Nearing the end of a long educational journey, medical students around the country are graduating this month, and are preparing for the landmark that culminates four years of hard training - their first job as a doctor.
But as students enter the workforce, many have negative views of their future day-to-day work lives as physicians, shown by a multi-school study led by the University of Michigan Health System. Students had an especially grim view of entering primary care - an area facing a looming shortage of doctors as millions of people are newly insured under federal health care laws .
In a study published in Family Medicine
, medical students surveyed at U-M, Brown University and Michigan State University between 2006 and 2008 believed both primary care and specialty physicians had too much administrative work and were harried by the pace of their jobs.
Students were also unsure whether physicians had control over their work schedules, were able to develop good patient relationships or whether they were overwhelmed by patient needs.
"The study indicates students are influenced by experiences before medical school but observing and participating in the work of practicing physicians doesn't seem to change those views," says lead study author Julie Phillips, M.D., M.P.H. Phillips was a U-M resident at the time of the study and is now Lansing Community Clerkship director with MSU's Department of Family Medicine.
"Our learners' negativity about their future work lives reflects a pessimistic culture of medicine," Phillips says. "Some of their views are based on broader cultural messages but some come from what they see.
"Physicians sometimes struggle to meet the high expectations set by patients and their profession with limited time and resources - students are paying attention to that struggle."
The study also offers a glimpse into what makes students choose a career path. Primary care work life was viewed more negatively than that of specialists, reflecting declines in primary care physician satisfaction in recent years.
Students who were surveyed also viewed primary care physicians as being under-compensated and having less control over work hours than specialists.
Surprisingly, students choosing primary care expressed the same negative sentiments about primary care work life as peers pursuing specialty work - suggesting that these students' values, altruism and commitment to primary care outweighed expectations of a difficult work lifestyle, Phillips notes.
In 2010, only 14 percent of medical students nationwide entered family medicine, medicine-pediatrics, primary care internal medicine or primary care pediatrics. The American College of Physicians has predicted a shortage of 35,000 to 44,000 adult primary care physicians by 2025.
"More medical students are choosing specialty care even though it appears the country needs more primary care physicians, so there has been a lot of interest in what impacts medical students' career decisions," says Katherine J. Gold, M.D., M.S.W., M.S., assistant professor of family medicine at the U-M Medical School.
"Student views of primary care are particularly negative and improvements in the work life of primary care physicians may be necessary to attract more students to the primary care workforce."
The U-M Medical School follows a broader definition of primary care than the study by including obstetrics/gynecology, and reports an uptick of students entering these fields over the last two years. Primary care to patients is increasingly being provided by a more diverse set of fields, including those from other health professions, and may be missed in the numbers, notes Rajesh S. Mangrulkar, M.D., associate dean of medical student education.
"Concerns about primary care physician shortages are shared among medical schools around the country and we are constantly working to address this issue," Mangrulkar says. "At U-M specifically, we have seen positive signs in recent years indicating that students are showing more interest in primary care fields than before. The numbers don't always tell the whole story, as the primary care field and views about its attractiveness continue to evolve."