Despite hospital systems and health officials citing the need for more primary care doctors, graduates of U.S. medical schools are becoming less likely to choose a specialization in this field.

According to the 2019 National Resident Matching Program—the nonprofit group that determines where medical students will study in their chosen specialties after graduation—the percentage of primary care positions filled by fourth-year medical students was the lowest on record. The 2019 report shows that of the 8,116 internal medicine positions offered, only 41.5% were filled. Family medicine and pediatrics reflected a similar trend. In fact, according to an analysis of historical Match data, the percentage of U.S.-trained physicians matched into primary care positions has declined since 2011.

Meanwhile, recent data from the American Association of Colleges of Osteopathic Medicine shows that medical colleges granting MD degrees graduate nearly three-quarters of U.S. students moving on to become doctors. The rest graduate from osteopathic schools that grant DO degrees. The five medical schools with the highest percentage of graduates choosing primary care are all osteopathic institutions, according to a 2019 U.S. News & World Report survey.

Physicians trained at foreign institutions, including both U.S. and non-U.S. citizens, accept unfilled primary care residency positions as well. In the 2019 match, 68.9% of foreign-trained physicians went into internal medicine, family medicine and pediatrics.

Despite osteopathic graduates and foreign-trained doctors taking up primary care spots, a primary care physician shortage is still expected. In April 2019, the Association of American Medical Colleges predicted a shortage of between 21,100 and 55,200 primary care physicians by 2032.

Why the decline? One reason may be as simple as higher income. According to a recently published Medscape survey of physicians, the annual salaries of internal medicine practitioners average $243,000—a little over half of what orthopedic physicians bring home. Family medicine and pediatrics reportedly earn even less.

Another deterrent to choosing within the primary care field may be the time primary care physicians spend on paperwork and completing electronic medical records. According to the Medscape data, in 2012, 53 percent of physicians completed approximately 1 to 4 hours of administrative tasks per week. The 2019 report shows that the numbers have risen to 74 percent and about 10 hours per week.

Tellingly, only 62% of internal medicine doctors in the survey said they would choose to go into their specialty again; the lowest percentage on record for all physician specialties surveyed.

—Adapted from “American Medical Students Less Likely To Choose To Become Primary Care Doctors,” by Victoria Knight, Kaiser Health News, July 3, 2019.