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Match shows continuing decline in primary care

While internal medicine programs saw a 1.5% decrease, family medicine residencies took a 17% hit

From the May 2001 ACP-ASIM Observer, copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

For the fourth year in a row, primary care—including internal medicine—has attracted fewer U.S. medical school seniors.

According to Match results released March 22 by the National Resident Matching Program, just under 49% of U.S. seniors selected primary care residencies, a drop of roughly 3% from last year.

Internal medicine posted only a slight decline. The number of U.S. seniors matching to internal medicine residency programs—including categorical, primary care and medicine-pediatric tracks—fell 1.5% from last year. In 2001, 3,369 U.S. students matched to internal medicine; in 2000, 3,419 matched. (The 2000 internal medicine Match results for U.S. seniors declined 4% from 1999.)

While pediatrics actually gained 4% in the 2001 Match, family practice took a big hit. More than 17% fewer U.S. seniors selected family practice residency programs compared to last year. (In 2001, 1,503 seniors matched to family medicine; in 2000, 1,817 matched.)

Even among total Match applicants—numbers that include osteopaths and U.S. and non—U.S. foreign graduates, as well as U.S. seniors—family practice showed a decline of more than 9%.

Analysts said that the relatively stable Match results for internal medicine compared to family practice reflect the fact that internal medicine gives seniors an option to later subspecialize. Analysts also said that this year’s figures confirm a declining interest in generalism among U.S. medical school students.

“That [decline] probably has to do with the extraordinarily high level of student debt,” said past president of the Association of Program Directors in Internal Medicine, Lisa B. Wallenstein, FACP. “There is a perception that subspecialties offer higher salaries and more job opportunities.”

As evidence, several specialty categories posted gains this year. One was preliminary internal medicine, which drew almost 12% more U.S. students than in 2000. The one-year track is the gateway to non-internal medicine specialties such as ophthalmology, dermatology and radiology.

Anesthesiology this year drew 64 more applicants among U.S. seniors than last year, an increase of almost 37%. Pathology also saw its matches jump nearly a third, while psychiatry posted a gain of almost 9%. Emergency medicine matches were up by slightly less than 4%.

Another continuing trend borne out by this year’s Match results is the rapidly shrinking number of foreign-born international medical graduate (IMG) participants. This year, IMG numbers fell to 9,038 from 10,839 in 2000, a decline of almost 17%. That drop follows a more than 22% decrease in the number of IMG Match participants between 2000 and 1999.

Herbert S. Waxman, FACP, the College’s Senior Vice President for Education, speculated that the decline may mean more IMGs are shifting out of the Match to fill residency slots earlier or later in the year. He also said that the trend may mean that fewer IMGs are interested in doing graduate medical education in the United States, perhaps in response to the inconvenience and expense of taking the clinical skills assessment exam, which has been administered since mid-1998.

“The total pool of interested IMGs may have declined because of that burden,” Dr. Waxman said. He also pointed out that immigration rules governing the return of IMGs to their home countries have tightened, which may be another factor causing fewer IMGs to participate in the Match.

A total of 20,642 first-year residency positions were offered in the Match. Of those positions, 89% were filled, 66% by U.S. medical school seniors.

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