Internist attrition a factor in primary care physician shortage

About one in six general internists leaves practice by midcareer, a new study says. Medical organizations offer possible solutions to stem the tide.

By — Posted May 26, 2010

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Even though fewer midcareer general internists are leaving than in past years, more needs to be done to stem those losses and to attract new doctors to the specialty in light of an expected physician shortage, say two organizations.

About one in six general internists leaves practice by the middle of his or her career, according to a study posted online April 29 in the Journal of General Internal Medicine. About one in 25 internal medicine subspecialists leaves by midcareer.

Twenty-one percent of general internists who became certified between 1990 and 1992 left internal medicine, according to 2004 research by the American College of Physicians and the American Board of Internal Medicine. Only 4% of subspecialists left internal medicine.

For the latest study, researchers in 2006 surveyed 2,058 internists who became certified in general internal medicine or its subspecialties between 1990 and 1995. Among general internists, 17% were no longer in internal medicine a decade after their original certification. Four percent of subspecialists left the field. Of the internists who left, some went into another medical field, some quit medicine, and others retired or were temporarily out of medicine (link).

Overall, three in four internists reported being somewhat or very satisfied with their careers. Satisfaction was higher among internal medicine subspecialists (77%) than among general internists (70%).

Researchers said it was not clear whether greater levels of job dissatisfaction led more general internists than subspecialists to leave internal medicine. They said it is more likely that the wide-ranging skills gained in general internal medicine make the specialty a starting point for other medical careers.

Wayne Bylsma, PhD, the study's lead author and ACP vice president and chief of staff, cited more predictable work hours and better scheduling as other reasons that general internists may leave internal medicine for other medical careers.

"If [general internal medicine] was more attractive in and of itself, it might serve as a stepping-stone for fewer people," he said.

If the attrition rate among internists continues, the expected physician shortage is going to grow larger, said ACP President Fred Ralston Jr., MD.

By 2025, the Assn. of American Medical Colleges projects that there will be a nationwide shortage of 46,000 primary care physicians. Contributing to the doctor shortage is the decreasing number of new entrants into general internal medicine, according to the ACP and ABIM.

To help remedy the problem, the ACP recommends making general internal medicine more attractive by bolstering support for primary care training programs, and increasing Medicaid and Medicare reimbursements to primary care physicians. The organization also recommends expanding pilot testing and implementation of patient-centered medical homes.

Dr. Ralston said he views such medical homes as a way to strengthen internal medicine practices, and in turn, make the specialty more attractive to practicing doctors and medical students. For example, he said medical homes will allow a better payment structure, which could cover the costs of electronic medical records.

Bylsma said many factors could have an effect. "Anything that can help change the practice environment by making it more rewarding for doctors ... may make a difference in attracting new doctors and keeping doctors happily working."

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