Journal of General Internal Medicine

, Volume 25, Issue 10, pp 1020–1023 | Cite as

Where Have All the General Internists Gone?

  • Wayne H. Bylsma
  • Gerald K. Arnold
  • Gregory S. Fortna
  • Rebecca S. Lipner
Original Research



A shortage of primary care physicians is expected, due in part to decreasing numbers of physicians entering general internal medicine (GIM). Practicing general internists may contribute to the shortage by leaving internal medicine (IM) for other careers in and out of medicine.


To better understand mid-career attrition in IM.

Design and Participants

Mail survey to a national sample of internists originally certified by the American Board of Internal Medicine in GIM or an IM subspecialty during the years 1990 to 1995.

Main Measures

Self-reported current status as working in IM, working in another medical or non-medical field, not currently working but plan to return, or retired; and career satisfaction.

Key Results

Nine percent of all internists in the 1990–1995 certification cohorts and a significantly larger proportion of general internists (17%) than IM subspecialists [(4%) P < 0.001] had left IM at mid career. A significantly lower proportion of general internists (70%) than IM subspecialists [(77%) (P < 0.008)] were satisfied with their career. The proportion of general internists who had left IM in 2006 (19%) was not significantly different from the 21% who left in 2004 (P = 0.45). The proportion of general internists who left IM was not significantly different in earlier (1990–92; 19%) versus later (1993–95; 15%) certification cohorts (P = 0.15).


About one in six general internists leave IM by mid-career compared to one in 25 IM subspecialists. Although research finds that doctors leave medicine because of dissatisfaction, this study was inconclusive about whether general internists left IM in greater proportion than IM subspecialists for this reason. A more likely explanation is that GIM serves as a stepping stone to careers outside of IM.


primary care physicians general internal medicine physician shortage 



The American Board of Internal Medicine Foundation and the American College of Physicians, Inc., funded the study.

Conflict of Interest

The lead author is employed by the American College of Physicians, Inc; other authors are employed by the American Board of Internal Medicine. Both organizations may benefit financially as the number of general internists increases.


  1. 1.
    Dill MJ, Salsberg ES. The complexities of physician supply and demand: projections through 2025. Association of American Medical Colleges, Center for Workforce Studies. 2008 Oct. Accessed at on 24 March 2010.
  2. 2.
    Robinson L, editor. AAMC data book. Statistical information related to medical schools and teaching hospitals. January 2002 edition. Washington, DC: Association of American Medical Colleges; 2002. (Table B13)Google Scholar
  3. 3.
    Brandeburg K, Gaillard S, Geraci W, Vassev P, Youngclaus J, editors. AAMC data book. Medical schools and teaching hospitals by the numbers. May 2008 edition. Washington, DC: Association of American Medical Colleges; 2008. (Table B14)Google Scholar
  4. 4.
    Salsberg E, Rockey PH, Rivers KL, Brotherton SE, Jackson GR. US residency training before and after the 1997 Balanced Budget Act. JAMA. 2008;300:1174–80 [PMID: 18780846].CrossRefPubMedGoogle Scholar
  5. 5.
    National Residency Matching Program. Results and Data 2008 Main Residency Match; 2008. Accessed at on 24 March 2010.
  6. 6.
    Zuger A. Dissatisfaction with medical practice. N Engl J Med. 2004;350:69–75 [PMID: 14702431].CrossRefPubMedGoogle Scholar
  7. 7.
    Mechanic D. Physician discontent: challenges and opportunities. JAMA. 2003;290:941–946 [PMID: 12928472].CrossRefPubMedGoogle Scholar
  8. 8.
    Jauhar S. Eyes bloodshot, doctors vent their discontent. New York Times. 2008 June 17. Accessed at on 24 March 2010.
  9. 9.
    Steiger B. Special report: discouraged doctors. Survey results: doctors say morale is hurting. The Physician Executive. 2006; Nov-Dec:6–15.Google Scholar
  10. 10.
    Landon BE, Reschovsky JD, Pham HH, Blumenthal D. Leaving medicine: the consequences of physician dissatisfaction. Med Care. 2006;44:234–242 [PMID: 16501394].CrossRefPubMedGoogle Scholar
  11. 11.
    Tu HT, Ginsburg P. Losing Ground: Physician income, 1995–2003. Tracking Report No. 15. 2006 Jun: Jun;1–5. Accessed at on 24 March 2010. [PMID 16791996]
  12. 12.
    Bodenheimer T, Berenson RA, Rudolf P. The primary care-specialty income gap: why it matters. Ann Intern Med. 2007;146:301–6 [PMID: 17310054].PubMedGoogle Scholar
  13. 13.
    Bodenheimer T. Primary care—will it survive? N Engl J Med. 2006;355:861–864 [PMID: 16943396].CrossRefPubMedGoogle Scholar
  14. 14.
    Lipner RS, Bylsma WH, Arnold GK, Fortna GS, Tooker J, Cassel CK. Who is maintaining certification in internal medicine--and why? A national survey 10 years after initial certification. Ann Intern Med. 2006;144:29–36 [PMID: 16389252].PubMedGoogle Scholar
  15. 15.
    Liebhaber A, Grossman JM. Physicians moving to mid-sized, single-specialty practices. Track Rep. 2007 Aug;(18):1–5. Accessed at on 22 October 2008. [PMID: 17710764]
  16. 16.
    Lowes R. Group practices pay better. Medical Economics. 2007;16 Nov:23-5. [PMID: 18159882]Google Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Wayne H. Bylsma
    • 1
  • Gerald K. Arnold
    • 2
  • Gregory S. Fortna
    • 2
  • Rebecca S. Lipner
    • 2
  1. 1.American College of PhysiciansPhiladelphiaUSA
  2. 2.American Board of Internal MedicinePhiladelphiaUSA

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