Alexander Sterner writes in an op-ed that no young doctor is entering primary care Internal Medicine. The numbers are this residency program are emblematic of the nationwide trend:

Last year, Rush Presbyterian St. Lukes and Loyola University graduated more than 40 physicians trained in Internal Medicine. None will work as traditional primary care doctors. All but 6 chose to complete several more years of training as cardiologists, gastroenterologists, oncologists or nephrologists.

Of the six who will practice Internal Medicine, three chose to be “Hospitalists,” who deliver care only to hospitalized patients. Three joined “boutique” practices, where they are highly paid to be on 24-hour call for entitled individuals, but do not accept Medicare or private insurance.

This is the first I’ve read where graduating residents are starting to go directly into boutique practices. Normally, established physicians are the ones who make the transition to concierge care. It’s a disturbing that significant money is spent to train these doctors only for them to go to cash-only practices.

Dr. Sterner also takes a jab at universal health coverage:

“Universal Health care” threatens to cause “Universally unavailable Health care” by adding people to the mix, creating competition for appointments, increasing waiting times and shortening visits. Soon, an aged adult will have difficulty getting an appointment with his or her physician of choice.

He predicts a future where mid-levels will take over direct patient care, with doctors only in a supervisory role.