have Rads making 450K(down from 500). In the end the problem is that primary care is not attractive to 3rd and 4th year medical students. As a student, all I ever see a PCP doing is managing chronic conditions like type 2 diabetes, doing super small procedures like wart removal, and referring everyone out to a specialist because of the current litigious nature of the work. They spend half their day doing crappy paperwork and fighting with insurance companies, their patients are fat, lazy, and entitled, and the flu is just not that interesting. When family medicine was competitive, it was because med students perceived it as having a good income, hours, and being able to be a jack-of-all-trades. Those days are gone. And if there really is a true shortage of PCPs then everyone will argue, true or not, that an NP will be able to handle everything that I mentioned above while handing the difficult cases off to the physician. In the end, so many things would have to change to make medical students perceptions change; insurance hassles, reimbursement, malpractice, and even patients. And it doesn’t help that every PCP I talk to tells me to run like hell from family medicine. Every single one. I don’t know the answer to these problems, but I sure don’t see taking 5% away from rads and giving it to FM solving any of them. And there is simply no money in the system for a complete overhaul. That said, I am sure there are some really great opportunities out there for people who really enjoy the work. What do you think?

 

[cbest]

I understand the idea of increased reimbursement for PCPs and decreased reimbursement for specialists acting as incentive for med students to enter PCP fields... clearly, there is an ever increasing need for PCPs for North America's population. I mean, you can walk around any Wal-Mart and get a pretty good idea of the health of the average North American these days! Yikes!

Having said that, it is in no way fair to the specialists who have spent however many more years working the butts off in residency and fellowship while making $50K to get the shaft! They have endured more training; they can make diagnoses and perform procedures and surgeries that few others can; and, to generalize a bit, chances are they worked harder throughout medical school in order to get the board scores, 3rd year grades, research, etc. necessary to even think about applying to the given specialty then entered.

Yes, it's awful that there is such a shortage of PCPs and the health of the population is definitely suffering because of it. But to take it out on the (insert highly trained specialists making an awesome salary here) seems quite unfair!

 

[exPCM]

How about we just all pay every doc 200K per year to be fair?
Oh,but wait - I guess we won't have any more neurosurgeons or cardiologists in the future. I mean why do 7-8 years of training after med school when you can do a 3 year primary care residency and make 200k just like all the other specialists.

 

[asmallchild]

Don't worry change is coming. We had a lunch lecture given by a former national president of the association for a procedural specialty (trying to be vague to keep anonymity). He said that the powers to be in government are discussing a redistribution of reimbursement, taking salaries from procedural specialties and high cost specialties like Radiology and giving it to primary care specialties in order to alleviate the current PCP crisis. When PCP's start averaging over 200k working 50 hours/week, more students will start to applying to primary care again.

I highly doubt it.

 

[Frijolero]

You're wasting your time trying to assign worth by years of training/board scores/etc. Nobody will ever agree and it's useless from a practical standpoint anyway. How much do most PhDs make again? The market clearly will bear a decrease in ROAD salaries, as evidenced by the US grad fill rates for those residencies. Hell, I'm sure there are 4th years who would pay 50 grand a year to do a derm residency. If there's truly a shortage of physicians (and there is) it's clearly skewed towards primary care. More money for PCPs is the surest way to remedy that problem.

 

[asmallchild]

You're wasting your time trying to assign worth by years of training/board scores/etc. Nobody will ever agree and it's useless from a practical standpoint anyway. How much do most PhDs make again? The market clearly will bear a decrease in ROAD salaries, as evidenced by the US grad fill rates for those residencies. Hell, I'm sure there are 4th years who would pay 50 grand a year to do a derm residency. If there's truly a shortage of physicians (and there is) it's clearly skewed towards primary care. More money for PCPs is the surest way to remedy that problem.

I'm curious about this projection. The fill rate for the "ROAD" residencies are certainly high but the # of spots are not increasing each year (AFAIK, I know for derm there isn't a large yearly increase in spots). If the # of spots aren't increasing, I don't see a risk of saturation. Or am I wrong?

 

[Coastie]

In the coming years with Obama doing his best to destroy healthcare access and quality, I think primary care will be the place to be. Why?

Well, even with "doctor nurses" claiming equivalency, and a democratic congress who buys it, I think that family docs will be able to have the last laugh.

I'm an anesthesiology resident. I'm a slave to the insurance companies and medicare for reimbursement. You guys are not.

You can market yourselves, charge cash, refuse medicare/medicaid, and run a low overhead practice out of your house..a mobile practice...Your skillset (knowledge and outpatient procedures) follow you wherever you go. If I don't have a good oxygen supply and expensive drugs, I'm only as good as my ACLS and invasive procedural skills.

With such a dip in the numbers, this should be seen as an opportunity. Instead of whining to the government, AAFP leadership should throw off the government mantle, and start educating their residents heavily in the business of medicine. While my reimbursements are dictated by a marxist majority in the senate, yours don't have to be.

Market forces look like family practice is headed for an even bigger shortage than already exists. TAKE ADVANTAGE OF THIS. With "doctor nurses" coming online, the quality of healthcare will only dip..TAKE ADVANTAGE OF THIS.

Americans want BOARD-CERTIFIED PHYSICIANS taking care of them and their families. We want Family Practice physicians. Rise up, get your medical skillset, market yourself, and stop crying for breadcrumbs to the government. Your time is coming.

When offered the carrot of socialized medicine, reject it. In the UK, family docs do well compared to specialists...the system is still broken. You guys have real unlimited potential for great income AND a great doctor-patient relationship. In fact, when the economics of your practice are solid, you are able to spend more time per patient, delivering higher quality care at a lower cost than a government-subsidized system.

I say it's an exciting time to be a Family Practice resident, as the opportunities are limitless. All you have to do is think outside of the socialist box most of medicine is falling in love with at the moment.

Countless studies have demonstrated that a strong primary care workforce is essential to a high-quality, cost-effective health care system. But the latest Match numbers are out of step with that premise. Instead, they show a disappointing dip in the number of students choosing family medicine.

The number of positions filled by family medicine residency programs decreased 3.2 percent this year to 2,329 positions, according to preliminary information from the 2009 National Resident Matching Program. The number of family medicine positions filled by U.S. seniors decreased 7.4 percent, to 1,083 positions.

AAFP President Ted Epperly, MD, had this to say: "This decline has nothing to do with the value of primary care and everything to do with a system that claims to support primary care but fails to actually act on its pronouncements."

He added, "Research has demonstrated unequivocally that the world’s successful health care systems depend on primary care. With a ratio of 70 percent subspecialists to 30 percent primary care physicians, the American health care system is upside down. No health care reform can succeed unless we bring both financial and actual access to the primary care physicians that provide more than 80 percent of all health care services Americans need."

A 2006 AAFP workforce report indicated the United States would need 139,531 family physicians by 2020, which means it must graduate 4,439 family physicians each year. "In our current environment, the nation is attracting only half the number of future family physicians that we will need," said Epperly.

Here's how several other specialties fared in the Match:

Internal medicine-primary filled 18 fewer positions (-7.6%),
Pediatrics-primary filled one more position (1.3%),
Internal medicine-pediatrics filled 13 more positions (3.7%),
Anesthesiology filled 44 more positions (6.1%),
Diagnostic radiology filled six fewer positions (-4.0%),
Emergency medicine filled 89 more positions (6.1%),
Obstetrics-gynecology filled 28 more positions (2.4%).

Source: http://blogs.aafp.org/fpm/noteworthy/entry/the_2009_match_results_are

 

[Coastie]

I vote we take it from professional athletes, actors, and rock stars. Give some to the soldiers, cops, and teachers, while we're at it.

Who's with me?

Cops make great $ with fat pensions.

Teachers make great money for 9 months a year of work.

Soldiers could always use some more.

I say give everyone a flat tax, cut back on the grossly enlarged entitlement system the government funds, and start to pay back our debt.

An ole' doc can dream, can't he?

 

[Coastie]

Those law guys will not be making 100k, they will be employed and making 50k, IF LUCKY. Law is in such bad shape....Oversupply with rapidly shrinking demand.

Here's my issue with the argument ... in five years, those law school guys will be making 100k, but the teacher will still be making 30 grand, burned out, and now tenured ... ergo doesn't care and won't try. Also, my mom is a teacher and I can assure you that they may be at WORK from 7am-4pm, but she grades papers, makes lessons plans, grades tests etc ... much longer after hours. Plus there is a ton of politics in it, and you're always a slave to pathetic budgets and poor test scores because kids dismiss state exams, which leads to months of bureaucratic BS from every level of decaying administration that now needs you to do more for the kids with even less money. Plus, happy teachers = better education all around = more likely to go to college, be successful etc. I really can't see the harm in bettering education.

Not trying to stir any pots ... I just have a lot of educators in my family, and have witnessed this crap first hand. The US education system probably needs more of a reworking than the healthcare system.

 

[danzman]

I say it's an exciting time to be a Family Practice resident, as the opportunities are limitless. All you have to do is think outside of the socialist box most of medicine is falling in love with at the moment.

I agree that much of the current situation is not as bad as it seems, and that there are a lot of options for FM. However, I think you oversimplify the problems. If it was just one main issue, then yes FM could overcome it. But the problem is systemic and vast. People may want board certified brain surgeons but they seem less interested in who is giving them tamiflu. There was a study done that showed that over 30% of people thought that a dental assistant was a "doctor" and that most people had no idea what the difference between a physical therapist and a physician was. I also think the NPs have a certain advantage in this area because they can claim that they have better patient centered skills. Much like herbal supplements claim that they are healthier because they are "natural". Just a sleight of hand...

And creating a concierge practice is much more difficult than it would seem. The practice is really only viable in big cities and rich areas, and even then Im still not convinced it can be a long term career. Also, no one wants to pay for FMs skills when they can go to the ER for free (sorta), not to mention that going concierge means you are on call 24/7/365. I think the public believes that they no longer need a family doctor because they can look it up on Wikipedia. Now you and I know that this is just silly, but people are stupid. They are the same people who buy little pads to put into their shoes to pull out toxins. (I have got to get into that scam!)

I hope you a correct, but I just don't know. There just seems to be too many problems.

 

[DrMom]

Teachers make great money for 9 months a year of work.

2 quick things on this:

1) When teacher salaries are mentioned, they almost always include all benefits as $ values, including employer retirement contributions and insurance premiums. That means that the actual monthly salary is likely hundreds less than the #s given out publicly.

2) Way back when I taught for those 9 months a year, I worked approximately 2000 hours...the standard annual work hours for routine "full time" employees. I know we get used to working much more than that in medicine, but a 40 hr workweek is still considered the standard for the general public.

[/tangential rant]

 

[badasshairday]

I agree that much of the current situation is not as bad as it seems, and that there are a lot of options for FM. However, I think you oversimplify the problems. If it was just one main issue, then yes FM could overcome it. But the problem is systemic and vast. People may want board certified brain surgeons but they seem less interested in who is giving them tamiflu. There was a study done that showed that over 30% of people thought that a dental assistant was a "doctor" and that most people had no idea what the difference between a physical therapist and a physician was. I also think the NPs have a certain advantage in this area because they can claim that they have better patient centered skills. Much like herbal supplements claim that they are healthier because they are "natural". Just a sleight of hand...

And creating a concierge practice is much more difficult than it would seem. The practice is really only viable in big cities and rich areas, and even then Im still not convinced it can be a long term career. Also, no one wants to pay for FMs skills when they can go to the ER for free (sorta), not to mention that going concierge means you are on call 24/7/365. I think the public believes that they no longer need a family doctor because they can look it up on Wikipedia. Now you and I know that this is just silly, but people are stupid. They are the same people who buy little pads to put into their shoes to pull out toxins. (I have got to get into that scam!)

I hope you a correct, but I just don't know. There just seems to be too many problems.

It is terrifying how uninformed and ignorant (re:stupid) some of the general public is.

However, Coastie does make very valid points. I think it is time to be more optimistic about FM. You really are not a b*tch to medicare and insurance like specialists have to be.

 

[andwhat]

Any hard evidence to support this statement or is it just your opinion/conjecture/etc?

I am totally in agreement with the horrendous, but true thought of every physician making less, and N.P.s and other midlevels making more, and being in much higher demand.
This is already happening.
I do not agree with at all, but this is where things are headed.
Now taking money away from Specialties, and splurging it into Primary Care? I don't see that happening. This has been the talk for over a decade now, and no answers whatsoever -- as a matter of fact the opposite, even worse compensation in Primary Care and Preventive Medicine. This is all that it will ever be, just talk and speculation -- pertinent to more reimbursement into Primary Care. The state of Primary Care will not improve. This is a fact.
Now, taking money away from Specialties, and putting into Primary Care (which will not happen)
There is not an absolute and complete negative outcome towards this.
Isn't the new Obama administration targeting the richer, by increasing taxes on the richest?
This is unfair, but at the same time the money is going to respectable causes hopefully.
Bright side is? Cannot possibly be worse than the previous presidential administration.

 

[FMstudent]

Andwhat has made a good point...as I have read these posts...

All of this conversation about primary care has been happening for years..you can search the forums and see the same threads over and over...about getting more money for FM , and for change coming to primary care...med students commenting on what their preceptors told them...and attendings trying to explain how things really are...

Personally I think we are reaching the breaking point though...primary care has to change in the next 5-10 years...i doubt either side would disagree on this....each year we the "US seniors" don't pick FM is another year we drive the shortage higher...

The question is will this change be in our favor , as FM docs, or will it lead to the same / lower pay with the possibility of mid-levels filling the FM void....

i haven't really heard compelling evidence either way yet ....but I chose FM as my specialty ....and I have no doubt this change will occur in my career..

I am just keeping optimistic that I bet on the right horse ....and if not ...I'll just have to be smarter and more determined to be better than the norm...

 

[andwhat]

Andwhat has made a good point...as I have read these posts...

All of this conversation about primary care has been happening for years..you can search the forums and see the same threads over and over...about getting more money for FM , and for change coming to primary care...med students commenting on what their preceptors told them...and attendings trying to explain how things really are...

Personally I think we are reaching the breaking point though...primary care has to change in the next 5-10 years...i doubt either side would disagree on this....each year we the "US seniors" don't pick FM is another year we drive the shortage higher...

The question is will this change be in our favor , as FM docs, or will it lead to the same / lower pay with the possibility of mid-levels filling the FM void....

i haven't really heard compelling evidence either way yet ....but I chose FM as my specialty ....and I have no doubt this change will occur in my career..

I am just keeping optimistic that I bet on the right horse ....and if not ...I'll just have to be smarter and more determined to be better than the norm...

there should be a "Primary Care" bailout You should do what you truly love, and can picture yourself doing for a long time. 2 weeks off per month, great pay, is my idea of something I can get used to doing for a very long time!

 

[commonwealth ki]

I agree. PCP will not benefit from the suffering of specialists. Both will suffer!

 

[montessori2md]

My hope is that Big Brother cuts a deal so that FPs (or PCPs, whatever) don't pay their Federal Loans. This supposedly is already the case if you work for Big Brother for ten years (read the fine print on PLUS loan's info brochures). But I'm not holding my breath.

 

[HCE]

My hope is that Big Brother cuts a deal so that FPs (or PCPs, whatever) don't pay their Federal Loans. This supposedly is already the case if you work for Big Brother for ten years (read the fine print on PLUS loan's info brochures). But I'm not holding my breath.

I agree that the solution is in tuition reimbursement across the primary medicine fields. To me, Big Brother is no more scarey a thought than the current mess created by Big Insurance.

 

[142348]

I agree that the solution is in tuition reimbursement across the primary medicine fields. To me, Big Brother is no more scarey a thought than the current mess created by Big Insurance.

Tuition reimbursement to one subset of physicians...you have to be kidding me. No offense, but if you pick a primary care specialty you should walk into it knowing that at this time subspecialties are going to be reimbursed at a higher rate and that it will be harder for you to pay back loans. Will that always be the case, who knows?

Why do you think the cream of the crop AMG's are jumping on ROAD specialties for the most part? Great pay and great hours. I made it to the top of my class and had top notch board scores and knew I was headed into a lifestyle specialty because of it. That's the current state of specialty selection at this time.

Originally Posted by aparecida http://forums.studentdoctor.net/showthread.php?p=7927171#post7927171
I don't believe the overall physician-pay pie is going to get any larger. Granting a larger share of it to primary care means it will have to come at someone's expense. My vote there is for the ROAD specialties, which I think are grossly, unsustainably overpaid.

Seriously, you have to be kidding me. As a Radiation Oncology resident, I don't see my specialty as overpaid, if anything underpaid. If you look at the clinical, physics, and biology components as well as the technical skill that goes into procedures such as brachytherapy, you would realize that it simply does not make sense to take from ROAD specialties to give to primary care.

 

[lowbudget]

Tuition reimbursement to one subset of physicians...you have to be kidding me. No offense, but if you pick a primary care specialty you should walk into it knowing that at this time subspecialties are going to be reimbursed at a higher rate and that it will be harder for you to pay back loans. Will that always be the case, who knows?

Why do you think the cream of the crop AMG's are jumping on ROAD specialties for the most part? Great pay and great hours. I made it to the top of my class and had top notch board scores and knew I was headed into a lifestyle specialty because of it. That's the current state of specialty selection at this time.

Agreed, that those who choose primary care should understand what the job entails.

But I don't think it's a matter of informed consent or even an issue of meritocracy, like you put it. It's a public policy issue.

Wouldn't it be interesting to ask the general public, "If you had limited amount of money, how much are you willing to pay for your primary care, your cancer diagnosis, the reading of your MRI, the delivery of your baby, your child's vaccinations, etc...."?

I think the general public, at least from recent, are saying that they want more (& better) primary care, and some are willing to pay for it. Others want someone else to pay for it (and even others, don't want to pay for it at all). But the general consensus is that there's an appetite for primary care... so long as it's good. I think the public wants the cream of the crop AMG's to choose primary care.

Why then is it so hard to make primary care... good? If what you say about why the cream of the crop AMG's choose ROAD is true, it stands to reason that if you want the cream of the crop AMG's to go into primary care, you gotta make the pay and the hours better for primary care. You have to fix the system.

Believe it or not, there are a lot of people out there who want to do primary care. You hear it all the time here on SDN! Unfortunately, the system does not allow them to do it; so people pick other specialties. Fix the system... Save the cheerleader, save the world.

Case in point: the years leading up to the ACGME 80 hour work-week, categorical general surgery could not fill to save its life. Students say that they would have loved general surgery but the residency hours are too brutal. Then 2003, 80 hour work week, and then all of a sudden, positions were filling. http://www.nrmp.org/data/resultsanddata2003.pdf

If you want good people to go into primary care, we have to do better in trying to attract them.

(Unless, you don't believe in primary care, or you don't believe it has any value... in which case, the debate changes.)

 

[tony montana]

Just because ROAD type specialties mostly recruit based on high board scores/grades etc, it does not mean that EVERYONE who chooses FM does not have similar OR BETTER scores than ROAD type specialty applicants...

 

[lowbudget]

Just because ROAD type specialties mostly recruit based on high board scores/grades etc, it does not mean that EVERYONE who chooses FM does not have similar OR BETTER scores than ROAD type specialty applicants...

Totally agree. But unfortunately, the need & demand for primary care, for FM in particular, is so great that many times programs & communities are forced to hire sub-par students/physicians because it's better than nothing. To the point where they would rather a midlevel with less training take care of them when they're sick... and a midwife deliver their child... than to have nothing at all.

I think as students we pick up on this, as physicians & nurses we pick up on this, and as patients we pick up on this.

Personally, I would love it if FM raised their standards. But that would be like having a strict bouncer in front of an empty bar.

 

[142348]

While I agree with you that there are FM residents with exceptional stats, I don't think you can compare the ROAD speciality stats to FM stats and come even close. The ROAD specialites are primarily for AMG's with top stats while FM programs often (Not always) get the dregs of American med schools.

Whether it's completely true or not, the stigma for FM is that it's what people in the bottom of their class, people from rural areas who want to go back and be that do it all doc, or FMG's go into. I'm not saying that this accurate but this is the stigma that's out there for the most. I know for a fact this isn't the case at many university based FM programs; however, I have seen first hand that this is the case at many small community based programs.

I do agree with the above post saying that if FM is to get top tier AMG candidates that something has to change. I just don't see it happening at this time. The question I have to ask then is, why would I or any other top tier candidate pick FM over a specialty such as mine where I have direct patient care, work excellent hours, and get paid significantly better than primary care?