Context Trends in career choice among specialties have varied greatly. Most
notable is the recent decrease in the percentage of US medical student graduates
choosing a primary care career, which has important implications for the US
Objective To review temporal trends in career choice by graduates of allopathic
US medical schools, focusing on US medical doctors entering residencies since
Data Sources Three databases, the Association of American Medical Colleges Graduation
Questionnaire (AAMC GQ), the National Resident Matching Program, and the national
Graduate Medical Education census, were used to review temporal trends in
the number of US medical doctors entering residencies in primary care, general
or subspecialty surgical, and non–primary care and nonsurgical specialties
from 1987 to 2002.
Data Synthesis In 1987, 49.2% of all medical school graduates matched to one of the
generalist residencies (internal medicine, pediatrics, or family medicine).
The percentage of students matching to primary care specialties declined in
the early 1990s, peaked at 53.2% in 1998, and declined to 44.2% in 2002. Concurrent
with the latter decline, AAMC GQ data showed a decrease in medical student
interest in primary care careers (35.6% in 1999 to 21.5% in 2002). The total
percentage of US medical doctors matching to general or subspecialty surgical
residencies remained stable at 11% to 12% from 1987 to 2002. During this same
period, emergency medicine and plastic surgery increased as a match choice,
while anesthesiology, pathology, and psychiatry were more variable over time.
Conclusions Distribution of medical students' career choices among specialties varied
considerably from 1987 to 2002. The debate will continue regarding the appropriate
specialty mix within the physician workforce.