JAMA: Med students not pursuing internal medicine as career choice

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Medical students express reservations about internal medicine as a career because of patient complexity, the practice environment and the lifestyle, compared with other specialties, according to a study in the Sept. 10 issue of the Journal of the American Medical Association.

Internists in primary care and subspecialty practice provide a large portion of the chronic care for older and medically complex patients. However, the investigators said that the number of students choosing residency training in general internal medicine (IM) has declined, and young physicians are leaving general IM, suggesting that projected shortfalls may greatly underestimate the future problem.

The number of older U.S. adults is expected to nearly double between the years 2005 and 2030, and one planning model predicts that the U.S. will have 200,000 too few physicians by 2020. Current students’ perceptions about IM careers and the factors that motivate them to choose the field are not well understood, according to researchers.

Karen E. Hauer, MD, of the University of California, San Francisco, and colleagues conducted a study to understand current students' impressions and concerns about careers in IM and to identify potentially modifiable factors in their decision making. Researchers surveyed 1,177 fourth-year medical students at 11 U.S. medical schools in the spring of 2007, who were questioned regarding their educational experiences and career choice.

Overall, the investigators found that 23.2 percent reported they were most likely to enter careers in IM, including 2 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, according to Hauer and colleagues.

Factors cited by students for choosing IM included the intellectual challenge—teaching on the IM rotation—the continuity of care and the competence of IM residents.

“Career interest in general IM is particularly low, reflecting the challenges in the primary care practice environment. A national effort to address the factors affecting students' career choice regarding IM is needed and should include interventions to modify the nature of work and lifestyle in the field, ”the authors wrote.

In an accompanying editorial, David C. Goodman, MD, of Dartmouth Medical School in Hanover, N.H., wrote that the U.S. should establish a permanent health work force commission to help overcome the current limitations of health professions training.