The fill rate for family medicine residency slots was up slightly from last year, but leaders in the field continue to be concerned about overall interest in the specialty as well as interest among U.S. medical school graduates.
This year, family medicine had 2,711 residency slots; 85.1% of those were filled, a slight increase over last year's fill rate of 82.4%. U.S. seniors filled 41.4% of the slots this year, compared with 40.5% last year.
Dr. Larry Fields, president of the American Academy of Family Physicians, noted that while more people matched to family medicine this year, compared with last, there were also fewer slots available.
As for the high percentage of residency positions being filled by international medical graduates, “we are certainly concerned about that,” said Dr. Fields, who practices in Ashland, Ky. The reason for the low fill rate among U.S. graduates is pretty simple: “It's basically the high amount of student debt combined with postresidency income potential,” he said.
To combat these problems, “The [AAFP] is working very hard to change the postresidency environment so that it is an inducement for people to select the specialty,” he said. “Nobody has any argument with the fact that family medicine is the most rewarding career you can have because of the ongoing relationship with patients and families. It comes down to what your environment is going to be after you finish training.”
The academy is focusing on payment in particular. “We are working very hard on changing payment systems both with private [insurers] and with Medicare, and we hope to see some efforts come to fruition fairly soon,” said Dr. Fields. “For instance, we're all working on changing the Medicare payment formula, which would help everyone. We are also working to increase the value of the evaluation and management codes we use every day in our offices.”
Medical liability reform is another area of concern “because that's such a large component of office overhead,” he said. “If that was under control, and people didn't have to practice such a large amount of defensive medicine, [it] would be a lot easier as well.”
Like family medicine, the match rate for internal medicine residencies also increased slightly, from 97.2% last year to 97.9% this year; 56.3% of the slots were filled by U.S. graduates. Despite the increase, however, the American College of Physicians remained concerned about what appeared to be a decreased level of interest in general internal medicine.
“We're not as much concerned about internal medicine overall if you look at all the subspecialties,” said Dr. Steven E. Weinberger, senior vice president for medical knowledge and education at the American College of Physicians in Philadelphia. “The concern is with the number of people going into primary care.”
Match Day itself doesn't reveal how many medical students plan to go into internal medicine subspecialties instead of primary care, “in part because a lot of them don't know yet,” Dr. Weinberger said. But the ACP also gives residents a questionnaire asking about their plans. “In 1998, 54% of graduating residents were choosing to go into general internal medicine; the comparable number for residents graduating in 2005 was only 20%,” he said. “With the aging of Baby Boomers who have more complex chronic diseases, it's going to be harder to find people to coordinate their care, so that's going to be a concern.”
Perceived lifestyle issues play a part in graduates' choices, Dr. Weinberger noted. “Medical students are going into things they view as having more regular hours and a better lifestyle,” he said. “Some of that is attributed to Generation Y having a different set of values and priorities than an older generation of physicians had. I don't know whether that is truly the case or not, but people do say lifestyle is an issue.”
That view was echoed by the National Resident Matching Program (NRMP), which runs Match Day. In a statement, NRMP noted that graduates continued their increasing interest in “lifestyle” specialties that are considered to have more reasonable work hours. For example, 100% of first-year dermatology residency slots were filled, with U.S. seniors filling 93.3% of the slots. In anesthesiology, 97% of the positions were filled, including more than 80% by U.S. seniors.
Overall, more than 26,000 seniors graduating from medical schools—including more than 15,000 U.S. seniors—participated in the match. Nearly 22% of available slots were in internal medicine, making it the largest specialty, according to the NRMP.
Pediatrics was also popular, with 96.5% of its 2,288 slots filled; 72.9% were filled by U.S. seniors. And ob.gyn. continued its upward trend, with 97.9% of its slots filled, 72.4% of them by U.S. seniors. Otolaryngology was new to the match this year and got off to a good start: 98% of the 264 slots offered were filled, 92% by U.S. medical school seniors.