Today is the day that about 35000 medical students around the country find out what the rest of their lives are going to be like. Sort of. This morning, these graduating medical students were notified of which specialties they will be going into and at which program they will be working geographically for the next 3-4 years or more. For the past year, they have been completing applications, visiting programs and undergoing interviews. Then each program ranks in order the applicants that they want most. The students, likewise, rank in order the programs they want most. Then a computer sorts it all out. The formula is not TOO complicated other than for a little tweaking that has to occur for students who "couples-match". This involves spouses or almost-spouses who wish to stipulate their preferences jointly so that they will end up in programs that are geographically matched, thereby preventing them from being in a long-distance relationship for the next 3-4 years.
Among the students whom I know personally, all got near their top choices, even the ones who couples-matched! But that’s not always the case.
Each year, many applicants fail to match in the specialty of their choice, forcing them either to take a different specialty or find some other way, either by scrambling for a spot or reapplying next year.
As Dr. Reece points out in his blog, the most competitive residency spots to get include Dermatology, Plastic Surgery, Orthopedic Surgery, ENT, Radiation Oncology and OB-Gyn with fewer than 90% of applicants getting accepted in 2007. Dermatology was the toughest, with only 61% of applicants getting their wish. Internal medicine and family medicine, on the other hand, was successfully matched by 98%+ of the applicants. Many of these internal medicine physicians will some day transition to a more lucrative subspecialty, such as cardiology. Infertility is also a two-step process, with applicants first completing a general OB-Gyn residency before applying later for a Reproductive Endocrinology / Infertility fellowship position.
After my lectures, I ask my 3rd-year medical students what factors they take into account when choosing specialties and the answer is overwhelming – LIFESTYLE, which some of them defined as "the best salary for the least hassle". Doctors do not differ from engineers, lawyers or plumbers in this respect. Human motivation for optimizing ones state does not necessarily rule out a place for personal integrity and compassion. In fact, in a free-market environment (which we don’t have) the hardest-working, most ethical, most compassionate, most caring doctors would be the most attractive to patients and command the most favorable compensation. Sadly, in the artificial model we have today, only the most idealistic souls would enthusiastically embrace a career in primary care, and it’s arguable how long their idealism will sustain them after facing a few years or even a few months of reality. If economics holds true, what will happen eventually is a severe shortage of primary care doctors (already happening) and then a cyclical increase in demand as people suddenly become willing to pay what’s reasonable in order to have access to the sparse pool of good primary care doctors. However, medicine does not follow normal economic models the way it’s set up now.
I repeat what has been said many times already by others, but falling on deaf ears. The way our medical system is headed, some day soon, we will be facing a severe shortage of primary care doctors.
