Internal medicine a ‘stepping stone’ to other careers

Nine percent of internists board-certified between 1990 and 1995 no longer work in general internal medicine or a subspecialty.

“Where Have All the General Internists Gone?”, a survey published by the Journal of General Internal Medicine and conducted by ACP and the American Board of Internal Medicine (ABIM), also found that:a significantly larger proportion of general internists (17%) than internal medicine subspecialists (4%) left practice at mid-career (P<0.001);although most are satisfied with their career choice, a significantly lower proportion of general internists (70%) than internal medicine subspecialists (77%) were satisfied with their career; andmore general internists and internal medicine subspecialists who left internal medicine are satisfied with their career (87%) than those still working in internal medicine (74%).

Study authors analyzed responses from a national mailed random sample of physicians originally certified by ABIM in general internal medicine or an internal medicine subspecialty. Of 3,583 eligible survey recipients, 2,058 (57%) returned usable responses. The proportion of general internists who had left internal medicine in 2006 (19%) was not significantly different from the 21% who left in 2004 (P=0.45). The proportion of general internists who left internal medicine was not significantly different in earlier (1990-92; 19%) versus later (1993-95; 15%) certification cohorts (P=0.15).

Two factors contributing to the primary care physician shortage include decreasing numbers of medical students pursuing careers in general internal medicine and general internists leaving their practices for other careers in and out of medicine. Existing research reviewed by the authors suggests that general internists may be particularly discontent and more likely to leave internal medicine due to a widening income gap between primary care physicians and many subspecialists, increasing demands, growing expectations and accountability for providing high-quality care, and payment based on the ability to perform in a challenging environment.

Authors made no conclusions that general internists left internal medicine in greater proportion than subspecialists because they were dissatisfied. Instead, internal medicine's general nature provides more career options in and outside of medicine. Authors suggested increasing support for primary care training programs, increasing Medicaid and Medicare reimbursements to primary care physicians, and expanding pilot testing and start-ups of patient-centered medical homes.