Doctors come in all shapes and sizes and embody a variety of specialities. Plastic surgeons, orthopedists, neurologists, cardiologists, pathologists, radiologists, internists, pediatricians, family docs and the list goes on….
Internists, pediatricians, and family physicians have much lower salaries then their surgeon/specialist counterparts.
Unfortunately the double whammy is that many believe those who chose these primary care specialties had lower grades, board scores and would have chosen a higher paying specialty if they had “what it took”. This theory could not be more incorrect.
True, specialties, especially the higher paying ones, are very competitive.
According to the University of Michigan, Medical School
Competitive programs that are the most difficult to match into include:
- Cardiac and Thoracic Surgery
- General Surgery
- Orthopedic Surgery
- Plastic Surgery
- Radiation Oncology
Moderately competitive programs include:
- Emergency Medicine
- Medicine/Pediatrics (combined)
- Obstetrics and Gynecology
Less competitive specialties include:
- Family Medicine
- Internal Medicine
- Physical Medicine and Rehabilitation
To get accepted to a competitive residency program, a medical student must compete with thousands of students for the 3-10 positions that the program may offer. Their board scores, class rank, faculty recommendations, interviews are all taken into account. So logic dictates having high grades in medical school helps those students attain a residency spot in the field of their choosing.
Now, primary care openings in residency are much more abundant than those in other areas of medicine.
But still each residency has x number of positions and they will choose those best suited for their program, whether its a primary care program or one offering anesthesiology training. Strong grades offer a huge advantage to those who compete for their primary care program of choice. And many who choose primary care still rank top in their class.
Surprisingly, despite the less pay, many desire to go into primary care. Excelling in multiple systems of the body and being able to address most medical issues whether its acute, in a child, a pregnant woman etc. is very tempting. When one codes on an airplane or if child injures oneself during a JV football game, having the knowledge and ability to help out in almost any situation is pure gold.
To be able to perform primary care is also no easy task. One must understand all the body systems (circulatory, pulmonary, dermatological, neurological, psychological, etc) and be able to recall and apply this information when a patient leads with “The internet thinks my condition is…..”. Moreover, primary care demands people skills and frequent interactions with not only patients but their families and insurance companies. Makes working all day in an operating room pretty enticing for some. But for those of us who like the communication, stimulation and personalities we come across every day, primary care can be fun and exciting.
Back in my urgent care/emergency room physician days a patient presenting with a “urinary tract infection” was actually feeling poor from a heart attack she had the night before. Another patient who had frequent episodes of “burping the night before”(requesting an anti gas medication) was actually suffering from an inferior MI (heart attack as well). A boy who “fell off a trampoline” and had abdominal pain the next day was actually presenting with acute appendicitis.
No one can become a primary care physician with “poor grades”. It’s near impossible. Moreover if one did have poor grades its unlikely they would graduate medical school in the first place. The level of proficiency one needs to execute good primary care is as high as any other specialty.
And let’s not underestimate the power of instinct. When a patient you’ve never met before comes into your office and “doesn’t look right”, he’s not. Having that spidey sense is crucial for being a great physician.
So getting an “A” in biochemistry, pathology and anatomy is commendable and encouraged when we’re in our first/second of seven years of post graduate training. But its the whole picture that counts when it comes to residency acceptance and more importantly, patient acceptance.