AIM: Internal medicine is meaningful, but not chosen

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In 2007, more medical students viewed internal medicine as a potentially meaningful career compared with 1990. However, the 2007 students had higher debt, more negative perceptions of workload and stress in internal medicine, and less career interest in general internal medicine, according to a report in the Archives of Internal Medicine.

Mark D. Schwartz, MD, of the division of general internal medicine at New York University School of Medicine, in New York City, and colleagues conducted a secondary analysis of data collected during 1990 and 2007 national studies of senior medical students. Both studies addressed topics including specialties chosen, clerkship experiences and perceptions of internal medicine compared with other specialties. The 1990 survey included 1,244 students at 16 schools and the 2007 survey included 1,177 students at 11 schools.

Schwartz and colleagues compared responses from 1990 and 2007 by analyzing a merged dataset of identical items from the two surveys (65 percent of the items). Compared with the 1990 survey group, the 2007 survey group included more women (52 percent vs. 37 percent) and students reporting more educational debt, with an average of $101,000 compared with $63,000 in 1990, Schwartz and colleagues found.

The proportion of students planning careers in internal medicine (combining all types of internal medicine including subspecialty and pediatrics) was similar in 1990 and 2007 (24 percent and 23 percent, respectively); however, the percentage of students planning general internal medicine training declined from 9 percent in 1990 to 2 percent in 2007.

The appeal of being a primary care physician as an influence toward internal medicine declined from 57 percent in 1990 to 33 percent in 2007. Although most students in both cohorts were attracted toward careers in internal medicine by the “esteem” offered by the specialty (68 percent of students in 1990 and 82 percent in 2007), some students were less attracted to internal medicine by the “types of patients cared for by internists,” the authors reported.

Although “students in 2007 felt that opportunities for meaningful work in [internal medicine] were greater than did students in 1990 (58 percent vs. 42 percent),” students in both groups also felt that workload and stress are greater in internal medicine than in other fields.

“To rebuild the generalist physician workforce, improving students’ experience of internal medicine in medical school is no longer sufficient,” the authors concluded. “Bolder reform will be required to improve the educational pipeline, practice and payment of generalist internal medicine physicians.”

The 1990 study was funded by the American College of Physicians and the American Board of Internal Medicine. The 2007 study was supported by the Shadyside Hospital Foundation of Pittsburgh and the American Board of Internal Medicine Foundation.