Only 2 percent of graduating medical students plan to pursue careers in primary-care internal medicine, according to a study released earlier this month.
Linda Simmons, senior residency coordinator of internal medicine at the UNM School of Medicine, said residents have been changing their area of concentration.
"There is a nationwide downward trend of students choosing to go into internal medicine," she said.
Bob Leverence, chief of general internal medicine at the school, said a majority of students are going into sub-specialty care, such as sports medicine.
"We've seen a gradual (decrease) in the number of medical students going into internal medicine, and also we've seen a reduction in the number of internal medicine residents going into primary care," he said.
Leverence said students may be leaving the field because specialists make more money than primary-care physicians.
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UNM medical students said the decline is partially due to not being compensated for the amount of work they are expected to do.
Katy Flynn-O'Brien said primary-care physicians have it rough.
"Quality of life is worse and pay is less," Flynn-O'Brien said.
Leverence said that's not the main problem.
"I really do believe the primary problem is professional satisfaction in our current health care system," he said. "The clinic system is really archaic. It hasn't changed probably in the last 50 years."
He said patients with chronic medical conditions who go to primary-care physicians get rushed exams and still feel sick afterward.
"Unfortunately, the system has not adapted to (patient) needs, so consequently, it is very unsatisfying for a physician," Leverence said.
He said physicians feel compelled to try to do too many things in a 20-minute visit and know they can't get it all done well.
The solution, he said, would be to allow nurses and medical assistants to participate more in patient care, keeping physicians out of the clerical aspects of serving patients.
"Consequently, doctors spend a lot of their time doing things that don't really need an MD-level decision-making to do it," he said.
Martha Cole McGrew, head of family and community medicine at the school, said some students worry about the depth of knowledge required to go into primary care. She said they may be too intimidated to go into the field.
"Some people would rather focus on one thing than to have a broad knowledge base to be able to treat birth-into-life care," she said.
Leverence said UNMH is a teaching hospital with a large internal medicine residency likely to produce nearly 100 primary-care doctors per year, but he said the health policy problem is still a concerning issue nationwide.
"It's difficult to be innovative when there's not a reimbursement mechanism to allow it to become financially sustainable," he said. "So even here in a teaching institution, if we want to try something novel, new and interesting, it's unlikely to float if there's no reimbursement mechanism from Medicare, Medicaid - the big insurers - to keep it going."
Simmons, the internal medicine residency coordinator, said 30 residents are accepted each year, and 79 residents are now in internal medicine. The school normally caps the program at 75 students, but since more internal medicine doctors are needed, the program was allowed to expand.
