Gen Zers want to be doctors — but only if it makes them rich

Growing up with a cardiologist dad, Anna always knew she wanted to become a doctor. She had watched her father spend decades building trust with his patients so he could care for them, and she wanted to have that kind of impact.

"I went into medical school thinking I'm going to specialize," says Anna, a 27-year-old in her fourth year as a medical student at Georgetown University. "I thought the best and the smartest pick something specific so that they can really master it."

But after completing her third-year rotations, she found she most enjoyed family medicine — where she could focus on caring for patients long term. But at a school that's mostly focused on specialties, her interest wasn't well received.

"People would say, 'Oh, wow, you're such a competitive applicant. You could do anything you want. Why family med?'" says Anna, who asked to use just her first name to avoid professional backlash. "It made me think I wasn't reaching my full potential."

Like Anna, a lot of Gen Zers want to be doctors — a survey last year found a rising interest in healthcare work among high-achieving high school students, and the number of med students has grown by 17% in the past decade. As boomers get older and AI upends white-collar work, this is really good news. The Bureau of Labor Statistics forecasts that we will need far more people working in healthcare over the next decade. And the National Center for Health Workforce Analysis predicts a shortage of about 87,000 family doctors by 2037, a problem exacerbated by an aging doctor workforce and increasing demand for elder care.

But each year, hundreds of medical residencies for primary care programs struggle to find students, and many who enter the field end up abandoning it. Across the medical field, people look down on primary care work — which includes family medicine, internal medicine, pediatrics, OB-GYNs, and geriatrics — because it doesn't pay as well, is an administrative slog, and isn't considered as prestigious as other specialties. There's even a term for the bad-mouthing of primary care: specialty disrespect. Georgetown notes a study that found it could affect up to 80% of students, particularly those considering going into primary care.

That's leaving Americans without enough doctors to go around.

If you type "Match Day" into TikTok, you'll be flooded with clips of anxious young med students in school auditoriums ripping open letters to find out which residency they landed. It's a nerve-racking process, made even more daunting by the fact that everyone gets their results at the same time — together. Through the National Resident Matching Program, med students are interviewed by representatives from residency programs, and both parties rank each other. On Match Day, based on those rankings, the students learn whether they got into their preferred specialty.

Despite being in an honors society, volunteering, joining clubs, and studying day and night, Match Day didn't go as Dr. Erica Ginsburg had hoped. Ginsburg, 27, did not get matched with her top choice for dermatology, a specialty so competitive that about 20% of applicants don't match. "Some people were screaming, crying tears of joy. Me and my friend were crying tears of sadness," she says. As a child, a dermatologist treated her for eczema, and the results gave her confidence. She wanted to do the same for others. Once she got older, she said, she realized that dermatology also "has it good" when it comes to work-life balance.

"I do want to have both, you know, a career and a family," she says.

While students compete for spots in fields like dermatology and surgery, primary care programs go unfilled. After 2024's Match Day, there were over 600 unfilled spots in family medicine, nearly 500 in internal medicine, and 250 in pediatrics. Meanwhile, about 6.3% of applicants — more than 1,200 med students — were left unmatched. (About 900 of them found positions through a subsequent matching program for unmatched students, but that still left hundreds of future doctors without a residency spot and 164 unfilled primary care positions over the past two years.)

It's not surprising that so many people want to avoid primary care. When third-year med students rotate through underresourced primary care practices, they witness how stressed out doctors are. Even those who may have wanted to go into the field sometimes change their minds.

"I've been in situations where they're saying, 'OK, here's a new patient. You've got seven minutes to try to get an intake on who they are, write their notes,'" says Annelise Silva, the president of the American Medical Student Association, who recently graduated from the Boonshoft School of Medicine at Wright State University. "There are family practice clinicians who see upwards of 20 to 30 patients a day." They often spend hours after their appointments writing up clinic notes, she adds.

Dr. Yalda Jabbarpour, a family doctor and director of the Robert Graham Center at the American Academy of Family Physicians, says primary care is the "backbone" of our healthcare system, but the US allocated only $0.05 in 2021 to the field for every dollar spent on healthcare. "Most countries that have a robust primary care system and better health outcomes, longer life expectancy, are closer to double or even triple that," she says. She and other researchers found other wealthy countries spent an average of $0.14 in 2021.

Part of the undervaluing of primary care is structural. Most doctors are paid through the fee-for-service structure — a monetary value is assigned to each service based on the risk and complexity involved. "That system is pretty biased against cognitive specialties and towards procedural specialties," Jabbarpour says. "The specialties where you're taking time to talk to the patient, coordinate their care, think about their complex medical issues, but aren't necessarily doing a procedure on them, are going to be paid less, and that is primary care."

Of course, "tiny violins come out when we're talking about salaries of physicians," she says, adding: "Yes, a cardiologist makes more than a primary care physician. A primary care physician still makes a pretty good salary."

A 2023 Medscape report said family doctors made an average of $255,000 in 2022. That's a far cry from the $619,000 average salary of the highest-paid doctors, plastic surgeons. When you've accumulated over $200,000 in debt to go to medical school, the pull toward a better salary is tough to ignore.

Bias against primary care, like what Anna experienced at Georgetown, can also deter people.

Specialty disrespect was defined by one study as "unwarranted, negative, denigrating, even sarcastic comments made by trainees and physicians about different specialties." It surveyed med students at the University of Washington School of Medicine between 2008 and 2012, and 87.7% of students who matched into family medicine residencies said they had experienced specialty disrespect — a higher percentage than for any other specialty — compared with just under 80% of all respondents. About one-quarter of respondents said the comments had a moderate to strong impact on their choice.

Even among students who wind up in primary care, a good chunk of them don't stay there. In 2021, 37% of all residents started out training in primary care, but after three to five years, only 21% remained practicing it, the Primary Care Scorecard said. Instead, many go on to subspecialize in fields like endocrinology or rheumatology or work in hospitals.

The first doctors most people meet are in primary care. When there aren't enough primary care doctors, diseases aren't caught early and patients have a harder time managing chronic diseases. Already, nearly one in every three Americans lacks reliable access to primary care, the National Association of Community Health Centers found in a data analysis. Researchers from Case Western Reserve University and Academia Sinica estimate that the number of people over 50 with at least one chronic illness will double from 71.5 million in 2020 to 142.6 million by 2050, which would add pressure to an already stressed healthcare workforce.

The impact will be felt most acutely by those in rural communities and people of color — a problem that could get worse if the Trump administration cuts healthcare spending. The House of Representatives passed a budget on February 25 that would cut $880 billion from the House Energy and Commerce Committee, which includes Medicaid, though it hasn't yet been passed into law. Some medical students interested in maternal health are also avoiding states with abortion bans and practicing OB-GYNs in those places are fleeing.

"Patients don't have access to healthcare. It's really hard for them to get in to see their primary care doctor. Because of that, we have higher rates of chronic disease. We have higher mental health burden. We have lower vaccination rates than we've ever had," Jabbarpour says.

Dr. Amol Navathe, a professor of health policy, medicine, and healthcare management at the University of Pennsylvania, says the shortage is also moving patients away from more holistic relationships with a doctor familiar with their needs and into more fragmented care as patients go to urgent care or seek out specialists on their own. "It's not good for patient health," he says. "It's not good for the efficiency of how our resources get used."

To address some of these issues, Jabbarpour says, the US needs to invest in payment models that value primary care more effectively. Some medical systems are already trying this. Navathe has worked with the Hawaii Medical Service Association, a licensee of the Blue Cross Blue Shield Association, to design a system through which physicians are paid a fixed rate per patient and then given additional fees for services like providing vaccines or dermatology. The goals are to help patients get better care and reduce the number of patients doctors need to see to get paid.

The new structure, which started as a pilot project in 2016 and is now in place across the state, has had some success: More people got vaccines and cancer screenings, and there were fewer emergency room visits and hospitalizations for chronic diseases. Navathe says Medicare has tested similar pilot projects but would require approval from Congress to roll them out widely.

Medicare funding for graduate medical schools is another bottleneck. "It's going to these large academic hospitals, which aren't necessarily primary-care-oriented," Jabbarpour says. "Most people are not going to the hospital to get their healthcare."

Some schools are trying to address the shortage: Ginsburg says her medical school at Florida State University enthusiastically promoted going into primary care — resulting in nearly half of her class matching into the field. She was one of only three who went into dermatology. "We had all these people who just really love medicine for underserved populations," she says. "So we had all these clubs, organizations that were really geared towards primary care."

At other schools, addressing the issue of specialty disrespect head-on can make a difference. Georgetown's School of Medicine has launched a campaign to combat the issue, with posters around the school featuring common negative tropes about various specialties and rebuttals to these comments. In a 2020 survey of Georgetown med students, 31% of respondents said derogatory comments affected their career decisions, and 38% said they had disparaged a specialty.

Anna says she understands the instinct more experienced doctors have in wanting to protect students from negative experiences. "You don't want to be naive to the realities of their specialties," she says. But she wishes these topics were brought up in a more neutral way.

"Most people come into medical school with an inherent drive to help people and to want to do good," she says. "When you hear these comments, it pulls you further from your values and doesn't allow you to explore and feel good about what you want to go into."

The next generation of doctors has a lot riding on them. The last thing the medical system — and the government — should be doing is deterring them from their job: keeping Americans healthy.

Manisha Krishnan is an Emmy award-winning journalist who covers healthcare. She is based in Brooklyn.