PHILADELPHIA – A new survey reveals that a significantly lower proportion of general internists are satisfied with their careers than are internal medicine sub-specialists, raising further concerns about the growing shortage of primary care providers.
"Where Have All the General Internists Gone?" published in the Journal of General Internal Medicine, found that 70 percent of general internists are satisfied with their medical career, as opposed to 77 percent of internal medicine sub-specialists. Also, 87 percent of general internists and internal medicine subspecialists who left internal medicine are satisfied with their career, while 74 percent of those still working in internal medicine express satisfaction with their jobs.
The results are troubling, given the shortage of primary care physicians in the United States. Factors contributing to the shortage include decreasing numbers of medical students pursuing careers in general internal medicine and general internists leaving their practices for other careers in and out of medicine.
"General internists are major providers of primary care to adults in the United States," said lead author Wayne Bylsma, vice president and chief of staff at the American College of Physicians. "The research results underscore the importance of increasing the attractiveness of careers in general internal medicine and of retaining those who enter the field."
The survey, conducted by the ACP and the American Board of Internal Medicine, found that 9 percent of all internists originally certified between 1990 and 1995 – including a significantly larger proportion of general internists (17 percent) than internal medicine subspecialists (4 percent) – are no longer working in general internal medicine or one of its subspecialties.
The study authors analyzed responses from a national random sample of 2,058 physicians originally certified by ABIM in general internal medicine or an internal medicine subspecialty from 1990 to 1995.
Existing research reviewed by the authors suggests that general internists may be particularly dissatisfied and more likely to leave internal medicine due to a widening income gap between primary care physicians and many specialists, increasing demands, growing expectations and accountability for providing high quality care or payment based on the ability to perform in a challenging environment.
Although research finds that dissatisfied doctors are particularly likely to leave medicine, the authors were not able to find conclusive evidence that the general internists they studied left internal medicine in greater proportion than sub-specialists for this reason.
"A more likely explanation is that the 'general' nature of general internal medicine may give internists more options for careers outside of internal medicine and in to some non-medical fields," said study co-author Rebecca Lipner, vice president of psychometrics and research analysis at ABIM.
According to Bylsma, increasing support for primary care training programs, increasing Medicaid and Medicare reimbursements to primary care physicians and expanding pilot testing and implementation of patient-centered medical homes could help increase and maintain the number general internists and other primary care physicians.
"A sizeable minority of internists – 40 percent – who have left medicine are open to returning," said Bylsma. "Changes in the practice environment might entice them back to primary care."
