Internists outline plan to boost interest in their specialty

The American College of Physicians says that to prevent a shortage of general internists, the nation needs a physician work force policy underpinned by a revised payment system and a redesigned education structure.

Speaking April 6 during the group's annual meeting in Philadelphia, ACP leaders revealed detailed plans to make sure Americans have access to quality primary care as the population expands and the percentage of those 65 and older grows.

C. Anderson Hedberg, MD, ACP president, said a shortage of general internists was imminent unless immediate action was taken to shape the supply and distribution of physicians.

Donna Sweet MD, chair of the ACP Board of Regents, said only 13% of first-year medical students were interested in general internal medicine in a recent ACP survey, which could indicate a sharper downturn in internal medicine numbers than previously expected.

Easing student debt would be one way to attract more students, Dr. Sweet said. The ACP wants federal loan repayment programs expanded, new loan programs tied to primary care careers created and loan repayment deferred until after residency.

Steven Weinberger, MD, ACP senior vice president of medical knowledge and publishing, said other educational changes also were in order.

"To attract more students into internal medicine, we need to provide students with the right role models early in medical school," Dr. Weinberger said.

Among other suggested changes that Dr. Weinberger outlined:

• Developing a core team of enthusiastic faculty so students are exposed to strong teachers who enjoy the field.
• Staffing outpatient clinics with well-trained assistants so that students and residents are exposed to well-run, efficient offices.
• Separating resident training in ambulatory and in-hospital settings -- for example, a month in an office, then a month in the hospital, instead of a half-day of clinic each week while caring for hospital patients. The goal is for the needs of hospitalized patients to not compete with outpatients.
• Customizing the last year of the three-year internal medicine residency. For example, a resident who wants to become a hospitalist would focus on inpatient care, while a resident seeking an office-based career would work in a clinic or private practice.

Lastly, the ACP leaders re-emphasized their desire to see the reimbursement system changed.

"If a primary care physician can keep a patient out of the hospital, there's [currently] not a way for those savings to flow back to the doctor," said Robert Doherty, ACP senior vice president of governmental affairs and public policy. "We're looking at reforms to shift the dollars to physicians when the system saves money."