Subspecialties flourish as IM residents shun primary care

A new study documents how many internal medicine residents are choosing a subspecialty, where they are going and why.

By Myrle Croasdale, AMNews staff. May 16, 2005.

It's well-known that fewer U.S. medical graduates are choosing primary care, a trend that the National Residency Matching Program has followed. Now in a study unlike others before it, researchers dig deeper, tracking internal medicine residents to find out exactly how many were going into primary care and how many were planning to subspecialize.

They found that only 27% of graduating residents were picking primary care careers in 2003, compared with 54% in 1998. There was even less interest among first-year interns in 2003, with just 19% expressing a desire for a primary care path.

"More and more over the past few years, we've been seeing them choosing subspecialties instead of primary care. It's a trend most people in the trenches are aware of. The data verify these impressions," said Richard Garibaldi, MD, chair of the Dept. of Internal Medicine at the University of Connecticut Health Center, who decided to study the issue more closely.

Dr. Garibaldi's study -- "Career Plans for Trainees in Internal Medicine Residency Programs" published in the May Academic Medicine -- expands on what's been widely observed within the medical profession.

Other studies have focused on why students are turning away from primary care disciplines and have found that declining reimbursement for nonprocedural care, the opportunity for a controllable lifestyle and a medical culture in which subspecialists are seen as more prestigious have played a big part.

Dr. Garibaldi's study focused on internal medicine residents and quantifying precisely where they are going and why. The study found that more than half of these residents were seeking subspecialties, and the bulk of this group was choosing the higher-paid procedural disciplines.