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    Are Primary Care Doctors a Vanishing Breed?

    Explaining Career Goals

    While the survey did not ask residents to explain their career decisions, West cites two possibilities.

    • Life-work balance. "A major consideration is lifestyle and work-life balance, particularly from younger residents," he says. Some specialists may have more control over their schedule and office hours.
    • Money. "Subspecialists can make twice as much," he says. While a general internist may make about $200,000, West says, citing a 2011 report, specialists such as a cardiologist often make twice that annually.

    Doctor Shortage: Perspectives

    Income is a major factor driving residents to become specialists, says David Battinelli, MD, chief academic officer at North Shore-LIJ Health System in Great Neck, N.Y., and dean of medical education at Hofstra North Shore-LIJ School of Medicine.

    He cites the hours, as well, with schedules for specialists often more predictable. "The general internist by and large takes care of the patient when he is sick, as opposed to when the doctor's office is open," he says.

    Economics is a driver, agrees Martha S. Grayson, MD, senior associate dean for medical education and professor of clinical medicine, Albert Einstein College of Medicine, the Bronx, citing her own research.

    "We found that the students who valued research, prestige, higher income, and better lifestyles were more likely to choose subspecialties for both pediatrics and internal medicine,'' she says.

    Work-life balance is a factor, according to Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges.

    "Students in general are increasingly more likely to choose specialties that allow part-time hours, highly flexible schedules, and don't require significant 'on-call' responsibilities," Mitchell says in a statement.

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