The number of US medical students going on to become full-time primary care doctors has hit a record low, figures show.
Experts believe graduates are deterred by the pay, which is half that of higher earners in different medical branches, such as orthopaedic physicians.
Overall, there are more job positions than ever before, but only three in five were filled this year, a report found.
A shortage of doctors is predicted within the next decade or so, amid an ageing population with multiple chronic conditions.
Graduates use the National Resident Matching Program — known as ‘the Match’ – to find a job position in their field.
The number of US medical students going on to become full-time primary care doctors has hit a record low, figures show
The Match assigns them a residency program based on how the applicant and the program rated each other after an interview process.
This year, the number of positions were the lowest on record, steadily declining since 2011, according to data from The Match analysed by Kaiser Health News.
The three key primary care fields are internal medicine, family medicine and pediatrics.
This year, 8,116 internal medicine positions were available, the highest number on record.
Just 41.5 per cent of the positions were filled by fourth year students, according to the 2019 Match report, with similar trends in family medicine and paediatrics.
A crisis in staff across the board is predicted by The Association of American Medical Colleges.
It is expected that by 2032, between 21,100 and 55,200 primary care physician job positions will be left unfilled nationwide.
Mona Signer, chief executive officer of The Match, said: ‘I think part of it has to do with income. Primary care specialties are not the highest paying.’
WOULD MEDICAL SCRIBES RELIEVE PRESSURE ON DOCTORS?
Doctors may benefit from using medical students as scribes, research by Cabrini Hospital in the Melbourne suburb of Malvern.
A scribe stands at a patient’s bedside documenting details of the consultation, arranging tests and printing paperwork – allowing the medics to focus on treating the problem at hand.
A study comparing the use of scribes in 589 shifts to 3,296 shifts without the admin support found they increased the number of patients a doctor saw every hour by 15.9 per cent.
Scribes also reduced the amount of time the average patient stayed in a hospital’s emergency department by 19 minutes.
After carrying out a cost-benefit analysis, the researchers claim hiring scribes puts hospitals in a ‘favourable financial position’.
The researchers analysed the use of 12 scribes across five emergency departments in public and private hospitals in the state of Victoria from November 2015 to January this year.
Results revealed the scribes increased the doctors’ productivity by 15.9 per cent from an average of 1.13 patients an hour per medic to 1.31.
It also improved the number of primary consultations – where the medic is the main doctor overseeing the patient – by 25.6 per cent from 0.83 to 1.04 patients an hour.
Writing in the BMJ in January 2019, the authors, led by Dr Katie Walker, said: ‘Given the strong preference of physicians for working with a scribe, no effect on the patient experience, minimal risk, and the productivity and throughput gains outlined.
‘Emergency department and hospital administrators should strongly consider the potential local utility of scribes in their workforce and financial planning.’
Internal medicine doctors earn $243,000 (£194,840) annually on average, a little over half of what the highest earners, orthopedic physicians, make with an average annual salary of $482,000 (£386,470), according to reporting by doctors to Medscape.
Family medicine and pediatrics earn even less than internal medicine, at $231,000 (£185,215) and $225,000 (£180,400) per year, respectively.
Ms Signer also said college influences the choice: ‘Many medical schools are part of academic medical centers where research and specialization is a priority.’
The strain of admin work and rampant burn-out is also off-putting.
Eight out of ten doctors are spending up to 10 hours a week filling in digitalised paperwork, according to a survey by Medscape.
Only 62 per cent of internal medicine doctors said they would choose to go into their specialty again because of the burden of admin. This is the lowest percentage on record for all physician specialties surveyed.
Dr Eric Hsieh, the internal medicine residency program director at the University of Southern California’s Keck School of Medicine, said: ‘I don’t think people realize how involved electronic medical records are.
‘You have to synthesize everything and coordinate all of the care. And something that I see with the residents in our program is that the time spent on electronic medical records rather than caring for patients frustrates them.’
Elsa Pearson, a health policy analyst at Boston University, said hiring more nurses or assistants to relieve pressure on primary care doctors may keep them interested in the job.
The situation in the US mirrors that of the desperate GP shortage in Britain, with many doctors turning their back on their profession before they have started.
Increasing demands and a pension scheme that taxes the highest earners is causing many others to retire early or cut back on hours.
Figures show that, although the number of medical students in the US are becoming primary care doctors is plummeting, osteopathic and foreign-trained physicians trained in the US are increasingly matching into primary care positions.
This year is the first year in which the percentage of osteopathic and foreign-trained doctors surpassed the percentage of trained medical doctors ‘matching’.