Balance becomes key to specialty pick

Family practice and general surgery are taking the biggest hit, but fewer students are choosing medicine overall.

By Myrle Croasdale, amednews staff. Sept. 22/29, 2003.

U.S. medical students want careers that give them more control over their personal lives, according to a study in the Sept. 3 Journal of the American Medical Association.

That's good news for specialties considered to favor controllable lifestyles, such as anesthesiology, dermatology, emergency medicine, neurology, ophthalmology, otolaryngology, pathology, psychiatry and radiology.

Road less traveled
See related content

"Not to cast aspersions on primary care, but to look at the numbers from our study, what is happening is that the best and brightest are applying in increasing numbers to controllable-lifestyle specialties," said Greg Rutecki, MD, lead author of the study. "Consequentially, the students applying to primary care are not in as high a standing in their class."

Fields with demanding schedules, such as family medicine and general surgery, are also drawing fewer doctors. U.S. medical school seniors filled 73% of family practice resident positions in 1996 but only 47% in 2002. In general surgery, U.S. seniors made up 89% of residency slots in 1996, compared with 75% in 2002.

The overall fill rate for general surgery was more than 90% in 2002 when international medical graduates and U.S. doctors who weren't fresh out of medical school were included. Family practice programs filled only 80% of their slots.

Joining family practice and general surgery on the list of specialties thought to have less controllable lifestyles are internal medicine, ob-gyn, orthopedic surgery, pediatrics and urology.

Time for a social life, family and hobbies has become a driving factor in more students' residency choices.

"What this is telling us is that we should look at primary care and see if there is a way, without compromising patient care, to limit the hours," Dr. Rutecki said.

Traditionally, prestige and pay have driven medical students' career choices, according to the study. But pay is less of an issue now despite rising medical school debt. Time for a social life, family and hobbies has become a driving factor in more students' residency choices.

In another article in the medical education issue of JAMA, researchers noted that the number of applicants for the limited number of medical school positions continues to drop. Applications fell 3.5% from 2000 to 2001 and almost 22% from 1997 to 2002.

Medical education experts are reluctant to speculate, but a past standard explanation has been that the medical field has lost prestige. Rising tuition and the threat of government regulation also have been cited as deterrents.

ADDITIONAL INFORMATION:

Road less traveled

The number of applicants to U.S. medical schools fell for the sixth year running in 2002-03. Lower reimbursements, higher medical school tuition and perceptions that physician autonomy is declining likely contributed to the slide. Since 1997, the number of people applying to medical school has dropped nearly 22%.

Applicants

1996-97 46,965

1997-98 43,016

1998-99 40,996

1999-00 38,443

2000-01 37,089

2001-02 34,860

2002-03 33,625

Source: Assn. of American Medical Colleges Note: Data includes only the 126 allopathic schools accredited by the Liaison Committee on Medical Education.