Fewer young doctors are choosing general medicine careers, and current training models are unlikely to produce the generalist workforce needed to treat an aging population with multiple chronic conditions, according to a report in the Journal of the American Medical Association
Researchers from the Mayo Clinic, Rochester, Minn., analyzed data from almost 17,000 third-year internal medicine residents who participated in a survey between 2009 and 2011 and compared their answers on career choice to the answers they gave when they took the survey as first-year residents.
In all, just more than 3,605 of graduating residents were choosing a general internist career, while 10,753 were reporting a subspecialty path. Of those who reported a generalist career plan as first-year residents, only 54.9% were planning to stay on that path by their third year. Among those who had changed career paths, 56.3% were planning a subspecialty career; 36.1% were planning to be hospitalists
; 1.1% were choosing a non-internal medicine career; and 6.5% were undecided.
While the total number of residency positions has not increased significantly since 1997, there were 146 internal-medicine residency positions added in 2012
. However, they warn, "Expanding medical school enrollment or the number of internal medicine residency positions may simply result in more subspecialists." (At last count, the U.S. had 113,142 new doctors in residency training programs
across all specialties.)
"Efforts to revitalize general medicine will be central to any successful strategy to train and retain larger numbers of general internists," the authors wrote. They added: "Reductions in administrative burdens, payment reform, medical education debt management and elements of healthcare reform hold promise for improving general medical practice."
The American College of Physicians, with 133,000 internist, resident and student members, is the largest physician specialty society in the U.S., and it has seen this trend coming
. In 2009, it lamented that as many as 75% of internal medicine residents would go into subspecialties.
According to the Association of American Medical Colleges' 2012 Physician Specialty Data Book (PDF)
, there were 109,048 internists practicing in 2010, which was more than any other specialty. But a 2010 study
, however, found that 9% of internists—including 17% of general internists—were leaving internal medicine mid-career.