Primary Care Track or Internal Medicine Categorical: Is a Rose a Rose?
Reading the news or blogs paints a grim portrait of primary care in the United States: time-intensive bureaucratic duties that take away from the doctor-patient relationship; a physician shortage in primary care with few medical students stepping up to fill the need; and high rates of burnout reported among primary care physicians. However, my residency interviews for internal medicine, several of which were for primary care tracks, gave me a very different perspective.
I met program directors who were committed to training the best possible general internists. Residents in these programs were passionate about primary care and dedicated to care for the underserved. And my fellow applicants, who came from a variety of backgrounds and experiences, were excited to begin their training in primary care.
Aside from wanting a strong foundation in internal medicine to practice primary care, I was unsure at the beginning of the application season what characteristics would appeal to me most in internal medicine residencies and primary care tracks. I was cautioned that some programs were primary care tracks in name only and might have just one or two features that distinguish them from categorical programs. However, nearly all of the primary care tracks I saw appeared to offer exceptional training to prepare future physicians to not only adapt to, but also innovate in, our evolving healthcare system. Following my interviews, several aspects of these tracks stood out:
Primary care track highlights
Multiple Ambulatory Clinic Sites: In addition to the resident continuity clinic, a few primary care tracks provide the opportunity to have an additional longitudinal clinic. While many internal medicine residencies have more than one inpatient site, it is nice to have multiple ambulatory sites to gain more experience in outpatient medicine.
Home Visits: Prior to interviewing, the idea of physician home visits conjured up images of a physician’s bag and Fildes’ famous painting The Doctor rather than an important component of modern medical care. A few primary care tracks included house calls to teach residents how to provide primary care to homebound patients. One program had a unique initiative in which residents conduct post-discharge home visits to reinforce education and address any concerns that the patient may have.
Specialty Practice Opportunities: Primary care tracks recognize the breadth of knowledge outside internal medicine that general internists need and include opportunities in important clinical topics in primary care including dermatology, orthopedics, and other specialties.
Other features of these primary care tracks that are appealing include a primary care curriculum addressing clinical topics in primary care, healthcare policy, and underserved care. Besides these features, I was heartened to see that terms and acronyms, such as patient-centered care, PCMH, and ACO, were not just buzzwords but relevant aspects of residency training. Seeing these programs, meeting the people who run them, and talking with residents who train in them made me excited for the future of primary care in the U.S.
Insights on choosing an internal medicine residency
For rising fourth-year medical students, I offer a few insights. First, while I would be thrilled to match to a primary care track at an internal medicine residency, there is excellent training for general internal medicine at categorical programs. It is important to note that some internal medicine residencies do not have a primary care or general internal medicine track, but that does not preclude those programs from training outstanding primary care physicians. While certain aspects of primary care tracks, like a specific didactic curriculum and additional continuity clinics, would be missing, a resident would otherwise receive excellent training to become a general internist.
So I’d advise rising fourth-years to apply widely. Some of the programs that I applied to on a whim turned out to rank among my favorites. Also, don’t limit yourselves solely to residencies with a primary care track – at some of the programs I found strong support for general internal medicine despite the residency not having a primary care track. You never know what you’ll find on the interview trail.
I went into the Match process unsure of what I was looking for in an ideal residency program. I’d been warned that primary care tracks were just categorical programs by another name and that categorical programs themselves weren’t training grounds for future primary care docs. But I was impressed by what I saw in both types of programs, and I believe that I can become a well-trained primary care physician coming from either program. However, I hope that the primary care tracks flourish and help regrow our primary care workforce. I also hope that next year’s applicants, especially those who are undecided on what they hope to pursue within internal medicine, consider applying to primary care tracks. Those applicants just might find that the guiding principles at these tracks resonate with them.