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Am Fam Physician. 2003;68(8):1484

See editorial on page 1494.

A persistent, six-year trend in the choice of specialty training by U.S. medical students threatens the adequacy of the physician workforce of the United States. This pattern should be reversed and requires the attention of policy makers and medical educators.

The Institute of Medicine concluded in 1996 that in the United States, family physicians, general internists, and general pediatricians play an unequivocally vital role as primary care physicians. These family physicians, general internists, and general pediatricians presently provide a majority of the office-based visits people make to physicians in the United States. Medical students desiring residency training explicitly directed towards primary care may choose among family medicine, primary care internal medicine, primary care pediatrics, and combined internal medicine and pediatrics.

In the 2003 graduating classes of U.S. medical schools, of 14,332 matched graduates, only 47 seniors opted for residency training in primary care pediatrics, 192 matched into primary care internal medicine, and 258 matched into combined internal medicine and pediatric residencies. The number of U.S. graduates entering family medicine dropped to 1,234, barely one half of 1997 numbers. Most graduating medical doctors opted for more specialized fields or for programs in internal medicine or pediatrics that provide the opportunity to subspecialize.

Given the proven, vital role of primary care physicians in improving population health, these trends plead for immediate attention by medical educators and policy makers at federal and state levels.

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