2009 Residency Match - The Primary Care Canary
March 21st, 2009 by Candice Chen (email author)The total number of PGY-1 residency positions offered and filled increased again this year, with 400 (1.9%) more PGY-1 positions filled. However, despite a promising increase in family medicine position filled last year, the number of positions offered and filled is down again this year - 100 fewer positions were offered and there were 75 fewer positions filled (Figure).
Figure. Results of the NRMP, 1997-2009, for Family Medicine Positions Offered and Filled (Source: AAFP)
The number of internal medicine and pediatric positions offered and filled rose incrementally, but increases in these PGY-1 positions will not necessarily equate to more primary care as more and more of these residents are choosing to further specialize after their initial “primary care” residencies.
Congress is increasingly recognizing the physician workforce and medical student specialty choices as critical components to developing a health care system in the U.S. that is equitable, accessible and cost-effective. But the 2009 Match is another step in the wrong direction and hopefully it sends a message. The time to act is now.
March 30th, 2009 at 9:21 am
As a general internist involved in resident educations for 30 years, the gradual (precipitous?) decline in primary care is neither surprising nor likely to change in the foreseeable future. Politicians in my neighborhood see non-MD/DO providers as the solution so why bother to address the concerns of the physicians. In all honesty, it is not clear to me even if we could increase the number of non-MD/DO providers that they would continue to work in our dysfunctional primary care system. The patient centered medical home is an intriguing but not yet proven salvation for our troubles. We have come a long way from Marcus Welby to ER or House as the mass media representation of attractive medical careers. My daughter asked me if Grey’s Anatomy is an accurate picture of medicine today! My concern is the light at the end of the tunnel may be an oncoming AMTRAK special or that emergency measure to address primary care medicine’s needs. As Paul Batalden has warned us, “every system is perfectly designed to achieve the results it is achieving”. I cannot even think of a good primary care site for my residents and students to experience the joys of good ambulatory practice. The time for incremental change is long gone. All I can say is stop fiddling while we are burning in the trenches.