Health and Human Services Secretary Kathleen Sebelius wants health care reform to “usher in a new era for primary care providers,” but a new report warns that increasing numbers of general internists are leaving the field.

A survey conducted by the American College of Physicians (ACP) and the American Board of Internal Medicine (ABIM) found that nine percent of all internists originally certified between 1990 and 1995 are no longer working in general internal medicine or any of its subspecialties. That figure includes both general internists and internal medicine sub-specialists.  When the data for general internists is broken out separately, the portion defecting from the field rises to a whopping 17 percent, compared to only four percent for the sub-specialists.

“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 Wayle Bylsma, Vice President and Chief of Staff for the 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.”  The report notes that the departure of internists from the field exacerbates shortages that result from decreasing numbers of medical students choosing to pursue careers in internal medicine.

The survey results, published in the Journal of Internal Medicine with the title “Where Have All the General Internists Gone?” found significantly more career dissatisfaction among general internists than among internal medicine sub-specialists.  The most likely causes, according to the authors, are a widening income gap between primary care physicians and specialists, increasing demands, growing expectations and accountability for providing high quality care, and the difficulty of obtaining payment for services in a “challenging environment.”

Researchers said the survey results do not conclusively establish that physician dissatisfaction is the reason for the disparate rates of departure for general internists and sub-specialists. According to the study co-author, Rebecca Lipner, Vice President of Psychometrics and Research Analysis for ABIM, another explanation is that “the ‘general’ nature of general internal medicine may give internists more options for careers outside of internal medicine and in ... some non-medical fields.”

To increase and maintain the number of general internists and other primary care physicians, the ACP suggests 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. According to Bylsma, “A sizeable minority of internists – 40 percent – who have left medicine are open to returning.  Changes in the practice environment might entice them back to primary care.”

This entry was written by George O’Brien