Where Have the Internists Gone?

Joe Cantlupe, May 13, 2010

Their careers began mostly during the George H.W. Bush and Clinton administrations, and the general internists were on their way: All that hard work, all that money spent, and the promise of a lofty career ahead.

And now? Probably having a nice career, but, for many, not as a general internist.

About 17% of general internists who were originally certified in the 1990s have left their practice in mid-career, not necessarily dissatisfied by their careers, but looking for other options as a "stepping stone" for careers outside of internal medicine.

And when they left, they were happier that they did. Compared to internal medicine subspecialists, such as cardiologists or rheumatologists, in which 4% left, the general internists departed in droves.

Those are the findings are in a recent study conducted by the American College of Physicians and the American Board of Internal Medicine and its lead author, Wayne Bylsma, PhD, the ACP Vice President and Chief of Staff. We talked about the findings of the study, and some of its surprises.

The study focused on internists originally certified between 1990 and 1995 who are no longer working in general medicine or one of the subspecialties about a decade after original certification by the ABIM. About 6 % are working in another medical field; less than 1 % left medicine; 1 % retired, and 2 % are temporarily not working but plan to return to the workforce, though not necessarily in internal medicine.

"Where Have All the General Internists Gone?" published recently by the Journal of General Internal Medicine also found that, although most internists are satisfied with their career choice, a significantly lower proportion of general internists (70 %) than internal medicine subspecialists (77 %) were satisfied with their career. More than 3,500 physicians participated in the study.

In the so-that-isn't-very-new category, but worth repeating for context:

Bylsma and the other authors noted that existing research shows that some general internists may be particularly discontent and "more likely" to leave internal medicine as a result of a widening income gap between primary care physicians and many specialists and other factors, such as "increasing demands, growing expectations and accountability for care, and payment based on the ability to perform in a fast moving environment."

"General internists are major providers of primary care to adults in the United States, which faces a shortage of primary care physicians," Bylsma says. The ACP states that the shortage of primary care physicians may reach 46,000 by 2025, "greater than shortages predicted for any other specialty area."

Yes, we've heard that before. But there were some interesting surprises in the survey. Among those surprised were the report writers themselves, Bylsma says.

All the talk about doctors leaving medicine because of dissatisfaction with the job; well, that's only somewhat true, Bylsma says. In fact, the study was inconclusive about whether general internists leave internal medicine in greater proportion than internal medicine subspecialists because they are so unhappy, Bylsma says.

A more likely explanation is that many doctors simply viewed internal medicine as a launching pad for something else in their career, and in fact they thought about that prospect even when they began as internists. The average age of those surveyed was around 50, according to Bylsma.

"Most general internists and IM (internal medicine) subspecialists are satisfied with their career. While general internists are more likely to leave IM and are somewhat less satisfied than subspecialties, they may not have left because they were less satisfied," the study states. "Those who left IM are more satisfied with the current career than those still working in IM, but dissatisfaction with IM may not be the reason they left the field."

Joe Cantlupe Joe Cantlupe is a senior editor with HealthLeaders Media Online.Twitter
Facebook icon
LinkedIn icon
Twitter icon