General Internal Medicine Practice Unattractive for Recent Graduates
Posted May 12 2011 12:00am
We are undergoing major changes in the choices being made by young physicians in terms of how they practice medicine after their completion of training. The most striking change has been the large percentage that are accepting salaried positions with large health systems, many as hospitalists. A recent article provides evidence of the continuing trend away from general internal medicine (see: Young doctors find general internal medicine doesn't pay ), Below is an excerpt from it:
Many young physicians continue to steer away from general internal medicine, despite increased exposure to the field during medical school and a more favorable view of the specialty among medical students. The decline is contributing to a growing shortage of primary care physicians when demand for such services is on the rise, said Mark D. Schwartz, MD....He is the lead author of a study on the subject in the April 25 Archives of Internal Medicine (Changes in Medical Students' Views of Internal Medicine Careers From 1990 to 2007). The widening gap in pay between primary care physicians and specialists, large medical school debts, inflexible schedules and heavy workload are some of the factors that influence students' decisions, he said. "What's happened in primary care practice is that physicians feel they are on a treadmill to maintain their salary," said Dr. Schwartz, a general internist. "Pay hasn't kept up with inflation, so to keep up, they see more patients."....The results demonstrate there is little that medical educators can do to encourage more students to go into general internal medicine, the study said. The solution is on the policy side, where lawmakers can take steps such as increasing pay for primary care....The average medical school graduate had a $132,000 debt in 2009, and the income gap between generalist and subspecialist physicians continues to widen, he said.
There is no question that medical school graduates have a large debt burden and the fastest way to reduce it is to choose a high-paying specialty. However, I am dubious that, as Dr. Schwartz maintains, the answer lies largely on the "policy side" and by increasing the income of primary care practitioners. I personally place greater emphasis on the young physicians' distaste for inflexible schedules and the heavy workload in primary care. These two factors are mentioned in the excerpt above. I also want to cite an additional factor that comes to my mind that make speciality practice more appealing for young physicians. The amount of information that must be learned in medical school is staggering. One way to mange this TMI (too much information) problem is to head for an information silo, which is to say a specialty practice. I think that it must be psychologically reassuring to establish some boundaries around the knowledge that you are expected to master. However, this increasing fragmentation of medical practice creates the conundrum for which we do not yet have a solution. Who is going to see patients initially and refer them to the appropriate specialists? My own answer to this question is nurse practitioners . However, they too seem to be going the route of specialization, also hoping to avoid the stigma and challenges of the generalist role.
We are undergoing major changes in the choices being made by young physicians in terms of how they practice medicine after their completion of training. The most striking change has been the large percentage that are accepting salaried positions with large health systems, many as hospitalists. A recent article provides evidence of the continuing trend away from general internal medicine (see: Young doctors find general internal medicine doesn't pay ), Below is an excerpt from it:
Many young physicians continue to steer away from general internal medicine, despite increased exposure to the field during medical school and a more favorable view of the specialty among medical students. The decline is contributing to a growing shortage of primary care physicians when demand for such services is on the rise, said Mark D. Schwartz, MD....He is the lead author of a study on the subject in the April 25 Archives of Internal Medicine (Changes in Medical Students' Views of Internal Medicine Careers From 1990 to 2007). The widening gap in pay between primary care physicians and specialists, large medical school debts, inflexible schedules and heavy workload are some of the factors that influence students' decisions, he said. "What's happened in primary care practice is that physicians feel they are on a treadmill to maintain their salary," said Dr. Schwartz, a general internist. "Pay hasn't kept up with inflation, so to keep up, they see more patients."....The results demonstrate there is little that medical educators can do to encourage more students to go into general internal medicine, the study said. The solution is on the policy side, where lawmakers can take steps such as increasing pay for primary care....The average medical school graduate had a $132,000 debt in 2009, and the income gap between generalist and subspecialist physicians continues to widen, he said.There is no question that medical school graduates have a large debt burden and the fastest way to reduce it is to choose a high-paying specialty. However, I am dubious that, as Dr. Schwartz maintains, the answer lies largely on the "policy side" and by increasing the income of primary care practitioners. I personally place greater emphasis on the young physicians' distaste for inflexible schedules and the heavy workload in primary care. These two factors are mentioned in the excerpt above. I also want to cite an additional factor that comes to my mind that make speciality practice more appealing for young physicians. The amount of information that must be learned in medical school is staggering. One way to mange this TMI (too much information) problem is to head for an information silo, which is to say a specialty practice. I think that it must be psychologically reassuring to establish some boundaries around the knowledge that you are expected to master. However, this increasing fragmentation of medical practice creates the conundrum for which we do not yet have a solution. Who is going to see patients initially and refer them to the appropriate specialists? My own answer to this question is nurse practitioners . However, they too seem to be going the route of specialization, also hoping to avoid the stigma and challenges of the generalist role.