I was going to put together a message congratulating everyone who successfully matched yesterday for the 2010 Match Day. As I was looking at what the general opinions are around the country's news outlets (seems like a lot are now blogs on newspaper websites - before you know it, my website may get lumped in as a "news" source!) and I saw a funny trend.

One article on the LA Times website (although looks like it may be a blog) saying that Primary Care is still not an attractive field based on the match results.

Another article on the Newsweek website (also looks like a blog) saying that Primary Care is a promising field.

As someone who is used to seeing "spin" based on the data (it's what pharmaceutical companies specialize in doing) I had to dig a bit deeper to see what the real trend is, if there is one.

Back when I was in medical school, there was a fairly large surge in people going into primary care fields. At that time, it looked like HMO's were going to take over the entire healthcare industry, and that specialists would be short of work. Of course, that didn't really happen, but doctors' salaries and lifestyles did change dramatically since the 1980's. It's isn't that doctors still don't make a good living, but the cost of medical education has increased at a far greater rate than the salaries of doctors - and I'm guessing a lot of doctors make less money now or are working more hours than was the case before managed care.

With all of the current talk about a national healthcare plan, there is again concern that people will be pushed towards primary care doctors and away from specialists. At least that seems to be what people are guessing. I honestly haven't been following the discussions as closely as I probably should, but I was disappointed with the first few things I read and felt that there was also a lot of confounding reports on what the real plan was. While I'm definitely interested in the ultimate outcome, I've just got too much other stuff going on than to follow what is currently being bantered around.

So back to the question of this post - what is the current trend in Primary Care?

According to the LA Times article:

the number of medical students choosing internal medicine residencies (where they learn primary care) increased only 3.4% from 2009, according to the 2010 National Resident Matching Program report.

Hmmm - so an increase of 3.4% means internal medicine isn't an attractive field? Actually, reading a bit closer now I realize that the author doesn't fully understand the medical education system. She says:

Some students may avoid primary care because they won't make as much money as their colleagues in cardiology or dermatology.

Obviously she doesn't realize that cardiologists have to do an internal medicine residency first. If there was an increase in interest in cardiology, there would be an increase in interest in internal medicine residencies (the first step before a cardiology fellowship).

So - aside from not being sure how to interpret the author's data, I'm concluding she doesn't really understand much about the medical education system.

Now - on to the Newsweek article:

And it’s an encouraging day for family medicine, because 1,169 of this year’s American graduates have chosen to go into that field, a significant increase from last year.

Ahhh - the LA Times article didn't mention anything about Family Practice and Pediatrics or even Ob/Gyn - which are all considered primary care fields. And the Newsweek article links to some real data that I browsed through. It looks like 1169 matched this year in Family Medicine (US graduates), compared to 1071 last year - an approximately 9.1503% increase (by my rough calculations). It seems they may have intentionally not presented the total number of Family Medicine residents this year (including international graduates) as the percentage increase isn't as impressive. Including international medical school grads, 2384 matched in Family Medicine this year versus 2311 last year - which is only a 3.1588% increase (roughly). When looking at trends in US medicine, it probably does make more sense to look at US medical school grads, but it is true that many international medical students do wind up staying in the United States to work after residency. Either way, there was an increase in people going into Family Medicine.

What about Internal Medicine and Pediatrics?

As for Internal Medicine - there were 2722 US grads this year (4947 Total) who matched in Internal Medicine. In 2009, the number was 2632 US grads (4853 Total). So - that makes for an increase of 3.419% (as quoted in the LA Times article). Pediatrics increased from 1682 US last year (2326 total) to 1711 US grads this year (2383 total) for an increase in US grads going into Pediatrics of 1.724%.

So - what are my conclusions after delving deeper?

1. There was a sizable increase in US grads going into Family Medicine this year.
2. There was a small increase in US grads going into Internal Medicine and Pediatrics.
3. It's too early to tell whether the new health care plan (if it passes) will really lead to a larger demand for primary care medicine services and less demand for specialist services.
4. "There are three kinds of lies: lies, damned lies, and statistics."

Here's the raw data for the NRMP 2010 Residency Match results.