General Internists, An Endangered Species?

Tuesday, December 11, 2012 // Uncategorized

Sigh.  More bad news about residences choices. 

Even many residents in primary care training programs not planning to enter primary care

Most internal medicine residents, even those in primary care residencies, don’t plan to practice general internal medicine, a recent survey found.

U.S. internal medicine residents were surveyed about their career plans while taking the Internal Medicine In-Training Examination (IM-ITE). Data were gathered from more than 57,000 residents who responded to the survey in 2009-2011. About a third of the responses came from third-year residents. Results were published in the Dec. 5 Journal of the American Medical Association.

Overall, 21.5% of the residents reported plans to practice general internal medicine (GIM). Residents in primary care residency programs were more likely to choose GIM than those in categorical internal medicine residency programs (39.6% vs. 19.9%), but a subspecialty career was the most common plan for both groups (52.5% of primary care residents, 65.3% of categorical residents). Among primary care residents, there was a significant difference between the plans of U.S. medical school graduates and international medical graduates (IMGs). More than half (57.3%) of primary care IMGs were planning to subspecialize, compared to only 27.3% of U.S. grads.

The study also found that female residents were more likely than male residents to ever report a plan of a GIM career (26.7% vs. 17.3%) and to stick with that plan over the course of their training (62.4% of women reporting a GIM plan in their first year also reported one in their third year vs. 47.2% of men). The study showed that many residents change their mind about career plans, both for and against GIM, the authors noted.

This is the first study to find that even primary care residents are commonly opting for subspecialty careers, the authors added. Thus, expanding medical school enrollment or primary care residency slots might not significantly increase the supply of GIM physicians. Further investigation of the causes and potential solutions to IMG primary care residents’ lack of interest in GIM may be important, however, since they fill the majority of the residency slots in primary care training programs, the authors said.

An accompanying editorial noted that the field of hospital medicine is an additional contributor to the shortage of general internists in primary care; 9.3% of the third-year residents reported plans to be a hospitalist. The editorial called for protection and realignment of graduate medical education funding.

I would bet that a lack of role models may be a contributing problem.

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