Range of jobs available within primary care

I know there are .7 Primary care physicians for every 1 needed. It also seems that even at the best Medical schools in the country internal medicine is the most popular specialization.

I guess I am asking if anyone has a bit of information about the range of primary care careers available for someone who graduates top of their class from a stronger med school, vs someone who just makes it through med school (obviously both are very difficult tasks).


First of all, I am no expert in this. And honestly, I’m not even sure what you mean by a “stronger” medical school; there are so many different factors to take into account if you’re trying to rank med schools.

That said … there are a few different “paths” that I am aware of. Perhaps you are already aware of them, too, I don’t know. I’ll just share what I know, from my personal experiences and own research.

First of all, do you want to specialize beyond general IM? There are nearly two dozen “specialties” in which you can be board certified AFTER you do your residency in IM (you have to do a fellowship and then take another board exam). These specialties include hematology, critical care medicine, infectious disease, medical oncology, etc. Here is a Web site with more information on each of these specialties, from the American Board of Internal Medicine: www.abim.org/specialty/

Of course, if you graduate from a more prestigious university (ie, Ivy League) with higher USMLE scores, for example, you may be more likely to get into a more competitive residency for IM, which means you may be more likely to get into a more competitive fellowship for a specialty after you finish your residency. That means you may be likely to get a more lucrative job once you finish the fellowship. I say “MAY” because you don’t really know. Again, there are a lot of factors involved that make it really hard to predict.

Second, there are the (somewhat) divergent paths of academic medicine and private practice. There are pros and cons to both, in terms of salary, regularity of hours, the opportunity to teach, ability to do research, etc. And of course, you can switch from one to the other if you choose. You don’t have to remain in one for your whole career.

As I said, this is pretty much what I know, partly from my own personal experience (my father is a family practice MD who has MOSTLY been academic medicine, so I’ve grown up around that side of things, although I’ve seen a bit of the private practice experience too). Partly this is gleaned from my own research about IM specialties (there are a couple that I’m interested in).

In the end, I’m guessing that if you finish higher in your med school class, with better test scores, etc., you may have more options in terms of what you want to do, and where you want to go. Hope this helps!

Be aware that what the famous (or infamous) rankings list as “stronger” schools is based on NIH funding dollars as well as some other research items. Thus those schools are primarily major academic research centers, which tend not to be primary care focused in their mission (their mission is typically to produce graduates who want to pursue academic medicine). In medicine, academic medicine means research. One might think that academic medicine means teaching medical students, and academic medical centers do that, but it is researchers who may or may not be interested in having their research interrupted by teaching obligations.

Thus, if true primary care (meaning not subspecializing) is your goal, then look at schools whose mission is to produce primary care physicians. These schools and programs are not usually recognized as “strong” schools in rankings.

Just my two cents. Hope this helps. Good luck!!

If there are only 0.7 primary care physicians for every 1, does it really matter where you are from? You will be in demand, especially in rural areas. Unless ofcourse you are trying to get into medical research. In that case, top of the class from a “stronger” institution will open more doors for you

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It also seems that even at the best Medical schools in the country internal medicine is the most popular specialization.

This is a little misleading. Medical schools tout the number of students going into IM residencies as proof of how many graduates are going into primary care, but it's not really a good indicator. As alluded to above, there are substantial numbers of specialties that require an IM residency. I forget exact numbers, but I think estimates are that of the number of students matching into an IM residency, the number that actually plan to pursue primary care as an IM doc is well less than 50%, maybe even less than 25%. The subspecialties are are usually NOT considered primary care.

As tec mentioned, "rankings" are kind of fuzzy. Over the past few years, USNWR has actually started ranking the best medical schools for producing primary care (NIH funding counts a little less), but even these numbers are skewed because of above.

Don’t forget the family docs! As Emergency! pointed out, the majority of those doing internal medicine residencies actually have their sights set on specialties.

On an average day in my office, I’ll do … newborn and well child exams, sports physicals for teenagers, GYN exams, and geriatric exams. I’ll remove moles, suture lacerations, and freeze off warts. I’ll provide counseling and medical management for psychiatric problems, and manage diabetes, hypertension, and all the other maladies that can afflict someone.

I have had families where I see three generations - grandparents, parents, and new baby. It is FUN when that happens