Residents: Will They Ever Pay Off Medical School Debt?

Carol Peckham


August 05, 2014

In This Article

Are More Residents Finally Going Into Primary Care?

Despite the dramatic need for primary care physicians (PCPs), given the Affordable Care Act, and substantial evidence pointing to improvements in healthcare, with a greater proportion of PCPs versus specialists, only 28% of residents who responded to the survey were in internal medicine or family medicine programs, with only half of them going on to primary care; the rest were planning to subspecialize. Respondents said that lower salaries and less respect for primary care within the residency programs are important reasons for such choices.

Resident training in US hospitals is still heavily oriented toward the specialties. There are two important reasons for this: First, most residents are trained in hospital settings, where there is a great need for specialists, rather than in the community setting, where primary care clinicians are needed to serve most of the patient population. Also, hospitals receive higher payments for specialized services.[6] There was some hope that female physicians, with their increasing numbers, would help support a rise in primary care. However, a study in Health Affairs found that although absolute numbers of new female physicians are rising, the percentage of them going into primary care has actually fallen.[6]

But there are some promising trends. About three quarters of medical schools are now implementing initiatives to encourage careers in primary care.[13] The GME initiative, a grassroots collaboration that includes leaders in family medicine residency training, has recently made recommendations to Congress for reforming PCP training.[6] Some of the recommendations include:

Create a workforce that is at least 40% PCPs, holding teaching hospitals accountable and increasing the primary care residency position cap;

Provide direct GME (DME) payments of $100,000 per resident annually for programs that produce graduates who truly go into primary care;

Provide indirect GME (IME) payments to support primary care residency education, including education outside hospitals; and

Allow states expanding Medicaid through the Affordable Care Act to increase PCP education capacity through Medicaid DME and/or IME.

Of note, the Institute of Medicine's July report on the overhaul of GME hopes to address the disproportionate increase in specialist training, which has occurred at the expense of primary care.


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