After a slight dip in the 2012 Match, the share of fourth-year U.S. medical students opting for residencies in primary care specialties rose again in 2013. But physician organizations and medical schools warned that rising student interest in primary care is not enough to avert projected physician shortages and does not make up for the lack of graduate medical education slots available due to a cap on federal funding of such residency positions.

The number of U.S. seniors entering primary care residencies fell by less than 1% in 2012 but saw an increase of 5.5% in 2013. A total of 6,327 seniors opted for GME positions in family medicine, internal medicine and pediatrics. Nearly 700 more residency positions of all kinds were offered this year, yet the share of U.S. students choosing primary care still rose by 1.3% to 38.6% in 2013.

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With the start of federally required tracking of industry payments to physicians to begin in August, some of the biggest names in medicine are staking a claim that shining a light on the financial ties between health industry companies and physicians should not discourage relationships that yield beneficial innovations in patient care.

In a statement of principles released March 11, a wide range of trade groups for pharmaceutical companies, device manufacturers, clinical research organizations and medical schools joined with physician organizations representing osteopathic doctors, neurosurgeons and other medical specialties to defend the value of research projects and other relationships among doctors and health industry companies.

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About once a year, a patient or family member will “jump up and just walk out of the room when I mention hospice,” says David Casarett, MD, chief medical officer of the University of Pennsylvania Health System’s hospice program.

“They will say: ‘We came to Penn for the best possible treatment. You were supposed to save Dad’s life, and now you’re giving up on him. How dare you do that to my father!’ ”

Even though such harsh reactions may be the exception, Dr. Casarett says, they are enough to make many doctors uneasy about bringing up hospice — a program that offers at-home nursing care, pain and symptom relief, spiritual counseling and other services but typically requires patients to forgo disease-directed treatments that aim to extend survival time.

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The experience of working in American health care is being drained of joy and meaning amid a rising rate of occupational injuries, episodes of verbal abuse and physical assaults from colleagues, and a seemingly relentless drive to provide more care in less time.

This toxic blend is setting back the effort to improve the quality of care and prevent patient harm, according to a recently published report produced by some of the most distinguished names in the field of patient safety.

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Graduating medical students rate their level of education debt as the least influential factor in their choice of specialty, according to an Assn. of American Medical Colleges survey of nearly of 14,000 students. But others said money is a driver among many of the reasons students named for picking their career path.

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Innovative research on diagnostic mistakes suggests that most misdiagnoses that occur in primary care practice are related to basic elements of the office visit. A new study illustrates how time constraints make it harder for physicians to solve the medical mysteries that confront them.

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When patients make demands about who should care for them based on race or ethnicity, the correct response is to refuse those requests, say experts on health law and medical ethics. With such demands rarely voiced, physician practices ought to make sure all members of the team know how to address them properly.

The issue is in the news after a recent case in Flint, Mich. An African-American nurse, Tonya L. Battle, accused her employer, Hurley Medical Center, of acceding to the demand of a white man that no black health professionals attend to the needs of his infant being cared for in the neonatal intensive care unit.

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There are now 135 tests, procedures and other medical interventions that specialty societies are urging physicians to think twice about before ordering, as part of the American Board of Internal Medicine Foundation’s Choosing Wisely initiative. The items were chosen based on evidence showing they are ineffective or unnecessary.

The campaign, launched with a list of 45 items in April 2012, also is stepping up its efforts to communicate a key message to patients, families and the public — in medicine, sometimes less is more. The widespread view that a physician who denies a test or treatment is offering substandard care puts pressure on doctors to order interventions against their better judgment, say the initiative’s leaders.

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Integrating fall-prevention protocols into scheduled rounds, grouping cognitively impaired patients into so-called safety zones and doing post-fall assessments are some new strategies to reduce the number of falls for hospital patients. The ideas are part of a recently released Agency for Healthcare Research and Quality toolkit aimed at cutting the estimated 700,000 patient falls that happen in hospitals each year.

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