Monday, April 4, 2011

The "Dean's Lie" About Medical School Primary Care Production

First, we want to congratulate all students who matched in family medicine!  Welcome to the Family Medicine Revolution!  (#FMRevolution)

We also want to congratulate all students who matched in primary care residencies AND who plan to stay in primary care!  We all need to work together to provide increased access to quality primary care to our future patients.

Over the past few weeks, I have had the pleasure to read summaries of match results from various schools and various national organizations.  Trust us, we are excited about the 11% increase in Family Medicine and the 94% fill rate - the most all time - for Family Medicine!  However, there are many misleading reports flying around from various sources touting their production of primary care.

These misleading reports are what some call "The Dean's Lie".  The Dean's Lie is commonly interpreted as the number of students that medical schools report that enter into residencies that eventually produce general internists, general pediatricians, and family physicians.  This seems like a good thing - though it is quite the contrary.

What is missing?  Consider how many of these future physicians choose to specialize into sub-specialties and never actually practice true primary care.  In many circles, the specialization rates vary between 80-90% for internal medicine and 60 -70% for pediatrics.

Would it be more appropriate for medical schools to publish how many of their graduates from 5 years ago currently contribute to our primary care workforce?  The problem is, most medical schools know about these specialization rates and publishing the results of retrospective graduates would most likely hurt the image of their medical school rather than boost them onto a pedestal.

How about some examples of the Dean's Lie from this year's match results.  Here we go!

Let's assume a 90% specialization rate in internal medicine and a 66% specialization rate in pediatrics (and some rounding).  Also, let's keep in mind that there are some that would consider these specialization rates on the lower side.

Remember, these are predictions according to current specialization rates and from taking into account historical numbers from the Med School Mapper tool. We would be more than happy if the specialization rates were lower and that all of these numbers were wrong!  We want them to be wrong!  Unfortunately, this is the current trend.

Some of these results may be disturbing (and some come from highly ranked schools, whatever that means) - viewer discretion advised.

Harvard’s Match Day stats bear out national trends -- in a good way

42% of 167 seniors into primary care
35 IM (4 primary care), 13 Pediatrics (4 primary care), 3 IM-Peds (1 primary care) and 8 Family Medicine
8 out of 167 = 4.8% Family Medicine
17 out of 167 = 10% Corrected for 32% Dean's Lie

Claim: 43% of 187 seniors into primary care
47 internal medicine (5 primary care), 22 pediatrics (7 primary care), and 11 family medicine
11 out of 187 = 5.9% Family Medicine
23 out of 187 = 12.3 % - Corrected for 31% Dean's Lie

Sixty Percent of Meharry Students Match Into Critically Needed Primary Care Specialties

Claim: 60% of 89 seniors into primary care
Meharry does traditionally well with primary care production and, because of this fact, I am using a lower specialization rate.
17 internal medicine (4 primary care), 16 pediatrics (8 primary care), and 10 family medicine
10 out of 89 = 11% Family Medicine
22 out of 89 = 25% - Corrected for 35% Dean's Lie

UA Match Day: Nearly Half Will Stay in AZ for Residencies
Claim: 43% of 129 seniors into primary care
13 internal medicine (2 primary care), 23 pediatrics (8 primary care), and 20 family medicine
20 out of 129 =  15.5% Family Medicine
30 out of 129 = 23% - Corrected for 20% Dean's Lie

Robert Wood Johnson Medical School Sends 157 New Physicians to Hospitals Nationwide
Claim: 32% of 157 seniors into primary care
33 internal medicine (4 primary care), 11 pediatrics (4 primary care), and 7 "family practice"
7 out of 157 = 4.5% Family Medicine
15 out of 157 = 10%  - Corrected for 22% Dean's Lie

The 2011 Stanford University School of Medicine Match Results
I will give Stanford credit - they don't lie here.  After searching for "primary care" in this article, it is only found once.  Additionally, it is not in regards to their own primary care production.
2 out of 91 = 2% Family Medicine

Does your school participate in the "Dean's Lie"?  We would love to hear your feedback as well as other articles and commentary about the Dean's Lie from other schools that we may have missed.

What will you do to help keep those in primary care?

As a side note - we would like to thank everybody who checked out our blog for our Family Medicine Match Day 2011 Coverage!  It was an exciting day for all US Seniors participating in the NRMP Match and congratulations to all who found their perfect match!


  1. Thank you. This is an important and timely post, pointing out how much the primary care reports from medical schools are inflated. "Why do they inflate them? In Ohio it has to do with money passed through to the medical schools. It may also relate to the competitive nature of institutions of higher learning, but also with the distribution of funding from the Board of Regents. Money, Pride, Money- sound familiar? The Alumni office of every medical school knows all the specialties of the graduates after all training is complete. Your idea of a five year out of training or medical school report is a good one. Honest, accurate reporting of actual medical school specialty production would be a nice change, but it won't happen without legislative leadership. The medical schools aren't up to breaking ranks and risking money. Thanks for the eye opener.

  2. Outstanding post. Specialization in internal medicine is actually 98% based on our study published in JAMA that only 2% students choosing IM would do primary care.
    Also, see my blog post on the inflated numbers coming out of the NRMP themselves. "Trust us, we are excited about the 11% increase in Family Medicine." Even this isn't entirely true.

  3. Another important consideration is the stabilization of residency slots in comparision to the growing medical student population. Residency is competitive, and every year more students go without "matching" due to the simple lack of slots. In a way, this "forces" medical students towards other tracks that they may not otherwise desire.

    Does this movement make the 11% look "as if" more students are suddenly interested in primary care? Or are they just going for it with no other options available?

  4. I agree with the 5 year out of training measure. I think that is what the Graham Center (the AAFP Policy Studies Center in DC) is supporting as well.

    In support of Harvard though (since I am doing a MPH there right now), they have never matched EIGHT students into family medicine from Harvard before and their average proportion over the past 10 years is only 2.14% (vs. 4.8% this year.. double!).

    I also think that despite the "dean's lie," the primary care match rate is actually going up. We are seeing more students going into family medicine as a whole (most of which end up in primary care). Or maybe I am being overly optimistic.

  5. Thanks for this insightful, likely highly accurate assessment of reality of Primary Care on the street. It would be called fraud in any other setting as far as I can see. It's like calling a regular car a hybrid "because some customers will choose to convert this to a hybrid, we count it as hybrid sales." That it continues to go on is a tragedy that will allow vital resources for expanding primary care to be used for things other than primary care. The day of reckoning.....will it happen, when will it happen, how will it happen?
    The true primary care match rate is going I (I agree), but it's going from <10% to nearly 10% of US Grads, not like it was in early 1990's when it was not uncommon to see 25% of grads going into Family Medicine at some schools.

  6. Check out Wayne Myers (former dean and former Office of Rural Health Policy director) about what to ask deans

    and about watch your medical school

    Geographic distribution and primary care are both predominantly about family medicine choice - something that deans and schools are ignoring along with the needs of 200 million people in 30,000 zip codes. These are all zip codes where pop-distributed family practice is 3 times more likely to be found along with being a 3 times greater solution for the elderly, poor, disadvantaged, rural, minority, frontier, Native, CHC...

  7. Reading this one year late, but agree with the content.
    Thanks for your blog!

  8. I am a Family Physician who graduated from the University of Wisconsin Medical School in 1991. A rough calculation of the % who went into primary care: 20 into FP, 15 into Peds (probably 10 in general Peds), 42 into IM ( maybe 2 into primary care IM) out of 138 = approx 23%. This is from a 'state school' that is mandated to produce primary care physicians for that state! I agree with many of my colleagues that until the pay for our specialty relative to others improves - and maybe the ''prestige' level with hospitals / patients as well - we will continue to see this trend - health care reform or no health care reform. Period. Thanks for your article!

  9. On Sunday, the dean of the University of Utah School of Medicine had a cozy sit-down with our local "spokesmodel" news anchor and made several remarks that she knew to be false.

    Lee recently seduced the Utah Legislature into giving the medical school yet another $10 million (on top of the hundreds of millions it already receives) in order, she said, to train more primary care doctors. She implied that the U. is dedicated to resolving the shortage -- which is rapidly becoming a crisis -- especially since Utah is fourth from the bottom nationally in primary care doctors per capita. She ardently made her case for what seemed like a moral as well as a practical cause.

    She referred to this victory during her interview on KUTV Channel 2 in Salt Lake City.

    What she failed to disclose is that the U. is 75th nationally in recruiting students who express a desire to practice primary care.

    Last year, there was NOT ONE TAKER for a scholarship that offered a $5,000 reward to any medical student willing to practice primary care medicine for just three years. That is a shocking indicator of how little interest the U. has inspired in this vital field of medicine.

    Although the need for more primary care doctors has been a critical issue nationally for years, the U. has blithely ignored it.

    The school glamorizes the specialties -- paying professors in those disciplines hundreds of thousands of dollars more than those who teach primary care and family medicine (a professor of orthopedic surgery, for example, was paid $1.3 million in taxpayer funds last year. A professor of family medicine got $125,000).

    Primary care has always been the "stepchild" of the U's medical school, while the glamorous, high-status, high-paid, high-tech specialties are made ever more alluring.

  10. Fantastic post!! Another example of how medical schools are so focused on their public image. It's shameful. Keep up the good work!

  11. It is indeed very appalling to read of such stories concerning supposedly credible authorities who take advantage of their position for their own personal benefits. Who knew a high positioned head of an educational institution could do such an unscrupulous and lowly act. What else can we expect then out of this very unexpected situation? Perhaps medical malpractice might even unfortunately be a common sight in the future. Who would then suffer in the end? Sadly, it is going to be the group of us either existing or future patients. Well, let's just hope that the situation will slowly improve as time passes by and technology gets even more advanced.