Ryan Circh's heart is drawn to family medicine, but his head - fixated on his daunting student loans and the uncertainties of health care reform - is leading him toward emergency or sports medicine.
The 24-year-old studying medicine at the University of Maryland is probably another potential primary care physician lost. In the school's most recent graduating medical school class, more than a third pursued internal and family medicine. That reflects a nationwide trend, according to the National Resident Matching Program, whose figures show about a third of graduating students are going into primary care, a number that's been dropping fairly steadily over the last generation.
"Sure, I would love to serve more people in family medicine, but when it's a difference of $200,000 in your paycheck, it's tough," says Circh, from Rochester, N.Y. "From what I've seen and heard, a lot of docs are going under or barely getting by, working 10-hour days and giving patients 15 minutes at a time. That's not my vision of how to take care of patients."
As the country wrestles with health care reform, these are the depressing realities on the minds of medical students. They face a debt approaching $150,000 when they leave medical school. And though most realize some sort of reform must happen, they can't imagine how any of it will actually work.
"The more I'm in the field, the more I'm starting to realize, they want to add 45 million uninsured to the rolls, but how do you treat 45 million more with no more people?" Circh asks. "Who's going to treat them if no one's going into family medicine in the first place?"
Jeremy Pollock, a third-year student from Baltimore, isn't sure what he wants to specialize in when he graduates: cardiology, orthopedic surgery, neurology are all on the list. Not listed: any primary care fields.
"It's lifestyle and money," he says. "You work longer and longer hours to earn less and less money."
Pollock, who favors reform, wishes more medical students were integrally involved in the debate. But with their "tunnel vision" focus on the end game - becoming doctors - "we're missing that we're involved in the most pivotal time in health care."
It's not even clear, for instance, if those high salaries will survive reform. Some would like to shift doctors' pay to a salary-based system, like that used at the Mayo Clinic, instead of the reimbursement-based system that they say allows many physicians ordering up extra tests and procedures to get more money.
