Match day reveals slight increase in IM fill rate.(internal medicine)(Statistical data)

The fill rate for internal medicine positions increased slightly for this year's resident match, but the American College of Physicians remained concerned about what appeared to be a decreased level of interest in general internal medicine.

This year, 4,735 internal medicine residency positions were offered. Of those, 97.9% were filled, with slightly more than half--56.3%--filled by U.S. medical graduates. In 2005, 97.2% of slots were filled, although a slightly higher number of positions were offered (4,768).

"We're not as much concerned about internal medicine overall if you look at all the subspecialties," said Dr. Steven E. Weinberger, senior vice president for medical knowledge and education at the American College of Physicians, in Philadelphia. "The concern is with the number of people going into primary care."

Match Day itself doesn't reveal how many medical students plan to go into internal medicine subspecialties instead of primary care, "in part because a lot of them don't know yet," Dr. Weinberger noted.

But the ACP also gives residents a questionnaire asking about their plans. "In 1998, 54% of graduating residents were choosing to go into general internal medicine. The comparable number for residents graduating in 2005 was only 20%," he said. "With the aging of Baby Boomers who have more complex chronic diseases, it's going to be harder to find people to coordinate their care, so that's going to be a concern."

As for the relatively low number of U.S. graduates choosing internal medicine, Dr. Weinberger said there were two reasons for that. "One is financial: It tends to be procedural-based specialties and subspecialties that have much higher reimbursement rates than primary care," he said. "The so-called cognitive specialties have not been reimbursed as well, which is part of our whole dysfunctional payment system."

Perceived lifestyle issues also play a part. "Medical students are going into things they view as having more regular hours and a better lifestyle," he said. "Some of that is attributed to 'Generation Y' having a different set of values and priorities than an older generation of physicians had. I don't know whether that is truly the case or not, but people do say lifestyle is an issue."