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The Dean's Lie About Medical School Primary Care Production

By Kevin Bernstein, MD, MMS

First, we want to congratulate all students who matched in family medicine! (Editor's note: This article refers to data from the  2011 match.) 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
Claim: 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! 


Kevin Bernstein, MD, MMS is a Family Medicine resident and advocate for all things primary care.  He is the Resident Chairman of the 2012 AAFP National Conference of Family Medicine Residents and Medical Students, member of the AAFP Commission on Education and co-founder of the Future of Family Medicine Blog (link -http://futureoffamilymedicine.blogspot.com).  He is a leading social media contributor for Family Medicine and Navy Medicine. Follow him on Twitter - @BernieMD31 (link - http://twitter.com/berniemd31)

This post originally appeared at Future of Family Medicine.

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Posted by Alex Folkl on Feb 21, 2012 1:58 PM America/New_York
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