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Where Have All the General Internists Gone?

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ABSTRACT

Background

A shortage of primary care physicians is expected, due in part to decreasing numbers of physicians entering general internal medicine (GIM). Practicing general internists may contribute to the shortage by leaving internal medicine (IM) for other careers in and out of medicine.

Objective

To better understand mid-career attrition in IM.

Design and Participants

Mail survey to a national sample of internists originally certified by the American Board of Internal Medicine in GIM or an IM subspecialty during the years 1990 to 1995.

Main Measures

Self-reported current status as working in IM, working in another medical or non-medical field, not currently working but plan to return, or retired; and career satisfaction.

Key Results

Nine percent of all internists in the 1990–1995 certification cohorts and a significantly larger proportion of general internists (17%) than IM subspecialists [(4%) P < 0.001] had left IM at mid career. A significantly lower proportion of general internists (70%) than IM subspecialists [(77%) (P < 0.008)] were satisfied with their career. The proportion of general internists who had left IM in 2006 (19%) was not significantly different from the 21% who left in 2004 (P = 0.45). The proportion of general internists who left IM was not significantly different in earlier (1990–92; 19%) versus later (1993–95; 15%) certification cohorts (P = 0.15).

Conclusions

About one in six general internists leave IM by mid-career compared to one in 25 IM subspecialists. Although research finds that doctors leave medicine because of dissatisfaction, this study was inconclusive about whether general internists left IM in greater proportion than IM subspecialists for this reason. A more likely explanation is that GIM serves as a stepping stone to careers outside of IM.

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Acknowledgements

The American Board of Internal Medicine Foundation and the American College of Physicians, Inc., funded the study.

Conflict of Interest

The lead author is employed by the American College of Physicians, Inc; other authors are employed by the American Board of Internal Medicine. Both organizations may benefit financially as the number of general internists increases.

Author information

Authors and Affiliations

  1. American College of Physicians, 510 Walnut St. Suite 1700, Philadelphia, PA, 19106, USA

    Wayne H. Bylsma PhD

  2. American Board of Internal Medicine, 510 Walnut St. Suite 1700, Philadelphia, PA, 19106, USA

    Gerald K. Arnold PhD, MPH, Gregory S. Fortna MSEd & Rebecca S. Lipner PhD

Authors
  1. Wayne H. Bylsma PhD
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  2. Gerald K. Arnold PhD, MPH
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  3. Gregory S. Fortna MSEd
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  4. Rebecca S. Lipner PhD
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Corresponding author

Correspondence to Wayne H. Bylsma PhD.

APPENDIX

APPENDIX

Survey Instrument

Respondents described their current status as (a) working in the field of IM or its subspecialties; (b) working in a medical field other than IM or its subspecialties; (c) working in a non-medical field; (d) not currently working but plan to return to IM or its subspecialties; or (e) retired. Respondents currently working but not in IM (b and c above) were asked to write in a response to the question “Why did you leave internal medicine or its subspecialty areas?” and to indicate whether or not they (a) intend to return to IM or its subspecialties, (b) might consider returning, or (c) do not intend to return. Current and past primary employer, principal medical specialty, and number of physicians in practice or primary work setting were assessed with close-ended response options. US region, location of medical school, and gender were obtained from ABIM’s administrative records. Respondents indicated their career satisfaction by answering the question “Thinking very generally about your overall satisfaction with your current career, how satisfied are you right now?” (-2= very dissatisfied; -1= somewhat dissatisfied; 0= neutral; +1= somewhat satisfied; +2= very satisfied).

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Bylsma, W.H., Arnold, G.K., Fortna, G.S. et al. Where Have All the General Internists Gone?. J GEN INTERN MED 25, 1020–1023 (2010). https://doi.org/10.1007/s11606-010-1349-2

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  • DOI: https://doi.org/10.1007/s11606-010-1349-2

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