Recent reports bemoaning how medical students and residents aren't interested in becoming general internists might have some believing that internal medicine is a dying field. But a look at the numbers tells quite the opposite story.
While general internal medicine in particular may be in a slump, internal medicine in general appears to be thriving. The concern, however, is that there may not be enough generalists to handle the increase in patient load brought about by the expanded coverage called for by the Patient Protection and Affordable Care Act and by the new focus on primary care included in the patient-centered medical home and accountable care organization delivery models.
According to the American College of Physicians (the internal medicine specialty society), general internists specialize in the prevention, detection and treatment of adult illness and are well-trained in the diagnosis of puzzling problems and ongoing care of complicated illnesses. Internal medicine subspecialists focus on a particular organ (such as nephrologists and kidneys), system (such as endocrinologists and glands), or age group (such as geriatricians). Other internal medicine subspecialties listed by the ACP are: adolescent medicine, allergy and immunology, cardiology, gastroenterology, hematology, infectious disease, oncology, rheumatology and sports medicine.
With 133,000 physician, resident and student members, the ACP is the nation's largest medical specialty society. And, based on the 2012 Physician Specialty Data Book, which uses 2010 data, there were 109,048 “active” internists in the nation—more than any other specialty. Not all of those internists, however, were directly active in patient care. The Association of American Medical Colleges says 93,381 of those physicians were practicing, 1,268 were teaching, 1,604 were researching and 12,795 were in administration or some other undesignated professional activity.
Of the subspecialties listed above, the AAMC says gastroenterology had the most active physicians, with 12,852. The AAMC list, however, does not include hospitalists. The Society for Hospital Medicine reports that there are about 34,000 practicing hospitalists. While it isn't required for a physician to be trained in internal medicine to be a hospitalist, most are.
The Accreditation Council for Graduate Medical Education, which evaluates and accredits the nation's 8,887 physician-training programs, says there were 113,142 full- and part-time medical residents for the 2010-11 academic year. Although residency positions have essentially been frozen since 1997, 156 new internal medicine training spots were created last year—but the AAMC is saying that's not nearly enough.
The group projects the nation will be short 45,000 primary-care doctors by 2020, and it has launched a campaign with ads stating, “By the time you notice America's doctor shortage, it will be too late.” The AAMC is calling on Congress to boost funding for residency positions by 15%.