Think of the NBA Draft, but then replace all those burly basketball players with fourth-year medical students.
That's Match Day, one of the biggest days in a med student's life. Students wait anxiously to collect an envelope with a piece of paper that says which medical residency they've been "matched to." Match Day was last Friday, and for medical students across the country, the day was a mix of excitement and dread.
"I'm about to throw up right now," said Andy Gausepohl, a fourth-year student at USC's Keck Medical School and a former distance runner on the Trojan track team. "I think I slept maybe two hours last night."
Gausepohl wasn't alone.
"I'm a little nervous," said Veronica Ramirez, one of his classmates, with a halfhearted laugh. "I didn't get much sleep last night, just thinking about the moment when we all open that envelope and find out where we're going to be going for the next three-plus years."
Match Day is a major turning point in the lives of med students that often sets the course for their career. After grinding through medical school, students practice medicine under the supervision of a licensed doctor for up to seven years, depending on the field. That residency period will make them eligible to become board-certified full-fledged doctors.
“I'm staying at USC," said Ramirez as she opened her envelope. "I'm staying at my home institution. I'm very excited. It was one of my top five, so I'm very happy to be continuing as a Trojan here.”
USC wasn’t her first choice – she really wanted UCSF Medical Center. But Ramirez said she's still happy with her match.
She's planning to go into primary care—a decision motivated in part by a brief stint as a volunteer at a health fair in downtown Los Angeles. Ramirez gave foot exams to diabetic patients, and the experience stayed with her in a powerful way.
"It was shocking to me see how with a lot of diabetic patients, their care was solely dependent on these health fairs," she said. "As someone interested in primary care, it just represented how critical of a role primary care [plays] in adequately caring for these patients and their chronic disease. It fed my hunger to want to go into community medicine and primary care, so I'm really excited to nurture that interest in this next step of my career.”
Demand for people like Ramirez is already high, and it’s growing fast. Starting next year, the federal Affordable Care Act will increase the patient population in two big ways: Everyone will be required to buy health insurance at statewide marketplaces, and Medi-Cal—the state's federally-funded health program for the poor—will expand to more than 1 million Californians. That’s expected to lead to a swell in demand for doctors, especially those who work in primary care.
“I'm very excited that President Obama is putting so much emphasis on primary care, and is acknowledging the importance of primary care in shifting the paradigm of health provision in this country from solely treatment-based to preventive medicine," said Ramirez.
That shift that Ramirez mentions will be a slow one. At UMMA Community Clinic in South Los Angeles, the shortage of primary care providers is evident.
Susana Salazar, who works the front desk, regularly tells prospective patients that the clinic isn't in a position to take new patients who don't have health insurance.
"We never have empty appointments," she said. "Everything's always filled. Every day.”
In UMMA’s part of town, surveys by the Department of Health and Human Services' Health Resources and Services Administration indicate there’s only one primary care doctor for every 3,900 patients. That's part of a nationwide primary care doctor shortage. A recent congressional report said the U.S. is currently short about 16,000 primary care doctors; by 2025, the shortage is expected to grow to 52,000.
Despite the need, medical students know primary care won't make anybody rich.
"I have friends who have hit half a million dollars in student loans just from undergrad and medical school," said Gausepohl.
Medscape's annual compensation survey found that doctors working in the primary care field of family medicine make an average of $158,000 a year, while specialists in radiology, orthopedics and cardiology make nearly double that.
“You're starting to move toward a period in your life where you have to take care of a family, possibly start looking into retirement and just financial stability. Some people have to make those decisions," said Gausepohl. He was matched to an emergency medicine residency at Harbor-UCLA Medical Center.
It should pay him better than primary care. The Medscape survey pegs the average emergency room doctor's annual salary at $237,000.
Ramirez, for her part, knows the challenges that lie ahead. “I just think that all of this that I'm doing is an investment for the betterment of the health of my future patients," she said. "If I would have focused on finances as a primary factor in my career, I would not be happy. And I think I have the best job in the world so I'm excited that I'm going in this for the right reasons.”
This is the last Match Day before the landscape of health care in the U.S. undergoes a dramatic shift. The students will celebrate for now. But soon they'll begin preparing to do their part to meet the country’s massive medical need—one that’s only going to get bigger.