Where Have the Internists Gone?

Joe Cantlupe, for HealthLeaders Media , May 13, 2010

When those who left IM were asked why they left, only 22% indicated negative aspects such as "long hours, limited income or hassles," the report adds. "Most–57%-said they left IM "due to a change in interest or to take advantage of a preferred opportunity," according to the study.

While there was frustration and negativity expressed, they mostly expressed interest in a different career, in a seemingly "neutral" way, Bylsma says. "I guess the venting that you hear about private practice is more anecdotal."

Generally, "we were hoping to get a little better sense of ‘why' internists left their positions," Bylsma says. "The current study fell short of the conclusion for ‘why.'"

Among the other surprises, he says, were findings that doctors, for the most part, were opting to go into emergency treatment, and more willing to leave academia than private practice.

Bylsma says he keeps going back to the "stepping stone" theory, that people wanted to pursue other careers, more security, better hours, etc. His report is just another piece of the puzzle about the uncertain future of physicians, especially in primary care.

"Policies and organizational support should continue to focus on increasing interest in general internal medicine (GIM) among students and residents, but must also ensure the attractiveness of GIM practice among those working in the specialty," Bylsma said in the study.

The government is trying to provide incentives for primary care physicians to stay in their chosen field. Under the new healthcare reform law, for example, grant and bonus programs are being established for primary care physicians.

Bylsma noted that a national workforce policy will examine primary care practices, and new funding for demonstration projects centered on the medical home, "for a more physician and patient friendly environment."

In the study, there was one last surprise.

"We found that a sizable minority of interns–40%-who have left internal medicine are open to returning," says Bylsma. "Changes in the practice environment might entice them back in the field."

Will the internists eventually take that "stepping stone" back home?

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Joe Cantlupe is a senior editor with HealthLeaders Media Online.

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