Citizen Staff Writer
It’s a choice fewer young doctors make.
When they recite the Hippocratic Oath on Friday, University of Arizona College of Medicine graduates Erica Lindsey and Nathaniel Rial will pursue residencies as primary care physicians. Generalists in an industry dominated by specialists, primary care doctors make hundreds of thousands of dollars less than cardiologists or neurosurgeons and work less-than-predictable hours.
Rial will remain in Tucson, beginning a three-year residency in internal medicine that will have him seeing patients at University Medical Center, Tucson Medical Center and the Southern Arizona VA Health Care System.
He spent his last week as a medical student studying for exams and working in a lab at the Arizona Cancer Center.
This summer, Lindsey will begin a three-year residency in primary care at St. Joseph’s Hospital and Medical Center in Phoenix. She spent much of the past two weeks moving into a new place.
The pair will gut out long hours, which, in the end, probably will reduce their salaries to “a little more than minimum wage,” Lindsey joked.
In recent interviews, both of the doctors-to-be said they entered primary care to fill a need.
Nearly half of the 124 students who will graduate from the UA medical school on Friday will remain in Arizona for at least the next three years, as they complete residencies at hospitals throughout the state. More than a third of the class of 2009 will go into primary care.
These are not insignificant numbers given the state’s overall shortage of doctors.
Arizona has 214 physicians per 100,000 patients, a ratio well below the national average of 250 doctors per 100,000 patients. A 2007 study by the Association of American Medical Colleges ranked Arizona 33rd out of 50 states based on that doctor-to-patient ratio.
The state’s ranking drops to 39th when the focus shifts to primary care.
In 2007, the latest data available, Arizona had 4,719 primary care physicians, a ratio of about 77 per 100,000 patients. Nationwide, the number of primary care physicians per 100,000 patients stood at 88 in 2007.
“We have more of a shortage than is found nationally,” said T. Philip Malan Jr., vice dean for academic affairs at the UA medical college. “I like it when our students go into primary care.”
As an area of practice, primary care requires physicians to do a little of everything – pediatrics, family and internal medicine, general surgery and obstetrics and gynecology.
No one can predict how many of the 43 UA medical school graduates will remain in primary care after completing their residencies.
A 2008 report by the Council on Medical Education found that 55 percent of the nation’s internal medicine residents in 2006 chose to enter a subspecialty the following year. Nearly 40 percent of pediatric residents chose to specialize as well.
A residency in primary care or internal medicine constitutes a “gateway” to specialty practices, Rial said.
He has yet to decide whether he will remain in primary care after completing his residency. Because the tuition at UA – around $18,000 a year – remains cheaper than at two-thirds of the nation’s medical schools, Rial said he has the “flexibility” to weigh his options.
“I think another way to look at why so few are going into (primary care), so many are following other pathways, is for lifestyle or quality-of-life issues,” Rial suggested.
The Council on Medical Education report found that nearly three-quarters of medical school graduates “reported that lifestyle had a strong influence on their choice” of specialty.
Mounting debt also factors heavily in medical students’ after-graduation decisions, according to the study. The average U.S. medical student had about $127,000 in debt in 2007, up 43 percent from 2000.
“You have a house in your brain by the time you’re done,” Lindsey said of the cost to complete four years of medical school.
The debt graduates must repay likely forces many of them into more lucrative specialties, she said..
“We don’t compensate (primary care doctors) well,” said Steve Nash, executive director of the Pima County Medical Society.
According to the U.S. Bureau of Labor Statistics, a family or general practitioner in Tucson can earn an average of $148,030 annually. Doctors in other specialties earn on average $52,000 more per year.
“One can live pretty well as a doctor in any specialty,” Malan said. “A student has to have a passion for primary care.”
The 43 UA graduates headed into primary care this year represent 35 percent of the graduating class.
“That’s about average for us,” Malan said.
It’s about twice the average in Pima County.
Of the 2,800 or so physicians practicing in PIma County, about 500 – 18 percent of them – focus on primary care, according to Nash. That’s about 50 primary care doctors per 100,000 patients, or 38 below the national average.
In rural or impoverished areas, like the Navajo reservation where Lindsey grew up, the average can be much worse.
“There’s a big need for primary care doctors,” Lindsey said. “It’s kind of always been the focus for me.”
Because Rial and Lindsey will remain in Arizona for their residencies, they are more likely to stay in the state afterward.
Arizona ranks 12th in the nation based on the number of its doctors who studied and completed residencies in the state, according to the Association of American Medical Colleges.
The UA medical school hopes to incrementally increase the number of doctors it trains annually, Malan said, by increasing its enrollment to 115 students per year, up from 110. “It’s all about training more physicians,” he said.
It’s long been a rule of thumb in medical circles that a doctor stays where he or she trains.
Lindsey said there’s a simple reason for that: life.
“You’re almost 30, you have a family or are thinking about starting one,” she said. “You’ve got relationships with the doctors you’ve worked with.”
Rial and his wife moved to Tucson 12 years ago.
“We’ll be here at least three more years,” he said.
BY THE NUMBERS
The University of Arizona College of Medicine will confer doctor of medicine degrees during a ceremony on Friday. The 2009 class includes:
• 124 graduates
• 66 women
• 58 men
• 17 Hispanics
• 2 Native Americans
• 61 who will remain in Arizona for their residencies
• 43 who will go into primary care
Source: University of Arizona College of Medicine
Convocations and graduation
The University of Arizona’s colleges and schools began holding convocation ceremonies Wednesday. The College of Medicine convocation for candidates for a degree in medicine, will be at 5 p.m. Friday at Centennial Hall.
The campuswide commencement ceremony is 8 a.m. Saturday at McKale Center.
The following are the remaining school and college ceremonies scheduled for this weekend.
Eller College of Management, undergraduates, 1 p.m. at McKale Center
College of Nursing, 1 p.m. at Centennial Hall
College of Social and Behavioral Sciences, 2 p.m. at Tucson Convention Center arena
University College, 3 p.m. at Integrated Learning Center
College of Optical Sciences, 5 p.m. at Integrated Learning Center 130
College of Agriculture and Life Sciences, 11 a.m. at Centennial Hall
College of Architecture and Landscape Architecture, 11 a.m. at Crowder Hall
College of Medicine, physiology undergraduates, 11 a.m. at Student Union Memorial Center
College of Law, 2 p.m. at Centennial Hall
Eller College of Management, graduate students, 5 p.m. at Centennial Hall
For more information on each college convocation, visit commencement.arizona.edu/collegeconvocations