Match Day primary care aftermath: The Dean’s Lie continues

Once again, medical schools continue their annual fraudulent and misleading statistics in regards to primary care workforce production.  The Dean’s Lie is back and rampant across the country.  It only seems to get worse.

When will they learn?

USA Today: Match Day: More medical graduates enter primary care

About one-quarter (11,762) of the applicants matched to resident positions that train doctors to be on the front line of care — in the areas of internal medicine, pediatrics and family medicine — where serious shortages exist.

Los Angeles Times: Match Day 2013 results are good for future internal-medicine patients

…. more med students are headed toward residency programs for internal medicine-primary care and med-peds, which combines internal medicine with pediatrics. Interest in med-peds programs is up 13% from last year, and interest in primary care is up 20% since 2011.

Physician News Digest: Match Day Results – More primary care doctors than specialists

More U.S. medical school seniors committed to primary care residencies over specialty positions in the largest main residency match in the history of the program.

The American College of Physicians confused me the most:

Internal medicine residency match results encouraging for adults needing primary care … The great majority of current internal medicine residents will ultimately enter a subspecialty of internal medicine, such as cardiology or gastroenterology. Only about 20 to 25 percent of internal medicine residents eventually choose to specialize in general internal medicine, compared with 54 percent in 1998

Compare the title of the article to the content – so what you are saying is: the match is encouraging for primary care, but most of those residents are not going to practice primary care.  It all makes sense to me now!

Before listing a large number of schools that published inaccurate information, it is of utmost importance to recognize those graduating medical students that stuck to their personal statement and joined the family medicine revolution.  It is also very important to recognize all those matching in primary care residencies who plan to join the primary care workforce.  The family medicine and primary care community is counting on you to prove the following data wrong.

As per the previous Dean’s Lie Post, let us assume a 90% sub-specialization rate in internal medicine and a 66% sub-specialization rate in pediatrics (and some rounding).  Also, let’s keep in mind that there are some that would consider these specialization rates on the lower side (JAMA December 2012 20-25%; another JAMA article publishing results of a survey showed 98% plan to sub-specialize within internal medicine).

Here is your list of examples of all medical schools misleading the public (additions will be ongoing as erroneous data continues to be publicized for misinterpretation by its readers).

It’s extremely unfortunate that the Dean of a brand new medical school at FIU is not immune to the Dean’s Lie:

Dean of the medical school John Rock said more than half of this year’s graduates will be going into primary care, and about a third landed residencies in Florida. Those two numbers are key, as increasing the supply of primary-care physicians — and making sure a good number stay in Florida — were two of the main justifications for state leaders’ decision to grant FIU a medical school in 2006. FIU’s College of Medicine officially opened its doors three years later.

62% of Meharry graduates headed into primary care (not quite).

Guess what?  Indiana University to fill primary care need!  They only mention a few out of their class of 304.  No other stats mentioned.  They were probably watching basketball at the time.

55% of Marshall graduates enter “fields defined as primary care in West Virginia: family medicine, internal medicine, OB/GYN (?), IM/peds, and pediatrics.”  Why, Marshall, why?

Some 42% of UAB graduates will enter primary care residencies. It’s unfortunate that not all 42% will remain in primary care.  It’s also unfortunate that the general reader does not know this fact.

The Atlanta Journal-Constitution’s headline: “More than 50% of Georgia medical students receive a primary care match.”  Looking into a crystal ball, the author states that the following schools produced “primary care physicians”: Morehouse School of Medicine with 67 percent, Medical College of Georgia with 40 percent, Mercer with 61 percent, Emory with 38.7 percent, and Philadelphia College of Osteopathic Medicine’s Georgia Branch Campus with 52 percent – and they did not even start residency yet!  That is power.  Do these schools do a better job than most at producing primary care physicians?  Absolutely.  However, how can anyone state that these schools already produced primary care physicians?  It is a shame that this author was fooled by an entire state worth of medical school deans.  Case in point:  read the following statement from Morehouse School of Medicine’s dean:

According to Dr. Valerie Montgomery Rice, dean and executive vice president at Morehouse School of Medicine, 96.3 percent of MSM seniors received a match. Of those, 67 percent matched in primary care and core specialties, a testament, Rice said to “us identifying students who are aligned with our mission, which is to work in under-served areas and have a high affinity for primary care.”

But, Dr. Rice, 3 of your 52 students that matched are going into family medicine (5.8%). Of your 14 graduates matching in pediatrics, maybe 7-9 will practice primary care (15%), and of your 8 that matched in internal medicine, 1-3 will practice primary care (a generous 6% of the class).  So, in actuality, maybe 26% of your class is going to practice primary care medicine in 5 years.  To be totally generous, we may get you to 30-35%.  We are still about 50% short of your number.  Where are you hiding your other primary care graduates?  Let us add OB/GYN: if we consider all of them primary care doctors, then we get to 12 more percent.  We are still very short and I am still very confused as to where this data is coming from.

33 of 55 graduates from Texas Tech will practice primary care — we are talking about practice.  Where is Allen Iverson when you need him?

In a rather sobering piece, OnCentral from South Los Angeles reported that only 1 of its 16 graduates from Charles R. Drew University matched into family medicine.  The report also makes mention that this program matched 18 out of 24 into family medicine in the 1990′s.  That is old school.

We do appreciate Tufts for their Maine track – 7 of its 32 students matched into family medicine.  They do state that a total of 16 from that track will pursue residencies in primary care fields.  Assuming a good mix of pediatrics, IM, med/peds, and assuming that many going for the track are more likely to go into primary care, this may be the closest to the 40% that COGME recommends for primary care workforce.  It is unfortunate that others do not do the same.  It is also unfortunate that Tufts states that 39% of its overall class will pursue potential careers in primary care.  Good job on them to throw in the word “potential.”  That is more accurate.  Hopefully the general public will read it the same way as it was intended.

Eastern Carolina University tells its local NBC news station that 58 percent of their graduates chose primary care.  Hopefully this was also televised so that those who were unable to read this were able to watch it on their evening news.  This is a true testament of their “sense of commitment” with primary care topping their list!

A vague statement, such as “43 percent matched into a primary care residency,” is also misleading.  The University of Connecticut knows that this will not accurately translate into primary care doctors.  A majority of its readers will most likely perceive this as a medical school that is pumping out primary care doctors.  A majority of its readers will also not read my comment because they still have not approved it.

Over 55% from Albany Medical College will enter primary care specialties, including family practice.  At least get the name of the specialty correct – that would be family medicine.  Thanks.

University of California Health gives us an action-packed story full of inaccurate information from all of its medical schools.  UC-San Diego: 40% , UC-Davis: 48.6%, UC-San Francisco: 48%.

Lee Jones, associate dean for student affairs, said students in the Class of 2013 matched to “really solid,” high-quality programs throughout the country, including residencies at Harvard University, Stanford University, UCLA, the University of Washington and other top-flight institutions, as well as UC Davis. The percentage of students entering primary care increased once again, reaching a 10-year high, he said.

According to the University of Iowa’s publication, Iowa Now, the headline reads: “More than 40 percent of the graduates chose primary care specialties.”  Iowa Now must be stuck in the past.

The University of Hawaii tells Hawaii News Now: Typically, more than 60 percent choose the primary care route, one of the highest percentages in the nation.  They do not break it down further in the article.  So, I am assuming that over 65% are going into family medicine?  That must be a record.

AnnArbor.com claims that 40% of the University of Michigan graduates will pursue primary care.  The article also states that half of Michigan State’s class will pursue primary care specialties.  It is a good thing that the author used “pursue” given that many of them will not end up within the primary care workforce.

In the Columbus DispatchOhio State claims that about 40% of its seniors are entering primary care. Maybe primary care residencies but definitely not the primary care workforce.

Dean Krugman at University of Colorado personally told the Denver Post that 45% of this year’s class is focused on primary care.  Many of those will also be focused on pursuing a sub-specialty fellowship in 3 years.

Wright State with 50.5%.  They do not provide any good quotes from deans.  Probably a good strategy.

The Medical College of Wisconsin believes that primary care attracted 38% of its graduates this year.  It’s a tough bullet to swallow with 14% going into internal medicine, 12.5% pediatrics, 9.5% family medicine, and 2% med/peds.  Adjusted for the Dean’s Lie, it’s closer to about 17-20%.  Ouch.

Florida State School Of Medicine sending 51% of graduates into primary care residencies.  Also misleading given the Dean’s Lie. Yes “primary care” residency, but all practicing primary care in 5 years? False.  Initially reported at over 60% by FSUSoM on Twitter, prompting this conversation.

LSU-Shreveport: 49 out of 115 graduated will geaux into primary care fields.

Most accurate assessment of the day, courtesy of the South Jersey Times.  Apparently, some graduates from UMDNJ are studying to become primary care physicians in the specialties pediatrics and OB/GYN. That is all.

The University of Washington did not lie.  Thank you.

At the University of Utah, they are watching primary care production closely, stating that 26 of its 73 matching seniors will enter primary care residencies.  We will be watching closely too.  Please report back in five years.

I understand the love affair with this piece by a Stanford medical student who defied the odds of attending Stanford to match into family medicine. It is definitely well-written and should be shared.  I agree and published this piece a while ago:  Family Medicine is a Waste of Your Talent!

Stanford also tripled its usual matches into family medicine, with its school usually producing 2-3 grads out of over 90.  This year they matched 8 out of 91, still among the nation’s lowest. I did praise Stanford in the past for avoiding the Dean’s Lie in my original blog post.  They just could not avoid it this year, courtesy of Dean Charles Prober, MD:

It was also somewhat unique in that almost half matched in an area of general medicine — pediatrics, general surgery, OB/GYN …

Wandering back to the state where I received my undergraduate, graduate school, and medical education: Pennsylvania.

Temple made no mention of primary care production.  Primary care was nowhere to be found at UPenn Medicine.  Penn State knew better.  Jefferson did not release any information. It is probably better that way.

University of Pittsburgh: 50 of 142 students matched into primary care fields.  Did they mean Heinz Field or the primary care workforce?

Last, but not least, is my alma mater!  How could I forget about you?  My bank account receives monthly reminders.

Drexel University College of Medicine informs CBS Philly that 39 percent of its 260 graduates matched to residencies in primary care!  I can tell you from those that matched “primary care” two years ago, a majority are not going to end up in primary care.  They also did not mention how many matched into family medicine.

Articles/blogs/schools that get the data?

Harvard: Always looking to set the example, including lack of primary care workforce production.  We are also still waiting for that Harvard Family Medicine Department.

“HMS no longer calculates the number of students going into primary care because it is impossible to determine how many of those who go into internal medicine will eventually go into primary care versus specialty care.”

So what does this all boil down to?

According to the AAFP, it is much more accurate to analyze medical school graduate statistics from at least five years ago.  This takes into account the number of residents that do not enter fellowship training after they complete their three or four year residency program.

In an effort to properly educate the general public who do not understand the Dean’s Lie, I have initiated an effort to reach out to the various media outlets that are publishing false data with this message:

Your story is misleading, false, and contains fraudulent information provided by medical schools. Also known as “the Dean’s Lie,” only about 20-25% of internal medicine residents remain in primary care (this is from the American College of Physicians, confirmed by a JAMA study 2012;308(21):2241-2247, down from over 50% in 1998). Internal medicine residencies should not be considered primary care residencies if an overwhelming majority do not practice primary care. Moreover, for a more accurate measurement of primary care workforce production, the percent reported that match into primary care should be based on looking at match data from 5 years ago (2 years after residency training). When looking at this data, the overall primary care workforce is trending towards and below 30%, much lower than COGME’s recommended 40+ percent primary care workforce.

Is it my personal mission to taint the mirage painted by medical schools?  Perhaps.

At some point the truth must come forward.  Hopefully a major media outlet will educate the public rather than continue to publish erroneous data while glorifying institutions that minimally provide solutions to primary care workforce production.

Kevin Bernstein is co-founder of Future of Family Medicine.

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  • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

    If the nation truly wants more primary care doctors then it would pay for the medical education of any physician who post training goes into a primary care practice and stays there practicing for at least 15 years. Raising the pay scale and providing some tort reform might help as well but simply picking up the $200-$250K price tag of a medical education would go a long way to convincing students to stay in primary care

    • buzzkillersmith

      Not really. Sub-specialists blow by that 200-250k in few years. Loan repayment would help only a little. Med students can do arithmetic, Dr. R. And tort reform is a red herring.

      Double PCP salaries or America and the med students got nothing to talk about. It’s the money.

      • ProudOkie

        I have to agree with Dr. Buzz….they need more money.

        • http://www.facebook.com/people/Jason-Simpson/100001631757606 Jason Simpson

          Yes and I suppose you think you should be getting paid the same amount as a doctor.

          Let me ask you this — why would I pay $50 copay to see a nurse when I can see a real doctor instead?

          Nurses are only worth seeing if they are CHEAPER than the doctors are. Otherwise, why should I pay the same amount?

      • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

        I agree with raising the pay scale for primary care but if the PCP rates remain below specialty pay you need additional incentives to get students to enter and remain in primary care.

    • http://www.facebook.com/shirie.leng Shirie Leng

      I’m with you Steven – money does the talking every time. If you want primary docs, you gotta pay them. My $200,000 student load did a lot more talking than my medical school dean did.

  • Adriana

    The taxpayer already largely pays for medical residencies, including all those specialist, non-PC ones which form the bulk of post-graduate training – given the recent numbers. Why should they pay for more? Nothing would reduce the cost of education and medicine more than ending private profit & public subsidization of the costs. Get the government out of insurance and education and let’s see how fast costs in both industries get a reality check.

    • ProudOkie

      This is true as well. It seems that the production of more family physicians and the free market are diametrically opposed? On one hand one needs a decent return on their investment…on the other hand the consumer wants the best value for their dollar and many consumers feel they have paid enough…..the proverbial hard spot.

  • Matthew Mintz

    Keep up the good work. The other “lie” is from the NRMP themselves and the media outlets that pick this up. They increased number of students filling true primary care spots with an increased interest in primary care. The reality is that though there are few more spots available in primary care fields, there are many more students (due to new medical schools). What the stats don’t look at is the proportion of students choosing primary care fields. My blog post on this compares that last three years worth up data.

    http://drmintz.blogspot.com/2013/03/residency-match-results-bad-for-primary.html

    What the data shows is that our US seniors ARE NOT choosing primary care as a career, and if anything, are choosing primary care slightly less than previously, and certainly not more.

    • buzzkillersmith

      I went to your blog. Surgical PAs earn more than PCPs? That’s a kick in the gut. Where did you get that info? Thanks.

      • Matthew Mintz

        Not tons of data out there. Here’s one site that shows PA’s in lucrative specialties can make in the $110K’s and higher. Some family physicians don’t make that much!
        http://www.physicianassistant.cc/physician-assistant-salary/physician-assistant-salary

        • buzzkillersmith

          I saw the salaries. Ouch. I wish I could explain to myself what temporary burst of insanity/stupidlity caused me to choose family medicine.

  • http://twitter.com/DiNovia DiNovia

    I am confused. Your article seems paint statistical data regarding residents entering into a specific sub-type of medical residency (primary-care-related) as a lie regarding the numbers of physicians and providers who eventually practice in a primary-care-related field.

    Schools who report a percentage of graduates who match into a particular residency program cannot be held responsible for residents who are lured away from that career path and practice elsewhere. The data they report is only one view of the landscape and anyone with any problem solving skill whatsoever should know to look at the data at the other end of the spectrum–what specialty those residents end up in after graduation–as the other important view.

    Should the programs incorporate language such as “potential”, “probable”, or “pursue”? Possibly. However, they might simply be reporting their data as it is applied or as it has been requested: the number of graduates matching into a particular program.

    Everyone knows that every major has this problem. How many people who major in theater, education, or French Modernism end up in careers having to do with their major?

    Now, if you can quote statistics from each university noting both the number of medical school graduates who match with primary care residencies and the number of residents who are still practicing in primary-care-related fields 5 years after graduation, you will have the left-most and the right-most frame of the panoramic view.

    In my opinion, it is the middle portion of the landscape–the part we cannot yet see–that is the most important.

    What is luring these residents away from primary care fields? What can we do about it?

    • southerndoc1

      “What is luring these residents away from primary care fields? What can we do about it?”
      We’ve known for thirty years exactly what is luring them away, and we’re still doing absolutely nothing about it.

  • FSUgrad

    I’d like to chime in here as a 4th year Florida State student who just matched into Family Medicine. I was surprised to see FSU being among the list of schools bashed on here. Of the 113 students matching at FSU, the field with the most matched was Family Medicine. We had 21 students match FM, or 19% of the class. This is a record for our school. If we’re going to infer that many IM graduates will sub-specialize, which is fair, then we must look to FM as the true primary care representative for a school. Therefore I think FSU is shining brightly compared to other schools and accomplishing its mission as primary care focused. Although I’m sure we would like our FM number to be higher than 19% to fulfill the massive primary care shortage, FSU is definitely on the right track and its community-based curriculum should be commended.

    • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

      Congratulations on your matchand your accomplishments to date ! . The state needs you. Whether you stay in general family medicine or specialize as you move towards completion of your residency is to be determined. What is clear is that unless you practice in an extremely rural area you will not be delivering babies or performing inpatient surgery. You will be economically credentialled out of it or medical legally credentialed out of it. You will be practicing general medicine with some pediatrics and gynecology thrown in. You will find that devoting time to your patients and thinking and researching is not compensated sufficiently to cover your loan repayments and living expenses and you will look for additional sources of income. This is the plight of the well meaning and well trained generalist. If your educational expenses were covered you would be far more likely to stay in general practice.