L. Liao1, K. Sirinek1, K. Sirinek1 1University Of Texas Health Science Center At San Antonio,San Antonio, TX, USA
Introduction: Recently, U.S. medical student career choices have changed. Several studies have implicated student loan debt powering a shift to more financially lucrative specialties following graduation from medical school. This study evaluated a two-decade trend of career choices by 3,660 medical students at one allopathic School of Medicine (SOM) and the 2012 NRMP data for 15,712 U.S. medical school graduates.
Methods: The data were obtained from the SOM reports for students in the NRMP match for twenty years and the 2012 NRMP results for the country. For the SOM, the second decade results were compared to the first decade and then to the 2012 NRMP data for the country. Results were analyzed by Chi Square (P<0.05).
Results:Compared to the first decade, the percentage of students matching for the second decade had increased but not significantly for General Surgery (5.3 to 6.6%), Surgical Specialties (7.6 to 9.1%). Obstetrics/Gynecology (6.5 to 8.0%) Pediatrics (12.1 to 13.6%), and Diagnostic Radiology (3.2 to 4.2%). The number of students pursuing Primary Care (Family Medicine, Internal Medicine, OB/GYN, Pediatrics) decreased significantly (13.7%) Table. Family Medicine accounted for most of the Primary Care decrease (22.1 to 9.1) P<0.001, while Internal Medicine also decreased (22.3 to 18.6%) P<0.01. Students matching to hospital based residencies increased (P<0.001), mainly secondary to increases in Anesthesia (7.0 to 10.7%) and Emergency Medicine (3.9 to 5.5%) (P<0.001). The last decade career choices at this School of Medicine mirror the 2012 national match statistics of 15,712 United States medical school graduates for each and every specialty (P=NS).
Conclusion:The increased appeal of a career in both Anesthesia and Emergency Medicine may reflect life-style issues as well as financial considerations. If the trend away from primary care by U.S. medical school graduates had been purely financial, a greater shift to Surgery should have been seen. Instead, General Surgery only increased 1.3% while the Surgical Specialties only increased 1.5%. To stay on par with the 20yr U.S. population growth (25%), the percentage of U.S. medical graduates pursing general surgery should have increased from 6.0% to 7.5%. The shortage of both primary care physicians and general surgeons with an increasing, aging U.S. population will adversely impact health care, potentially crippling implementation of the Affordable Care Act. Financial incentives to entice students to pursue these two specialties are urgently needed to avert this potential physician/surgeon manpower catastrophe.
