Medical Students’ Changing Views, Career Choice, and Primary Care Payment Reform

The timely research by Schwartz et al¹ describing medical students' views on internal medicine shows some encouraging and very significant changes: compared with 1990, today's medical students are much more satisfied with their internal medicine clerkships and a large percentage can envision internal medicine as a meaningful career. What is less heartening to primary care physicians is that a mere 2% of medical students wish to pursue careers in primary care internal medicine, and one of the main reasons for this is the increasing debt of medical students and the generalist/specialist income gap. This is unfortunate: general internists are doing their job to teach, mentor, and inspire medical students, but students are being primarily influenced not by what we all teach, but by the economics of medicine. This situation brings up the important role of physicians as advocates. The data are clear that unless the current payment structure for primary care physicians is revamped, the trend of fewer students choosing primary care will continue.²