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    The 20 worst residency programs for producing primary care physicians

    Last month we brought you the 20 best medical institutions when it comes to producing primary care graduates.

    This month we set our sights a bit lower - OK, a lot lower: The 20 worst residency programs, as ranked by percentage of primary care graduates.

    What immediately jumps out about this list is that some of the best hospitals are the worst, as The Atlantic so aptly phrased it.

    That is to say, the list of the bottom producers of primary care graduates includes some of the most prestigious and highly regarded hospitals in the nation: Cleveland Clinic, Johns Hopkins, Brigham and Women's, Massachusetts General and plenty of high-profile names.

    Once again, the data encapsulates the years from 2006 to 2008, and applies to the 161 institutions with more than 200 graduates during those years. The data was obtained from a recent study in Academic Medicine that discusses the need to hold GME-sponsoring institutions accountable for developing America's future primary care physicians.

    Institution Location Total # of graduates % of graduates in primary care
    161. Washington University St. Louis, MO 1,038 6.4%
    160. Massachusetts General Hospital Boston, MA 848 6.5%
    159. Brigham and Women's Hospital Boston, MA 893 7.7%
    158. Stanford Hospital Palo Alto, CA 781 8.3%
    157. Vanderbilt University Medical Center Nashville, TN 793 8.5%
    156. Temple University Hospital Philadelphia, PA 484 8.5%
    155. Cleveland Clinic Foundation Cleveland, OH 752 8.5%
    154. New York Presbyterian Hospital New York, NY 1,599 8.6%
    153. University of Pennsylvania Health System Philadelphia, PA 898 8.8%
    152. Duke University Hospital Durham, NC 861 8.9%
    151. Johns Hopkins University School of Medicine Baltimore, MD 1,148 9%
    150. Naval Medical Center San Diego, CA 256 9%
    149. University Hospital Inc. Cincinnati, OH 485 9.1%
    148. Beth Israel Deaconess Medical Center Boston, MA 631 9.2%
    147. Ochsner Clinc Foundation New Orleans, LA 215 9.3%
    146. Children's Hospital Boston, MA 423 9.7%
    145. Yale-New Haven Hospital New Haven, CT 865 9.7%
    144. Thomas Jefferson University Hospital Philadelphia, PA 705 9.9%
    143. University of Texas Southwestern Medical School Dallas, TX 1,157 10%
    142. Henry Ford Hospital Detroit, MI 591 10.2%



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    • Anonymous
      When MD's enter residency they select their specialty based on lifestyle expectations of which income is one facet, time off another, etc. If becoming a orthopedist means that you may earn $750,000 per year because you are going to be doing joint replacements at $3000-5000 a pop (and spending the rest of your time on your yacht) vs. the measly $175,000 you would earn as a primary care MD then I would consider the additional training to become the orthopedist. After all, I am not necessarily incurring dept during residency training. I am getting paid. As long as I can discipline myself not to spend too much money I will be fine once I get out of residency. But why should an orthopedist be paid $3000 - 5000 or more for a 2 hour operation or a 3 hour operation($1000 per hour)? That's more than our lawyer friends make and we know what we think of them! If we say, it is because of "risk" then perhaps younger, less experienced orthopedists should get less for a procedure until they have "proven themselves" by performing a threshold number of procedures successfully. Good luck getting that one passed. If insurance companies stop paying exorbitant fees then most likely many specialists will stop participating and attempt to go direct, that is charge patients directly. However, the number of patients able to do so will dwindle and the orthopedists will not be able to sustain their income and will be forced to accept lower reimbursement because "Something is better than nothing." New orthopedists will spring up to replace the satisfied and uncooperative ones and it is unlikely that the quality of the care with go down as it is not the $$ paid for the procedure but rather the technical skill and expertise of the surgeon and the facility that determine better outcomes.
    • Anonymous
      This is indicative of the distorted emphasis placed on specialty training and the payment inequality between specialty care and primary care. It is this inequality that leads the public as well as the medical community to believe that specialty care is more valuable than primary care and as such is deserving of higher payments. Actually long term, the money to be saved is in training primary care doctors better to maintain health and prevent diseases that have high long term costs rather than training highly specialized subspecialists to identify a one-in-a-million diagnosis that no one else seemed to be able to figure out and then allow him to charge and sometimes get many times what a primary care doctor would get paid for the same amount of time. When you think of it in terms RVU's, why should an uncomplicated colonoscopy which takes 10 - 15 minutes of the doctor's time be reimbursed $500(or more), above and beyond the utility fees which go toward buying and maintaining the scopes, ancillary staff, etc. when a 30 minute office visit is $120. I use a lot more brain in a 30 minutes visit organizing and coordinating the care of a complex patient yet get paid a fraction of what a gastroenterologist gets for an uncomplicated colonoscopy that takes less time. What message do you think this sends to the public who put some much emphasis on $$ as the indicator of value. The only way to level the field is to reduce reimbursement for procedures to more reasonable values based on time spent and complexity of the procedure. Once this starts to happen then graduating doctors will think twice about whether or not they want to go into a subspecialty or not. Granted we will always need a few super specialists for the one-in-a-million cases but not the way it is today with one on every corner.
      The "best and brightest" are exactly who we need in primary care. Perhaps these programs should focus more on showing these "best and brightest" how to make primary care a rewarding career,and how to meet the medical needs of our nation.
    • Anonymous
      This is a very misleading article. The programs on this list are the best because the attract the best and brightest minds. Unfortunately, practicing primary care is not as exciting as being a specialist. It is natural that the best and brightest minds will be attracted to the most advanced, high-tech aspects of medicine, and rightfully so. I earned my M.D. at a school on the list and currently practice as a specialist. I could not even imagine being in primary care. I would choose a completely different field of work if I had to be a primary care physician. There are many other bright students at other schools that will enter careers in primary care. I would temper an expectation that the best and brightest amongst doctors would choose to be a primary care physician (although some do). Just my opinion.
      This article has nothing to do with the quality of training. Disappointingly misleading title.

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