Low percentage of medical residents plan to practice general internal medicine

Colin P. West, M.D., Ph.D., and Denise M. Dupras, M.D., Ph.D., of Mayo Clinic, Rochester, Minn., conducted a study to evaluate career plans of internal medicine residents.

General internists provide comprehensive and coordinated care for both acute and chronic diseases. General internists are expected to play an increasingly critical role in health care provision as the population ages, the burden of chronic disease grows, and health care reform targets coverage of tens of millions of currently uninsured patients, according to background information in the article. Current medical training models in the United States are unlikely to produce sufficient numbers of general internists and primary care physicians. Differences in general internal medicine (GIM) career plans between internal medicine residency program types and across resident demographics are not well understood.

The researchers used an annual survey linked to the Internal Medicine In-Training Examination taken in October of 2009-2011 to evaluate career plans by training program, sex, and medical school location. Of 67,207 U.S. eligible categorical and primary care internal medicine residents, 57,087 (84.9 percent) completed and returned the survey. Demographic data provided by the National Board of Medical Examiners were available for 52,035 (77.4 percent) of these residents, of whom 51,390 (76.5 percent) responded to all survey items and an additional 645 (1.0 percent) responded to at least 1 survey item. Data were analyzed from the 16,781 third-year residents (32.2 percent) in this sample.

The authors found that a GIM career plan was reported by 3,605 graduating residents (21.5 percent). A total of 562 primary care program (39.6 percent) and 3,043 categorical (19.9 percent) residents reported GIM as their ultimate career plan. Conversely, 10,008 categorical (65.3 percent) and 745 primary care program (52.5 percent) residents reported a subspecialty career plan. GIM career plans were reported more frequently by women than men. U.S. medical graduates were slightly more likely to report GIM career plans than international medical graduates. Within primary care programs, U.S. medical graduates were much more likely to report GIM career plans than international medical graduates.

This study of a large national sample of internal medicine residents confirms that general medicine remains a less common career plan overall than subspecialty medicine. Combined with the fact that only a small minority of medical students express interest in general medicine and primary care careers, the small number of internal medicine residents reporting plans for generalist careers means a very limited number of generalists can be expected to enter practice each year.