With regards to career choice, you are unfortunately right. Most of my classmates will be choosing specialties and subspecialties. In 2005, the graduating class of around 130 from my school graduated TWO (2) students heading into family medicine! TWO! This year, it was 17. In the mid 90s, the school peaked at ~30 graduates heading into family medicine. This is still a lot lower than schools north of the border that graduate 40% family docs.
However, I am also happy to report that I myself have decided to go into family medicine. I like working with a wide variety of patients and I enjoy the broader outlook on a patient’s health. But my choice is also about lifestyle. There are other things besides medicine that I am interested in, and things outside of clinical medicine that I am interested in – like informatics. I think family medicine gives me that flexibility that I need to explore those things.
Yet, your point about the poor economic sense of primary care as a career still strikes fear into my decision. I go to the third most expensive medical school in the US. I am an only child who will have to care for two baby boomer parents. Some of my classmates from combined 8 year programs will graduate with $400,000 of debt. The large economic disadvantage of primary care is too much of a barrier for most sane people. I believe that people who would have been great primary care docs shuffle off into an internal medicine subspecialty or ER because of the pay differences.
The most important thing is that after 3rd year, I’ve found something that I will be very happy doing. But I would be lying if I said money does not more than occasionally cross my mind.