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    Are Medical Schools Biased Against Pediatrics and Primary Care?

    There is a brewing pediatric and other primary care workforce crisis on the horizon.  In a 2013 Policy Statement, the American Academy of Pediatrics warned that “the current pediatrician workforce is not meeting the primary care…needs to provide quality healthcare for US children” (1).  From 2017-2023, the percentage of filled pediatric residency spots remained consistent between 97% and 98%.  However, in 2024, that percentage fell dramatically to 92% (2).  Although the 2025 pediatric match did see an increase in filled spots (95%), it remained below those levels seen from 2017-2023 (3).  Family Medicine has seen a similar trend (4).

    These alarming trends are likely multifactorial: 73% of medical students have a debt load and 31% also had debt from undergraduate studies.  In 2024, the average medical school debt (excluding undergraduate costs) was $235,000 (5)!  The disparity between Medicaid (predominantly children) and Medicare (predominantly adults) payments to providers, along with pediatrics being one of the lowest paid specialties surely play a major role.  A 2024 survey by Weatherby Healthcare reported that pediatricians were the second lowest earning specialty (6).  A recent compensation report noted that “a solid majority of pediatricians believe they are underpaid and are unhappy with their pay” (7).  In addition to these economic factors, is it possible that medical schools share some blame for fewer students entering pediatrics and primary care?

    While most medical schools publicly recognize the importance of primary care, their actions and institutional culture often tell a different story. One study by researchers from the Council on Medical Student Education in Pediatrics (COMSEP) found that almost half of medical students considered pediatrics at one point in their training.  However, the majority chose another specialty (8).   A significant reason for this shift could be the subtle—and sometimes overt—biases students encounter during training.  Medical school education has traditionally been organized in a manner that “prioritizes certain specialties and disciplines” (9).  Academic centers that receive more NIH funding tend to produce fewer graduates entering primary care (10).   There may also be a perceived prestige issue. During my training, I sometimes felt as though specialties like dermatology, radiology, surgery, and orthopedics were often portrayed as more intellectually challenging, hence more respected. Faculty and mentors may unintentionally reinforce this by praising students who pursue competitive specialties while downplaying the value of generalist fields (11). Students may then regard a career in primary care is a “fallback” rather than a first choice.  I recall an experience I had during my 4th year while doing an elective in Pediatric Urology.  I had already made the decision to pursue pediatrics, so I felt an elective in Peds Urology would be valuable.  One day in the OR, the attending urologist asked me what specialty I was going to pursue.  When I told him pediatrics, he remarked “what a waste”.

    What about the pre-clinical curricula?   Studies from COMSEP researchers found that nearly one-third of students felt that their pre-clinical education was poor or fair in preparing them for the pediatric clerkship (12) and that most medical schools had 0-3 hours total in the pre-clinical curriculum addressing pediatric history and physical diagnosis (13).  Another COMSEP study that surveyed 525 medical students from four different schools found that only one of the schools had a pediatric themed lecture in all the second year system-based courses, one had a variable amount, and two had no pediatric themed lectures in each second year system-based course (14) .  Many medical schools have decreased their pediatric clerkship time down to 6 or 8 weeks, while internal medicine and surgery remain at 8.  I also have found that there are fewer pediatricians involved in the pre-clerkship curriculum, fewer pediatricians who serve as mentors and role models for students, and fewer pediatricians who serve in leadership roles such as Vice Chairs of Education.  At a recent COMSEP meeting, Dr. Robin English, Associate Dean of Student Affairs at the LSU Health School of Medicine, remarked that curriculum deans must balance demand for content with a limited number of weeks of curricular time; they cannot then focus on the pediatric or primary care workforce issues.  The Pediatrics 2025 AMSPDC Workforce Initiative challenged educators to change the educational paradigm and focus on attracting diverse trainees into pediatrics (15).  Given the impending workforce crisis, I argue that this is imperative for the longevity of pediatrics that medical schools intentionally work work   to increase the amount of exposure medical students get to Pediatrics.

    So, what do you think?  Am I crazy and just bitter because I am a pediatrician?  Or are medical schools unintentionally biased against pediatrics (and primary care)?  Can (or even should) Medical Schools work to alter the trajectory of the Pediatric (and Primary Care) Workforce Crisis?

    Let’s discuss….

    1. Are medical schools unintentionally biased against pediatrics and primary care? Why or why not?
    2. Can (or should) medical schools actively encourage or incentivize more students to enter pediatrics (or primary care) by offering early and meaningful exposure?
    3. What does your institution do to expose more students to pediatrics (or primary care). If they don’t, what initiatives/efforts could they do?
    4. Do you think initiatives like tuition free medical schools, creation of primary care tracks, or regional campus medical schools can help to increase the number of students entering pediatrics/primary care? Why or why not?

    References

    1. Committee on Pediatric Workforce, Basco, W. T., Rimsza, M. E., Rimsza, M. E., Hotaling, A. J., Sigrest, T. D., & Simon, F. A. (2013). Pediatrician workforce policy statement. Pediatrics, 132(2), 390-397.
    2. https://publications.aap.org/aapnews/news/28441/Pediatrics-fill-rate-dips-during-2024-Match-AAP (accessed June 27, 2025)
    3. https://publications.aap.org/aapnews/news/31676/Pediatrics-marks-milestone-in-2025-Match-with?autologincheck=redirected (accessed June 27, 2025)
    4. Chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.aafp.org/dam/AAFP/documents/medical_education_residency/the_match/AAFP-2024-Match-Results-for-Family-Medicine.pdf?utm_medium=email&utm_source=transaction. (accessed June 27, 2025).
    5. Hanson, Melanie. “Average Medical School Debt” EducationData.org, Updated August 28, 2024.  (accessed June 27, 2025). https://educationdata.org/average-medical-school-debt
    6. https://weatherbyhealthcare.com/blog/pediatrician-salary-2024 (accessed June 27, 2025).
    7. https://www.medscape.com/slideshow/2024-compensation-pediatrician-6017149 (accessed June 27, 2025).
    8.  Azok, J. G., O’Donnell, K. A., Long, M. E., Wang, H. C., Crook, T., Pogemiller, M. I., … & Weinstein, A. R. (2024). Factors influencing medical students’ career choice to pursue pediatrics. The Journal of pediatrics, 265.
    9. Wiedermann, C. J. (2023, June). Revitalizing general practice: the critical role of medical schools in addressing the primary care physician shortage. In Healthcare (Vol. 11, No. 13, p. 1820). MDPI.
    10. Seehusen, D., Raleigh, M., Phillips, J., Prunuske, J., Morley, C., Polverento, M., … & Wendling, A. (2022). Institutional characteristics influencing medical student selection of primary care careers: a narrative review and synthesis. Family medicine, 54(7), 522-530.
    11. Holmes, D., Tumiel-Berhalter, L. M., Zayas, L. E., & Walkins, R. (2008). ” Bashing” of medical specialties: students’ experiences and recommendations. Family medicine, 40(6), 400.
    12. Weinstein, A., MacPherson, P., Schmidt, S., Van Opstal, E., Chou, E., Pogemiller, M., … & Held, M. (2023). Needs assessment for enhancing pediatric clerkship readiness. BMC medical education, 23(1), 188.
    13. Guiot, A. B., Baker, R. C., & Dewitt, T. G. (2013). When and how pediatric history and physical diagnosis are taught in medical school: a survey of pediatric clerkship directors. Hospital Pediatrics, 3(2), 139-143.
    14. Held, M. R., Gibbs, K., Lewin, L. O., & Weinstein, A. R. (2017). Do pre-clinical experiences adequately prepare students for their pediatrics clerkship: a needs assessment to inform curricular development. Medical Science Educator, 27(3), 515-521.
    15. Vinci, R. J., Degnon, L., & Devaskar, S. U. (2021). Pediatrics 2025: the AMSPDC workforce initiative. The Journal of pediatrics, 237, 5-8.

    Author: Chris Peltier, M.D.; Council on Medical Student Education in Pediatrics