CHAPEL HILL - One by one, the fourth-year medical students at UNC-Chapel Hill filed to the front of the auditorium to collect a white envelope that held the key to their future. One by one, they erupted in shrieks of joy or, occasionally, grimaces of disappointment.

Inside each envelope was a single sheet of paper that revealed where each student would spend the next several years training for the medical specialty of their choice.

Diana Hsu, 25, was one of the first students called. With her parents on one side and her fiance, Ray Tan, on the other, Hsu tore open her envelope.

Great news -- Hsu had gotten her first choice, the University of Michigan Medical Center in Ann Arbor, which had accepted her as an anesthesiology resident. It is the same medical center where Tan, a medical student at the University of Michigan, already had snagged an early placement in the urology department. Hsu's family broke into relieved smiles: The couple would be together.

Thousands of similar scenes played out across the nation Thursday as more than 15,000 seniors at U.S. medical schools learned, simultaneously, where they had been accepted as residents. Residency training programs have a limited number of slots, so medical students compete to get their top choice. "Match Day" is the annual public announcement.

Students and their loved ones aren't the only ones intensely interested in who goes where. Public health experts who track the nation's physician supply consider the match an important indicator of which fields will thrive and which may suffer shortages.

North Carolina, which enjoys a relatively robust supply of doctors, is expected to have shortages of primary care physicians, obstetricians, psychiatrists and general surgeons by 2030 if steps aren't taken to increase the supply. Raising enrollment in the state's four medical schools, as well as increasing the number of residency slots available statewide, are two approaches suggested by the N.C. Institute of Medicine, which studies health-care work force issues.

Boosting residency opportunities might be particularly fruitful because doctors often stay in the states where they complete their residencies. About 35 percent of the doctors practicing in North Carolina did their residencies here, according to UNC-CH's Cecil G. Sheps Center for Health Services Research. Only about 27 percent of doctors in the state went to medical school here.

Craving the specialties

Over the past several years, experts have watched with concern as more young doctors have spurned careers in core primary care fields, instead pouring into residencies in dermatology, radiology, anesthesiology and other specialties where hours are manageable and pay is handsome.

The median annual salary for a radiologist was about $400,000 in 2006, according to national salary data.

A pediatrician took home a comparatively meager $150,000.

North Carolina medical schools, which traditionally have more medical graduates choose primary care fields, haven't been immune to the phenomenon. A decade ago, 60 percent of UNC-CH's medical graduates went into primary care; this year just 52 percent did.

Meanwhile, demand for the so-called "lifestyle" specialities remained strong, though there are some signs that interest is leveling off, said Mona Signer, executive director of the National Resident Match Program, the nonprofit organization that runs the match.

Hsu, the UNC-Chapel Hill medical student, said hours and pay were only part of the reason she settled on anesthesiology. The median annual salary for those specialists is about $450,000.

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