In the October 2005 issue of the American Journal of Medicine. Dr. Karen Hauer and a group of other academic internists tackle the issue of declining medical student interest in the field of IM particularly general internal medicine. The online version of the journal which is the official publication of the Association of Professors of Medicine offers some full text journals for free but not this one. It is entitled (Educational responses to declining student interest in internal medicine careers) and the reference is Hauer,K et al , 118, no. 10,1164, Oct 2005).
They do a good job pointing out numerous factors influencing students. A few of them are: perceived vastness of the IM knowledge base perceived to be difficult or impossible to master,heavy administrative burden,work hassle,income ,less control over lifestyle, unhappy IM residents' influence on students as they rotate on service, economic pressures that promote short patient encounters and leave no time for reflection and pathophysiologic considerations traditionally said to be core values of IM. The panel realizes that, while changes in the medicine clerkship may at least make some directional change in students views of IM that most of the factors are out of the control of clerkship directors. The usual suspects of unmanageable administrative burdens (Let us call it correctly insurance plan hassles), low compensation and time demands and tanking prestige are the real culprits. The medical schools cannot change them. The authors said that " practicing clinicians and their national organizations must address flaws in the current practice environment" I have not given up completely on meaningful change taking place but it sounds like Will Roger's "boil the oceans" [ to eliminate German U-boats]. When I was a medical student or house officer, we did not discuss "lifestyle" specialties and-believe it or not-income differentials were not a pivotal factor in the decisions many of us made. The 21st century medical student is much more savvy regarding what happens in the life post training. I believe the major blow to general internists was and is managed care. I seriously doubt that that juggernaut will be stopped or meaningfully altered by practicing doctors or their largely ineffective and sometimes misdirected national organizations. But I can still hope.
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For another take on this and a companion article, see this post (http://hcrenewal.blogspot.com/2005/10/little-more-realism-about-declining.html)on Health Care Renewal (http://hcrenewal.blogspot.com/)
Graduates also have much more educational debt relative to income than in the past, a fact that is not mentioned here but is inescapable in the calculations of anyone coming out of training with loans to pay. Most internists going to cities do not earn enough to service their debts and afford an average home, never mind retirement or children's college funds, especially considering that few have siginificant personal resources at the beginnings of their careers.
Low-pay specialties look correctly like a catchup game that cannot be won. The added 'administrative' burdens are additional insults. These results are entirely predictable. Too bad most representatives of IM national organizations are senior physicians whose own personal financial trajectories carried them much higher than their successors are likely to go, borne by better reimbursement relative to lower living and practice costs; I wonder whether they understand the realities in any other than an abstract sense.
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