For each of the past two years, the number of U.S. medical students choosing internal medicine residencies has decreased by approximately 1 percent from the previous year.
According to the 2009 National Resident Matching Program report, 2,632 U.S. seniors at medical schools enrolled in an internal medicine residency program -- down from 2,660 in 2008 and 2,680 in 2007.
"Although the year-to-year decrease is seemingly small, these numbers are particularly striking when compared with 3,884 U.S. medical school graduates who chose internal medicine residency programs in 1985," said Steven E. Weinberger, MD, FACP, senior vice president for medical education and publishing, American College of Physicians (ACP). "We are witnessing a generational shift from medical careers that specialize in preventive care, diagnostic evaluation, and long-term treatment of complex and chronic diseases, to specialties and subspecialties that provide specific procedures or a very limited focus of care."
The 2009 match numbers include students who will ultimately specialize in general internal medicine and provide primary care, as well as those who will enter a subspecialty of internal medicine, such as cardiology or oncology. Currently, approximately 20 to 25 percent of internal medicine residents eventually choose to specialize in general internal medicine, compared with 54 percent in 1998.
"This transition is happening at a time when America's aging population is increasing, and the demand for general internists and other primary care physicians will continue to grow at a much faster rate than the primary care physician supply," said Dr. Weinberger.
The Institute of Medicine recently announced that the U.S. needs 16,000 more primary care physicians just to meet the needs of currently underserved areas. The shortage will grow to 40,000 or more physicians, assuming current rates of health insurance coverage, according to two recent studies.
"Because it takes a minimum of seven years to train a primary care physician -- medical school and residency combined -- we need to expand the internal medicine workforce and reform our health care system so that young physicians are encouraged to choose primary care medicine as a career," said Dr. Weinberger. "ACP has long been concerned about the rising cost of medical education and resulting financial burden on medical students and residents, particularly for those choosing careers in internal medicine, who will find it difficult to repay these debts."
ACP has consistently called for reform of Medicare payment policies so primary care physicians can receive reimbursement that is commensurate with the value of their contributions.
"Reducing existing payment disparities would make internal medicine more attractive and increase the number of physicians entering and continuing to practice in primary care specialties," said Dr. Weinberger. "President Obama himself said at the White House Health Care Summit, 'we have to produce more primary care physicians.'"
In February, ACP called on President Obama to issue an Executive Order to assure that all federal agencies are working together to set primary care workforce goals and the policies necessary to achieve them. Expanding the primary care workforce goes hand-in-hand with access to affordable health insurance coverage -- a goal that ACP supports.
"Giving all Americans an insurance card will not guarantee that everyone will have access to care," said Dr. Weinberger. "There are not enough primary care physicians to care for them."
In November, ACP released a white paper documenting the value of primary care by reviewing 20 years of research. An annotated bibliography based on a literature review of more than 100 studies documents the evidence to support the critical importance of primary care in providing patients with better outcomes at lower cost, and the urgency of the need to prevent shortages of primary care physicians.
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 126,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illness in adults.