Young doctors find general internal medicine doesn't pay

High medical school debts and relatively low compensation are driving even more away from the specialty.

By — Posted May 6, 2011

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Many young physicians continue to steer away from general internal medicine, despite increased exposure to the field during medical school and a more favorable view of the specialty among medical students.

The decline is contributing to a growing shortage of primary care physicians when demand for such services is on the rise, said Mark D. Schwartz, MD, associate professor at New York University School of Medicine. He is the lead author of a study on the subject in the April 25 Archives of Internal Medicine. (

The widening gap in pay between primary care physicians and specialists, large medical school debts, inflexible schedules and heavy workload are some of the factors that influence students' decisions, he said.

"What's happened in primary care practice is that physicians feel they are on a treadmill to maintain their salary," said Dr. Schwartz, a general internist. "Pay hasn't kept up with inflation, so to keep up, they see more patients."

Researchers surveyed 2,421 medical students, including 1,244 in 1990 and 1,177 in 2007. There was little change in the proportion of students planning to go into internal medicine during the 17-year period, but the percentage going into general internal medicine dropped from 9% in 1990 to 2% in 2007, according to the study.

At the same time, overall satisfaction with internal medicine clerkships increased from 38% in 1990 to 78% in 2007. The percent of students who believed the field offered a meaningful career option also rose, from 42% to 58%, over the same period.

The results demonstrate there is little that medical educators can do to encourage more students to go into general internal medicine, the study said. The solution is on the policy side, where lawmakers can take steps such as increasing pay for primary care.

"There probably is not a whole lot that we can do at the pipeline level to dramatically improve the number of students choosing primary care, but I think that where the money is, is where the money is," Dr. Schwartz said.

The average medical school graduate had a $132,000 debt in 2009, and the income gap between generalist and subspecialist physicians continues to widen, he said.

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