Young doctors still pulled to specialties

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Local,Maryland

BALTIMORE (AP) — Despite nationwide efforts to encourage medical students to pursue primary-care specialties like pediatrics and internal medicine, most University of Maryland School of Medicine graduates are choosing other specialties.

This year, 57 percent of Maryland graduates will begin residencies in non-primary-care fields, the same percentage as last year's graduating class and slightly more than the class of 2012, of which 51 percent chose non-primary-care fields.

Though experts disagree about the scope and severity of the physician shortage, there's broad agreement that the demand for primary-care doctors will skyrocket in coming years, due to about 32 million people becoming insured and needing basic care.

However, that doesn't mean the 91 students in Maryland's class of 2014 who chose to pursue other specialties will be out of work. There's also an expected shortfall of specialists, thanks to the graying U.S. population. As people age, they tend to need more specialty care, experts said.

"The physician shortage is equally serious for specialists as for primary care," said Christiane Mitchell, director of federal affairs and government relations for the Association of American Medical Colleges, which predicts a deficit of more than 90,000 physicians by 2020. "It's a common myth that (the shortfall is) only in primary care."

That's good news for Debra Ravert, who will soon graduate from Maryland and begin a four-year residency in emergency medicine at the Johns Hopkins Hospital.

At a "Match Day" ceremony March 21 at the Hippodrome Theatre, Ravert and her classmates learned where they would continue their training. Of the 164 students in the class, 161 matched with a residency program.

The annual match is organized by the National Resident Matching Program, a computerized system that matches the preferences of applicants with the preferences of residency programs at teaching hospitals across the country.

During the ceremony, which is held on the same day at the same time across the country, each graduate opens an envelope containing the name of the program they will attend.

At Maryland's other medical school, Johns Hopkins University, at least 124 out of 126 students matched. The top five specialties for Hopkins students are: internal medicine, general surgery, pediatrics, anesthesiology and psychiatry.

Several University of Maryland students said their choice of specialty was not primarily influenced by broader trends in health care policy — like the Affordable Care Act's emphasis on primary care — or the availability of residency slots. They simply followed their interests.

At Maryland, emergency medicine was a popular choice, as it has been for the past several years, despite a lot of recent discussion among policy-makers about ways to reduce overutilization of ER services, which are among the most expensive services provided to patients.

Ravert — the mother of six children, who all attended Friday's ceremony — was one of 15 students who matched in an emergency medicine program.

"Everything about it appealed to me," she said. "You get to see a ton of people every shift. You get to help people when they're at their most vulnerable."

Ravert said although she enjoys the "rush of saving lives," she's also looking forward to helping people who arrive in the ER with non-life-threatening ailments and "just need some TLC."

Those are the kinds of visits, though, that health care officials would like to eliminate. It's not cost-effective, experts say, to provide care in the ER if those services could be delivered in another setting, such as an outpatient clinic or a physician's office.

But Ravert is not deterred. She says there's still a long way to go before affordable and accessible alternatives will be available to everyone who needs them. Besides, she said, she has her options open.

"I am certain that, even if the environment doesn't shift, I will change," she said. "As I become more comfortable and more experienced, I'm sure I will want to branch out — whether that's administration or teaching or something else."

Another popular specialty for Maryland graduates was general surgery. Fourteen students, including Heather Lillemoe, were matched with general surgery programs this year, up from eight students last year.

At the March 21 ceremony, Lillemoe, 26, squealed with delight and threw her arms in the air after ripping open her envelope. The Baltimore County native was accepted for a program at Vanderbilt University in Tennessee, her first choice.

"I'm really proud of our class," Lillemoe said after the ceremony. "A lot of my friends got their first choice; it's been a really exciting day — the emotion, the anxiety."

Match Day is a culmination of a months-long, agonizing application process that, for some, does not end as they had hoped. Jon Jaffe, for instance, had his sights set on orthopedics — one of the most competitive specialties — but he didn't match.

Jaffe, 25, will spend the next year training as a general surgery intern at Union Memorial Hospital; he'll reapply to orthopedics residencies for the following year.

"This was not how my plans were drawn up," Jaffe said.

And he's not alone. There are a finite number of residency slots available, despite an increased number of students applying and enrolling in medical schools in Maryland and nationwide, according to AAMC data.

Jaffe and others said when they applied to medical school, they didn't give much thought to the growing competition for residency slots.

"You take it one step at a time," Lillemoe said. "I don't think getting a residency spot was even something I considered when applying to med school, which is kind of funny, considering that is the ultimate goal."

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