EDITORIAL – Residency selection reflects changing medical field

This week, thousands of medical students will receive notification of their residency… This week, thousands of medical students will receive notification of their residency placements, the result of an arduous application process that, for some, involves applying to close to 100 programs.

Medical students are placed into their residencies by the National Resident Matching Program, which uses an algorithm to pair medical students with their top choice programs that also chose them. It’s kind of an online dating service – but with hospitals.

This year, the most selective residency programs are projected to remain consistent with last year, with dermatology and cosmetic surgery programs choosing from the most competitive field of applicants. According to The New York Times, last year only 61 percent of medical students whose first choice was dermatology were placed into those programs, as compared to 98 percent and 99 percent for the fields of internal medicine and family medicine, respectively.

This is certainly a substantive shift from 25 years ago, when the most competitive residency programs were for internal medicine and general surgery, two fields that are now forced to recruit in part from physicians from other countries to fill the gaps left by graduating medical students entering other specialties.

Whether or not one chooses to classify the current shift in interest as a problem, the declining interest in internal medicine and general practice is certainly reflective of the demands of a changing medical field. Many medical specialties require physicians to spend upward of six years in training, only to result in low pay and demanding hours. Internal medicine physicians, who often work at hospitals, are under pressure to meet the demands of the booming health care industry, which encourages physicians to see as many patients as possible, while still maintaining a high level of care.

Dermatologists and plastic surgeons, on the other hand, typically work fewer hours than internists and make more money. Because many work in private practice, they also experience a greater amount of autonomy than physicians working at hospitals.

With medical schools’ best and brightest going into what many perceive as less demanding fields, physicians will be left wondering how to lure motivated and intelligent medical students to pursue less popular fields like family practice. Part of the answer is simple: If the low level of pay is turning the medical field’s best and brightest away from disease-based medicine, health care centers should consider raising the standard for the salaries of internal physicians. Another answer is to allow more students the chance to earn a medical degree. There are simply too few medical schools in the United States, even when selectivity levels at U.S. medical schools are at an all-time high. If more students graduated from American medical schools, hospitals wouldn’t be forced to recruit physicians from other countries to fill vacant positions.

The status of what it means to become a doctor in the United States is not the same as it was 25 years ago. Students enter medical school hoping to cure diseases and leave hoping to inject Botox. And if the medical field doesn’t work to amend this stigma, some of our country’s brightest minds might choose not to enter the medical profession at all.