Despite some efforts to make primary care more appealing to med students and residents, there’s still a shortage of those doctors looming — particularly with more people gaining coverage under the health-care overhaul law. A study just published in the Archives of Internal Medicine compares med students’ attitudes about internal medicine careers in 1990 and 2007. And it finds that while about the same percentage of med students — 23% in the earlier survey of 1,244 students, and 24% in the later survey of 1,177 students — plan internal med careers, the proportion planning to go into primary care fell to 2% from 9%. And the appeal of primary care as a reason to go into internal medicine fell to 33% from 57%. Med students are “drawn more to what they see from specialties,” Mark Schwartz, a study author and associate professor of medicine at NYU Langone Medical Center, tells the Health Blog. Med schools have made efforts to improve the quality of the internal-med educational experience, Schwartz says. But there may not be much more room for them to boost the appeal of the career — not when there’s an estimated $3.5 million lifetime income gap between generalist and sub-specialist doctors, and the average respondent in the 2007 survey reported $101,000 in educational debt. To significantly shore up the

appeal of primary care with more money and improved work-life balance, “bolder payment and practice reform” are necessary, the authors write: Such policies include expanding scholarships and loan repayment opportunities for those choosing primary care training and practice, addressing physician work-life concerns by carefully designing patient-centered medical home models to reward visits that are not face-to-face and promote a satisfying and sustaining clinician experience and helping primary care physicians slow the productivity treadmill by shifting away from the fee-for-service system driven by volume incentives to one driven by value incentives. The authors note that many of those measures are part of pilot programs included in the health-care overhaul law. As the WSJ has reported , however, where the rubber meets the road on incentives — at least for Medicare, which also drives Medicaid and private reimbursement — is the Relative Value Scale Update Committee, known as RUC, which is made up of physicians who decide how to divvy up the Medicare pie between types of procedures and visits. Any tipping of the financial balance from specialties to primary-care doctors would likely have to take root there, and primary-care docs have argued that the makeup of the committee makes that unlikely. Image: iStockphoto

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Med Students Like Internal Medicine OK. Primary Care? Not So Much.