Survey finds general internists leave practice sooner than subspecialists

A survey conducted by the American College of Physicians (ACP) and the American Board of Internal Medicine (ABIM) 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 about a decade after their original certification by ABIM.

"Where Have All the General Internists Gone?" published by the Journal of General Internal Medicine also found that, although most are satisfied with their career choice, a significantly lower proportion of general internists (70 percent) than internal medicine subspecialists (77 percent) were satisfied with their career. A greater proportion of general internists and internal medicine subspecialists who left internal medicine are satisfied with their career (87 percent) than those still working in internal medicine (74 percent).

"General internists are major providers of primary care to adults in the United States, which faces a shortage of primary care physicians," said lead author Wayne Bylsma, PhD, Vice President and Chief of Staff, ACP. "The research results underscore the importance of increasing the attractiveness of careers in general internal medicine and of retaining those who enter the field."

Two factors contributing to the primary care physician 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. ACP and ABIM undertook the survey to better understand mid-career attrition in internal medicine. 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 discontent 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, and 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 subspecialists for this reason.

"A more likely explanation," said co-author Rebecca Lipner, Vice President of Psychometrics and Research Analysis, ABIM, "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."

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 are ways to increase and maintain the number general internists and other primary care physicians, according to ACP.

"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."