Primary care’s image problem is fueling the physician shortage

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A multi-institutional study led by researchers from Nova Southeastern University’s Dr. Kiran C. Patel College of Allopathic Medicine highlights the enduring perception among medical students that primary care specialties carry less prestige than surgical and other specialty fields — a dynamic that researchers say may be deepening the nation’s primary care shortage.

Published July 25 in Cureus via Modern Medical Educator, the survey of 100 med students across three medical schools in Florida and California found that most respondents rated their top specialty choice as more skilled and more respected in the health care community than primary care.

There have long been concerns that medical students’ career decisions are heavily influenced by perceptions of prestige and income expectations, with primary care often disadvantaged on both counts.

Prestige and income perceptions

Students overwhelmingly viewed their top specialty choice as requiring a higher skill level than primary care and having a better reputation in the health care community. The perception was particularly pronounced among students pursuing specialties like general and vascular surgery.

While income expectations did not dominate decision-making for all students, they did play a significant role.

The median minimum income that students said they would be satisfied with as an attending physician was $250,000 to $300,000. Those interested in primary care specialties — family medicine, internal medicine or pediatrics — tended to be more comfortable with a lower minimum salary than their peers.

“Only 20% [of students] agreed that income was the most important factor when choosing a specialty,” the authors wrote. But “those who desired higher incomes (more than $300,000) expressed lower interest in primary care, were more financially motivated and were less influenced by clinical experiences.”

Early clinical experiences can tip the scale

The survey also found that students satisfied with a lower minimum income were significantly more likely to say that clinical experiences shaped their specialty choice. In total, 73% of students reported that a clinical experience influenced their career decision, suggesting early exposure to primary care could counter perceptions of lower prestige.

“This suggests that interventions should ideally be targeted toward students who are satisfied with a more modest income,” the authors wrote. “Meaningful clinical exposure may outweigh financial motivations in shaping student preferences.”

The authors argue that medical schools can help address the primary care gap by boosting students’ exposure to primary care early and often. Suggested strategies include:

• Incorporating primary care physicians as faculty and mentors.
• Offering longitudinal primary care preceptorships during pre-clerkship years.
• Strengthening community-based clinical rotations, especially in rural and underserved areas.
• Providing bias training to students and faculty to combat negative perceptions of primary care.

“Addressing perceptions of lower prestige may be key to increasing interest in primary care,” the authors wrote. “Students may be more strongly influenced by modifiable factors such as clinical experiences than by financial incentives, suggesting that early exposure to primary care may help alleviate the shortage in this field.”

Why it matters

This study was published as the U.S. faces a significant projected physician shortage — the Association of American Medical Colleges (AAMC) projects a shortage of 86,000 physicians by 2036. The study cites a different model that puts the number upwards of 139,000 physicians by 2030. Primary care is expected to bear the brunt of the gap.

According to Florida’s Health Department, 9.7% of physicians in the state plan to retire in the next five years, with internal medicine and family medicine among the most affected specialties. Nationally, physicians aged 65 or older make up 20% of the clinical physician workforce.

For independent and private practice physicians already grappling with staffing shortages, it’s especially important to reshape perceptions of primary care for the next generation of physicians.