Teaching Hospitals Favor High-Paying Subspecialty Training, Study Shows

FOR IMMEDIATE RELEASE: Monday, February 22, 2010

Contact: Leslie Champlin, American Academy of Family Physicians
800-274-2237, Ext. 5224, lchampli@aafp.org

A carte blanche increase in residency training positions may not necessarily meet the nation’s need for primary care physicians, according to research in the Feb. 22 Archives of Internal Medicine.

That’s because teaching hospitals have increased the number of subspecialty residency training positions and slashed the number of primary care residency training positions over the past 10 years in order to support their financial bottom line, according to the authors of “Does Graduate Medical Education Also Follow Green?”

Nicholas Weida, Larry A. Green visiting scholar at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, and his co-authors launched the study in response to research showing that medical students are flocking to the high income specialties.

“While this is true, our research shows that hospitals are also flocking to the high income specialties, exacerbating the primary care physician shortage problem,” said Weida.

He and his colleagues investigated 10-year growth in residency training programs and physician income. They compared growth or contraction of primary care residency training programs to those of subspecialties that are noted for greater likelihood of driving hospital revenues.

Their findings: Between 1998 and 2008, general internal medicine lost 865 positions first-year positions from production of primary care physicians; Family medicine lost 390 first-year positions; internal medicine subspecialty programs grew by 1,150 and emergency medicine programs grew by 394. Over that same time period, general internal medicine income grew by 2%, family medicine by 4% while dermatology income rose by 40% and emergency medicine by 21%.

“Teaching hospitals have favored higher revenue-generating specialty training over primary care positions,” write Weida and his coauthors. “Expansion of positions in the ‘R.O.A.D.’ disciplines (radiology, orthopedics, anesthesiology, dermatology) and emergency medicine over the last 10 years parallels losses in family medicine, general pediatrics and general internal medicine. General internal medicine positions increasingly serve as channels for revenue-generating subspecialty programs, leaving fewer internal medicine positions dedicated to primary care.”

“Policy makers hoping to realize the superior health outcomes and decreased costs associated with greater access to primary care may find this trend alarming,” Weida continued. “Our findings support the concern … that instead of responding to policy aims to correct shortage in the primary care pipeline, hospitals are instead training to meet hospital goals.”

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The Robert Graham Center for Policy Studies in Family Medicine and Primary Care conducts research and analysis that brings a family practice perspective to health policy deliberations in Washington. Founded in 1999, the center is an independent research unit working under the personnel and financial policies of the American Academy of Family Physicians.

The information and opinions contained in research from the Graham Center do not necessarily reflect the views or policy of the AAFP.

February 22, 2010