A National Survey of Internal Medicine Primary Care Residency Program Directors

  • Paul O’RourkeEmail author
  • Eva Tseng
  • Karen Chacko
  • Marc Shalaby
  • Anne Cioletti
  • Scott Wright
Original Research



The United States is facing a primary care physician shortage. Internal medicine (IM) primary care residency programs have expanded substantially in the past several decades, but there is a paucity of literature on their characteristics and graduate outcomes.


We aimed to characterize the current US IM primary care residency landscape, assess graduate outcomes, and identify unique programmatic or curricular factors that may be associated with a high proportion of graduates pursuing primary care careers.


Cross-sectional study


Seventy out of 100 (70%) IM primary care program directors completed the survey.

Main Measures

Descriptive analyses of program characteristics, educational curricula, clinical training experiences, and graduate outcomes were performed. Bivariate and multivariate logistic regression analyses were used to determine the association between ≥ 50% of graduates in 2016 and 2017 entering a primary care career and program characteristics, educational curricula, and clinical training experiences.

Key Results

Over half of IM primary care program graduates in 2016 and 2017 pursued a primary care career upon residency graduation. The majority of program, curricular, and clinical training factors assessed were not associated with programs that have a majority of their graduates pursuing a primary care career path. However, programs with a majority of program graduates entering a primary care career were less likely to have X + Y scheduling compared to the other programs.


IM primary care residency programs are generally succeeding in their mission in that the majority of graduates are heading into primary care careers.


medical education-graduate medical education-career choice primary care medical student and residency education survey research 



Dr. Wright is the Anne Gaines and G. Thomas Miller Professor of Medicine which is supported through the Johns Hopkins Center for Innovative Medicine.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Prior Presentations

This work was presented at the Society of General Internal Medicine Annual Meeting in April 2018.


  1. 1.
    Macinko J, Starfield B, Shi L. Quantifying the health benefits of primary care physician supply in the United States. Int J Health Serv. 2007;37(1):111–126. Scholar
  2. 2.
    Chang C, Stukel TA, Flood AB, Goodman DC. Primary care physician workforce. JAMA. 2015;305(20):2096–2105.CrossRefGoogle Scholar
  3. 3.
    Baicker K, Chandra A. Medicare spending, the physician workforce, and beneficiaries’ quality of care. Health Aff. 2004;23(SUPPL).
  4. 4.
    Kravet SJ, Shore AD, Miller R, Green GB, Kolodner K, Wright SM. Health care utilization and the proportion of primary care physicians. Am J Med. 2008;121(2):142–148. Scholar
  5. 5.
    Dall T, West T, Chakrabarti R, Lacobucci W. The Complexities of Physician Supply and Demand: Projections from 2015 to 2030 (2017 Update). 2016:1–51.Google Scholar
  6. 6.
    Petterson SM, Liaw WR, Phillips RL, Rabin DL, Meyers DS, Bazemore AW. Projecting US primary care physician workforce needs: 2010-2025. Ann Fam Med. 2012;10(6):503–510. Scholar
  7. 7.
    West CP, Dupras DM. General medicine vs subspecialty career plans among internal medicine residents. JAMA. 2012;308(21):2241–2247. Scholar
  8. 8.
    U.S. Department of Health and Human Services HR and SA. Projecting the Supply and Demand for Primary Care Practitioners Through 2020. Rockville, Maryland; 2013.
  9. 9.
    Martsolf GR, Barnes H, Richards MR, Ray KN, Brom HM, McHugh MD. Employment of advanced practice clinicians in physician practices. JAMA Intern Med. 2018;178(7):988–990. Scholar
  10. 10.
    Buerhaus P, Perloff J, Clarke S, O’Reilly-Jacob M, Zolotusky G, DesRoches CM. Quality of primary care provided to medicare beneficiaries by nurse practitioners and physicians. Med Care. 2018;56(6):484–490. Scholar
  11. 11.
    Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis. 2014;11:E62. Scholar
  12. 12.
    McPhee SJ, Mitchell TF, Schroeder SA, Perez-Stable EJ, Bindman AB. Training in a primary care internal medicine residency program. The first ten years . JAMA. 1987;258(11):1491–1495.CrossRefGoogle Scholar
  13. 13.
    O’Rourke P, Tseng E, Levine R, Shalaby M, Wright S. The current State of US internal medicine primary care training. Am J Med. 2016.
  14. 14.
    United States Census Bureau. Census Regions and Divisions of the United States. Accessed May 16, 2018.
  15. 15.
    Perez JC, Brickner PW, Ramis CM. Preparing physicians for careers in primary care internal medicine: 17 years of residency experience. Bull N Y Acad Med. 1997;74(1):20–30.
  16. 16.
    Strelnick AH, Bateman WB, Jones C, et al. Graduate primary care training: a collaborative alternative for family practice, internal medicine, and pediatrics. Ann Intern Med. 1988;109(4):324–334.CrossRefGoogle Scholar
  17. 17.
    Witzburg RA, Noble J. Career development among residents completing primary care and traditional residencies in medicine at the Boston City Hospital, 1974-1983. J Gen Intern Med. 1988;3(1):48–53.CrossRefGoogle Scholar
  18. 18.
    Noble J, Friedman RH, Starfield B, Ash A, Black C. Career differences between primary care and traditional trainees in internal medicine and pediatrics. Ann Intern Med. 1992;116(6):482–487. Scholar
  19. 19.
    Stanley M, O’Brien B, Julian K, et al. Is training in a primary care internal medicine residency associated with a career in primary care medicine? J Gen Intern Med. 2015;30(9):1333–1338. Scholar
  20. 20.
    Chen D, Reinert S, Landau C, McGarry K. An evaluation of career paths among 30 years of general internal medicine/primary care internal medicine residency graduates. R I Med J (2013). 2014;97(10):50–54.Google Scholar
  21. 21.
    Dick JF 3rd, Wilper AP, Smith S, Wipf J. The effect of rural training experiences during residency on the selection of primary care careers: a retrospective cohort study from a single large internal medicine residency program. Teach Learn Med. 2011;23(1):53–57. Scholar
  22. 22.
    Peccoralo LA, Tackett S, Ward L, et al. Resident satisfaction with continuity clinic and career choice in general internal medicine. J Gen Intern Med. 2013;28(8):1020–1027. Scholar
  23. 23.
    Long T, Chaiyachati K, Bosu O, et al. Why aren’t more primary care residents going into primary care? A qualitative study. J Gen Intern Med. 2016;31(12):1452–1459. Scholar
  24. 24.
    Stepczynski J, Holt SR, Ellman MS, Tobin D, Doolittle BR. Factors affecting resident satisfaction in continuity clinic—a systematic review. J Gen Intern Med. 2018.
  25. 25.
    Noronha C, Chaudhry S, Chacko K, et al. X + Y scheduling models in internal medicine residency programs: a national survey of program directors’ perspectives. Am J Med. 2018;131(1):107–114. Scholar
  26. 26.
    Shalaby M, Yaich S, Donnelly J, Chippendale R, DeOliveira MC, Noronha C. X + Y scheduling models for internal medicine residency programs—a look back and a look forward. J Grad Med Educ. 2014;6(4):639–642. Scholar
  27. 27.
    Heist K, Guese M, Nikels M, Swigris R, Chacko K. Impact of 4+1 block scheduling on patient care continuity in resident clinic. J Gen Intern Med. 2014;29(8):1195–1199. Scholar
  28. 28.
    Chaudhry SI, Balwan S, Friedman KA, et al. Moving forward in GME reform: A 4 + 1 model of resident ambulatory training. J Gen Intern Med. 2013;28(8):1100–1104. Scholar
  29. 29.
    Mariotti JL, Shalaby M, Fitzgibbons JP. The 4∶1 schedule: a novel template for internal medicine residencies. J Grad Med Educ. 2010;2(4):541–547. Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Paul O’Rourke
    • 1
    Email author
  • Eva Tseng
    • 2
  • Karen Chacko
    • 3
  • Marc Shalaby
    • 4
  • Anne Cioletti
    • 5
  • Scott Wright
    • 1
  1. 1.Division of General Internal MedicineJohns Hopkins Bayview Medical CenterBaltimoreUSA
  2. 2.Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Division of General Internal MedicineUniversity of Colorado School of MedicineAuroraUSA
  4. 4.Division of General Internal MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  5. 5.Division of Primary Care and Value-Based Health, Dell Medical SchoolThe University of Texas at AustinAustinUSA

Personalised recommendations