Medical students match, but there still are gaps

Friday, March 20, 2009 — UNC's 156 fourth-year med students participated in Match Day yesterday.

Everyone got an envelope!

UNC's 156 fourth-year med students participated in Match Day yesterday. That's the frantic, euphoric and butterflies-in-the-stomach-breeding occasion that happens simultaneously -- noon Eastern -- across the country when people who have toiled mightily for four straight years as students learn where they'll mightily toil for another year as interns, then more toiling for two to six years as residents at academic medical centers or affiliated hospitals. One by one, secret envelopes that held their fates were opened. Tears (mostly of joy) were shed. There were shrieks, hugs, several confused babies.

Across the country more than 24,000 students matched. The AAMC breaks down a few of the numbers, and the National Resident Match Program says it's the largest match in history.

UNC School of Medicine associate dean Georgette Dent says Match Day is always an exciting time.

Match Day is also significant this year because it represents something missing from medicine; namely a lack of interest among students in becoming primary care physicians.

The number of students becoming pediatricians, ob/gyns, family and internal medicine practitioners has been declining nationally since 1997, says Dent. These are the specialties that serve on medicine's front line, battling some of the country's most pressing medical problems: chronic diseases such as diabetes, heart disease, obesity.

Just 45% of UNC students matched to primary care programs. That's about the national average. It used to be half or greater.

The Wall Street Journal pointed out yesterday, very clearly, one of the most common deterrents: money. Family medicine docs make, on average, $180k a year and work long, often unpredictable hours. An anesthesiologist has a steadier schedule and earns $400k. About 13% of UNC students are going into anesthesiology.

At UNC we encourage primary care. Students spend two weeks each of their first and second years working in primary care clinics throughout the state. But folks are starting to suggest creative ways to solve this shortage.

One, which Dent would support, is loan forgiveness to residents, once they're working in primary care.

Another, suggested by our dean, Bill Roper, is to mandate a two-year service program for all health-affairs graduates who attend public school in return for a decent salary and loan forgiveness.

The shortage problem is compounded by the aging population and greater need in rural and inner-urban areas -- the folks who haven't had access to physicians aren't getting relief anytime soon. Growing financial burdens make it difficult to expand schools to let more students in. For more, you can read this 2007 report by the North Carolina Institute of Medicine, and stand by for more from Dr. Roper.