Medical Students

Thursday, May 19, 2011 // Uncategorized

My patients are usually receptive to having medical students in the office.  The students seem to enjoy the experience.  Whether these rotations encourage students to go into Internal Medicine is unknown.  The following article from The ACP Observer suggests that it does not. Sigh.

Students enjoy internal medicine as a clerkship, not a career
Medical students enjoy their internal medicine clerkships but are less
likely than ever to become general internists, citing educational
debt, perceived workloads and stress as disincentives, according to a
comparison of students in 1990 and 2007.

Researchers compared results from two similar national surveys of
senior medical students from 1990 and 2007 that asked about their
clerkship experiences and perceptions of internal medicine careers.
Results appeared in the April 25 Archives of Internal Medicine.

The two surveys included 1,244 students at 16 schools in 1990
(response rate, 75%) and 1,177 students at 11 schools in 2007 (82%).
More students in 2007 reported high satisfaction with their internal
medicine clerkships (78% vs. 38%, P<0.001) and more students in 2007
than in 1990 (58% vs. 42%, P<0.001) felt that opportunities for
meaningful work in internal medicine were greater than in other

However, while similar numbers of students planned internal medicine
careers in the two survey years (23% vs. 24%), the percentage
intending to go into general internal medicine dropped from 9% to 2%

Students in 2007 were less likely than their 1990 counterparts to say that:

the appeal of primary care attracted them to internal medicine (33%
vs. 57%, P<0.001)
they were attracted to internal medicine by their outpatient rotation
(31% vs. 35%, P<0.001), and
their overall internal medicine clerkship made a career in general
internal medicine more attractive (19% vs. 24%, P<0.001).
But they were more likely in 2007 to say their clerkship made a career
in subspecialty internal medicine more attractive (49% vs. 35%,

Educational loans were a deterrent for more students in 2007 (26% vs.
16%, P<0.001). For the class of 2009, average total educational debt
was $132,000 ($158,000 for the 86% of students with debt), and one in
four students owed more than $200,000. Meanwhile, the income gap
between primary care and subspecialist physicians has grown to nearly
threefold, or $3.5 million during a 40-year career, the study authors

“Bolder payment and practice reform will be required to reduce the
remuneration gap between primary care and subspecialty physicians and
to address the adverse work conditions in general internal medicine
that students identify in clerkships,” the authors wrote. Such
policies might include:

expanding scholarships and loans,
addressing work-life balance through new and more satisfying practice
models, and
slowing the “treadmill” pace by replacing fee-for-service reimbursement.

On a positive note, I received an email from a fourth year medical student who had spent a month in the practice last year.  He matched in an Internal Medicine residency at the UTHSCSA.


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