Why US medical students are shunning primary care

The looming doctor shortage in the United States is nothing new. The American Association of Medical Colleges has projected a shortfall in primary care physicians of up to 48,000 clinicians by 2034.^[] 

By 2030, the US Health Resources & Services Administration estimates there will already be a 13% increase in the need for family physicians, and a 22% increased demand for general internal physicians.^[] The increased need for geriatric physicians could be as high as 50%, as the population ages.

The pain to come

Experts anticipate that the physician shortage could lead to declining standards of care and increased disease burden for patients. Ultimately, there could be higher mortality rates, too. 

Practicing physicians are keenly aware of the issues. According to a survey commissioned by MDLinx and administered through M3 Global Research, 42% of physicians in practice are very concerned about the upcoming doctor shortage.^[] Additionally:

• Only 2% of doctors feel strongly optimistic about being able to provide adequate care to increasing numbers of patients in the next 10 years. In contrast, 22% are not optimistic at all about their chances.

• 84% of physicians have already seen the quality of their patient care compromised.

• 34% of practicing physicians do not recommend that the next generation pursue a medical career.

These statistics reflect both the uncertainty surrounding the future of primary care physicians and the quality within the healthcare system in general. 

Barriers to becoming a PCP

Several barriers prevent more people from entering the primary care specialty.

Lack of residency programs. Medical schools have had more applicants than ever before, but there aren’t sufficient residency programs to keep up with the number of graduates.^[]

Low pay. But medical students also turn away from primary care for other reasons, notably lower pay and high work burden. According to some estimates, average annual earnings for an internal medicine physician are about $243,000. That is obviously a great salary compared to the average American’s wages, but it is still much less than medicine’s highest earners, orthopedic physicians. These specialists earn an average yearly salary of $482,000.^[] 

Student loan burden. The need to repay student loans also affects many students’ decision to turn away from such (relatively) low compensation. The AAMC reported that, in 2019, 73% of medical school graduates had significant student loan debt, at a median price tag of around $200,000.^[] For many, indebtedness automatically makes higher-paying specialties more attractive. 

Inadequate reimbursement. The financial problem is further complicated by reimbursement cuts affecting both Medicare and Medicaid patient segments. In 2023, US physicians can expect a 2% decline in reimbursement for Medicare patients.^[] This loss only puts salt on the wound of the 22% pay loss for Medicare physicians that occurred between 2001 and 2021.

High workload. Not to be underestimated is the sheer amount of work involved in primary care that turns many away from the specialty. Although technology and team support has helped to ease some of the work burden, primary care physicians are still working an average of 51 hours each week, seeing up to 20 patients every day.^[] 

And since they spend so little time with each one, they often have difficulty managing patients’ chronic conditions effectively.

Bringing students back to primary care

Fixing the anticipated primary care provider shortage is a multifaceted process that begins by keeping medical students in the specialty. The same survey by MDLinx and M3 Global Research asked doctors to point out which actions would have a significant impact on the upcoming physician shortages. Their responses were the following:

• 72% of respondents think increased training and retention strategies will help.

• 70% believe the administrative burden of working as a physician should be reduced.

• 42% see reducing or forgiving medical school debt as a positive step in the right direction.

• 30% of surveyed doctors think the healthcare system as a whole will need to increase reliance on PAs and APRNs.

An obvious solution involves reducing the financial burden primary care physicians face, both in terms of student loan debt and annual compensation. There are already many student loan forgiveness programs that can help eliminate medical school debt. Preserving and enhancing the Medicare Physician Fee Schedule may help more primary care doctors receive more appropriate compensation for their services.

Other solutions may also be effective. One 2020 study found that increasing education about lifestyle medicine may entice medical students to choose primary care as their specialty.^[] Lifestyle medicine, which focuses on diet, physical activity, sleep, and stress management as modalities for chronic disease treatment, has grown in popularity in recent years. 

Medical students do receive some instruction on these issues. However, most medical schools do not typically offer a curriculum designed to help students understand how lifestyle interventions can effectively manage many conditions and diseases. 

After all, the same 2020 study also suggests that students are interested in incorporating lifestyle medicine into primary care.

Finally, it may also be possible to keep medical students pursuing primary care with the addition of more support staff in primary care settings. Medical students are aware of the administrative burden placed upon primary care physicians; boosting staff numbers with physician assistants and nurse practitioners can take some of this burden off the physician. If medical students feel they will be able to spend more time with patients, they may be more likely to be attracted to primary care practice.