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US medical training may not produce enough PCPs to meet future demand

Internal medicine residents in the United States — including those in primary care training programs — are more likely to choose an eventual subspecialty career rather than general internal medicine, according to recent data.

“Current medical training models in the United States are unlikely to produce sufficient numbers of general internists and primary care physicians,” wrote the study authors from the Mayo Clinic in Rochester, Minn.

Using an annual survey from the Internal Medicine In-Training Examination (October 2009 to October 2011), researchers correlated career plans by training program, sex and medical school location. The survey was completed by 84.9% of 67,207 eligible internal medicine residents. After exclusion for incomplete responses and available demographic data, results from 16,781 third-year residents (32.2%) were analyzed.

A general internal medicine (GIM) career plan was reported by 3,605 graduating residents (21.5%). Five hundred sixty-two primary care program (39.6%) and 3,034 categorical (19.9%) residents reported GIM as their eventual career plan (adjusted OR=2.76; 99% CI, 2.35-3.23).

The Mayo Clinic analysis showed that 10,008 categorical (65.3%) and 745 primary care program (52.5%) residents planned a subspecialty career (aOR=1.90; 99% CI, 1.62-2.23).

Women reported more frequent GIM career plans than men (26.7% vs. 17.3%; P<.001). US medical school graduates also were slightly more likely to have GIM career plans compared with international graduates (22% vs 21.1%; P<.001).

“General internists are expected to play an increasingly critical role in health care provision as the population ages, the burden of chronic disease grows, and health care reform targets coverage of tens of millions of currently uninsured patients,” the researchers said. “This study of a large national sample of internal medicine residents confirms that general medicine remains a less common career plan overall than subspecialty medicine.”

Disclosure: The researchers report no relevant financial disclosures.