Reasons For Decline in Students

Internists in primary care and subspecialty practice provide a large portion of the chronic care for older and medically complex patients. However, the authors write, the number of students choosing residency training in general internal medicine has declined, and young physicians are leaving general IM. One planning model predicts that the U.S. will have 200,000 too few physicians by 2020.

The researchers conducted a study to understand current students’ impressions and concerns about careers in IM and to identify potentially modifiable factors in their decision making. The researchers surveyed 1,177 fourth-year medical students at eleven U.S. medical schools in the spring of 2007, who were questioned regarding their educational experiences and career choice.

Overall, 274 students (23.2 percent) reported they were most likely to enter careers in IM, including 24 (2.0 percent of the total sample) in general IM. Compared with other specialties they had chosen or considered, students perceived IM as requiring more paperwork (68.0 percent of respondents), requiring a greater breadth of knowledge (62.1 percent), and having a lower income potential (64.6 percent).

Other reasons cited by students for not selecting IM careers included the attractiveness of other (non-IM) specialties and the types of patients an internist sees. Factors for choosing IM included the intellectual challenge, teaching on the IM rotation, the continuity of care and the competence of IM residents.

“Current students recognise the increasing demands on internists, particularly primary care physicians, to accomplish large numbers of preventive and therapeutic interventions during short visits with chronically ill patients while also managing increasing administrative expectations,” the authors write. “Career interest in general IM is particularly low, reflecting the challenges in the primary care practice environment. A national effort to address the factors should include interventions to modify the nature of work and lifestyle in the field.”; Source: American Medical Association (AMA)