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The Daily Tar Heel

Doctor shortage increases

State faces trend of fewer primary care doctors

Jim Bedford has been studying at UNC for more than eight years.

Now a fourth-year medical student, Bedford, who specializes in psychiatry, recently learned he would be completing his residency somewhere he is desperately needed — right at home.

For years, North Carolina has struggled with a shortage of practicing general surgeons, primary care physicians and psychiatrists.

Bedford said that shortage factored into his decision to stay in-state for his residency.

“The area I’m interested in is needed and underserved,” he said.

Of the 148 UNC medical students graduating in 2011, only 53 — about 36 percent — will do their residency in North Carolina.

But it isn’t retention that has officials in the N.C. Health Professionals Data System worried. Rather, it’s the distribution of those who decide to remain in-state.

Erin Fraher, director of the data system, said a growing trend towards specialization while students are in medical school ultimately steers students away from more needed fields, like primary care and general surgery, which are in higher demand as the 2.4 million baby boomers enter retirement.

“Specializing takes students away from services like primary care and general surgery,” she said.

“But if the state is going to invest a lot of money in education we need to know that, in the end, there will be students who choose to stay in-state.”

Of the six studying primary care, only one is staying in North Carolina. And of eight general surgery graduates, four will remain in the state.

“We’re really staring down the barrel of physician shortage — especially in primary care,” said Samuel Cykert, a professor specializing in general medicine.

The overall retention rate is similar to recent years, although it has declined slightly of late. In 2010, 37 percent of medical students stayed in North Carolina. Thirty-nine percent remained in-state the year before.

The process isn’t as simple as just applying to a residency program, however. Medical students apply to residency programs across the nation and then rank them in order of preference.

After the programs ranks their potential candidates, the Office of Student Affairs in the School of Medicine matches students based on mutual preference.

After applying to 26 programs and traveling for interviews, Bedford said he was fortunate enough to get his first choice. He is one of three psychiatry students remaining in state out of eight total. All three of them will continue their studies at UNC.

Though he acknowledges there are underserved areas in need of psychiatrists, Bedford said it’s hard for rural areas to attract medical students after they graduate.

“It’s difficult because the majority of training programs are in urban areas and most physicians continue to practice where they went to medical school,” he said.

Cykert said though there are a lot of factors that play into the state’s shortage of physicians, ultimately lifestyle is the biggest factor.

“Primary care folks are paid substantially less, and the same holds true for psychiatrists,” Cykert said.

“The lifestyle is harder, you’re responsible for after-hours calls and admitting patients to the hospital. The world kind of comes to you.”

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As the doctors responsible for routine check-ups and surgeries, Cykert said primary care physicians are essential to reducing the incidence of preventable diseases such as cancer.

“In a good health system you would have half primary care physicians who focus on preventative care, and half specialists who perform the complicated procedures,” he said.

“In those communities, screening rates go up and deaths from diseases like cancer go down because there’s more of a focus on prevention.”

Cykert added that communication breaks down when patients only see specialists.

Regardless of where he chooses to practice medicine, Bedford said staying at UNC Hospitals was ultimately the best decision for him.

“I decided to go to medical school to help people with autism as best as I could, and I’m looking forward to doing that in residency and eventually in practice,” he said.

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