Match results: a 'blip' or a trend?
Internal medicine held its own--barely--but educators still optimistic
From the May 1999 ACP-ASIM Observer, copyright © 1999 by the American College of Physicians-American Society of Internal Medicine.
Despite showing a slight setback for primary care overall, the 1999 Match brought generally good news to internal medicine.
The number of applicants that matched to the three types of internal medicine residency programs that train doctors for careers in internal medicine or its subspecialties-- categorical, primary care and medicine-pediatrics--rose 0.2% this year, for a total of 5,393 filled positions. The Match fill rate nationally for internal medicine was 94%.
In addition, 1,275 applicants matched in preliminary internal medicine programs, representing an increase of nearly 8%. Most of these students, however, will pursue careers in other specialties, such as anesthesiology, radiology and dermatology after one year of internal medicine training.
For family practice, this year's Match results were not so good. The specialty posted a 4.6% decline and filled only 2,683 residencies through the Match, a drop from 2,814 in 1998 and 2,905 in 1997. Its fill rate was 83%.
Pediatrics, meanwhile, had a banner year, with 2,077 applicants matching in positions in general pediatrics, up 1.4% from 1998, which itself was up 2.8% from 1997. It was the eighth straight year of an increase for pediatrics. Its fill rate was nearly 99%.
Internal medicine's slight gain came despite the fact that the number of U.S. medical school seniors choosing internal medicine-career residency programs dropped by 3.3%. The shortfall was offset by an increased number of positions filled by osteopathic school graduates and international medical graduates.
Even with the dip, about a third of U.S. seniors selected internal medicine, which led most educators to declare 1999 another good year for the specialty. "We have about 60 fewer U.S. seniors than a year ago," said Henry J. Schultz, FACP, president of the Association of Program Directors in Internal Medicine. "But a year ago we were more than 100 up from the previous year, so I suspect this is a three-year kind of mean." Dr. Schultz, who is internal medicine residency program director at the Mayo Medical Center in Rochester, Minn., noted that his program had a spectacular year in the Match, filling all 47 positions from the top half of its Match list.
Internal medicine was not alone in experiencing a slight dip in interest by U.S. medical students. While more than half of all U.S. medical school seniors selected primary care residencies, the number of U.S. medical school seniors matching in one of the three major primary care specialties fell from 56% in 1998 to 54% this year.
While they are concerned about the interest level of American medical students, internal medicine educators echoed Dr. Schultz's optimism. "We won't really know until next year if this is a real turnaround from what has been a pretty progressive uphill course for internal medicine recovering from the dreadful numbers of the late 1980s, or whether this is just a blip," said Herbert S. Waxman, FACP, the College's Senior Vice President for Education.
"The changes are small enough that it's hard to draw any sweeping conclusions about this year's Match results," said Dr. Waxman. "One might say that there's evidence of a sustained interest in primary care careers on the part of graduating U.S. seniors, but within the spectrum of primary care, there seems to be a little bit of a shift over the past two years away from family practice and a steady growth in pediatrics and perhaps a leveling off in internal medicine."
Holly Peterson, a senior at the University of Minnesota Medical School who matched in an internal medicine residency at Hennepin County Medical Center in Minneapolis, said that she noticed a shift in interest away from family practice and toward internal medicine among her colleagues. She was one of 51 University of Minnesota seniors to match into an internal medicine residency, representing 22.4% of the class. Last year, the specialty only attracted 17% of the class, and 12% of the class in 1996. Family practice's popularity among University of Minnesota seniors, meanwhile, declined for the third year in a row, to 28.5% of the class, down from a high of 35% in 1997.
"I considered family practice," Ms. Peterson said, "but I decided it was too broad and not in-depth enough for me. With internal medicine, your [career] options are so much more open." She said she has not decided yet if she ultimately will go on to subspecialize; at the moment, she said, she envisions herself in an academic career.
This year's flat Match results also dispelled notions that medical students would flock to newer specialties like hospitalism. Some internal medicine leaders had predicted a surge of students toward hospitalism, but with so little movement, Dr. Waxman said that "we have to be cautious about any theories."
University of Pennsylvania senior Molly Conroy decided to match to a primary care residency at the University of California, San Francisco, but it had nothing to do with the school's reputation as one of the top places to train in hospitalism. Ms. Conroy found that the hospital also has been focusing in its primary care residencies on training general internists particularly interested in outpatient-oriented careers. "I'm not interested in being a hospitalist," Ms. Conroy said, "so spending more time in an outpatient setting as a resident just made so much sense to me because that's where I see my future career. That's where I see medicine moving."
Contact ACP Internist
Send comments to ACP Internist staff at acpinternist@acponline.org.