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Trends in market demand for internal medicine 1999 to 2004

An analysis of physician job advertisements

Journal of General Internal Medicine volume 21, pages 1079–1085 (2006)Cite this article

Abstract

BACKGROUND: The health care marketplace has changed substantially since the last assessment of demand for internal medicine physicians in 1996.

METHODS: We reviewed internal medicine employment advertisements published in 4 major medical journals between 1996 and 2004. The number of positions, specialty, and other practice characteristics (e.g., location) were collected from each advertisement.

RESULTS: Four thousand two hundred twenty-four advertisements posted 4,992 positions. Of these positions, jobs in the Northeast (31% of positions) or single specialty groups (36.8% of positions) were most common. The relative proportion of advertisements for nephrologists declined (P <.001), while the relative proportions of advertisements for critical care specialists (0.5% in 1996 to 1.7% in 2004,P=0.004) and hospitalists (1.0% in 1996 to 12.1% in 2004,P<.001) increased. Advertisements for outpatient-based generalist positions (i.e., Primary Care and Internal Medicine) declined (−2.7% relative annual change, 95% confidence interval [95% Cl] −4.1%, −1.2%) between 1996 and 2004, a decrease largely due to a substantial decline in advertisements noted between 1996 and 1998. However, over the entire time period, the combined proportion of advertisements for all generalists (hospitalists and outpatient-based generalists) did not change (0.5% relative annual change, 95% Cl −0.8% to 2.0%).

CONCLUSIONS: Since 1996, demand for the majority of medical subspecialties has remained constant while relative demand has decreased for primary care and increased for hospitalists and critical care. Increase in demand for generalist-trained hospitalists appears to have offset falling demand for outpatient generalists.

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References

  1. Greenfield S, Nelson EC, Zubkoff M, et al. Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study. JAMA. 1992;267:1624–30.

    PubMed  Article  CAS  Google Scholar 

  2. Greenfield S, Rogers W, Mangotich M, Carney MF, Tarlov AR. Outcomes of patients with hypertension and non-insulin dependent diabetes mellitus treated by different systems and specialties. Results from the medical outcomes study. JAMA. 1995;274:1436–44.

    PubMed  Article  CAS  Google Scholar 

  3. Eisenberg JM. The internist as gatekeeper. Preparing the general internist for a new role. Ann Intern Med. 1985;102:537–43.

    PubMed  CAS  Google Scholar 

  4. Auerbach AD, Hamel MB, Davis RB, et al. Resource use and survival of patients hospitalized with congestive heart failure: differences in care by specialty of the attending physician. SUPPORT investigators. Study to understand prognoses and preferences for outcomes and risks of treatments [see comments]. Ann Intern Med. 2000;132:191–200.

    PubMed  CAS  Google Scholar 

  5. Ayanian JZ, Guadagnoli E, McNeil BJ, Cleary PD. Treatment and outcomes of acute myocardial infarction among patients of cardiologists and generalist physicians. Arch Intern Med. 1997;157:2570–6.

    PubMed  Article  CAS  Google Scholar 

  6. Ayanian JZ, Hauptman PJ, Guadagnoli E, Antman EM, Pashos CL, McNeil BJ. Knowledge and practices of generalist and specialist physicians regarding drug therapy for acute myocardial infarction. N Engl J Med. 1994;331:1136–42.

    PubMed  Article  CAS  Google Scholar 

  7. Donohoe MT. Comparing generalist and specialty care: discrepancies, deficiencies, and excesses. Arch Intern Med. 1998;158:1596–608.

    PubMed  Article  CAS  Google Scholar 

  8. Harrold LR, Field TS, Gurwitz JH. Knowledge, patterns of care, and outcomes of care for generalists and specialists. J Gen Intern Med. 1999;14:499–511.

    PubMed  Article  CAS  Google Scholar 

  9. Willison DJ, Soumerai SB, McLaughlin TJ, et al. Consultation between cardiologists and generalists in the management of acute myocardial infarction: implications for quality of care. Arch Intern Med. 1998;158:1778–83.

    PubMed  Article  CAS  Google Scholar 

  10. Wu AW, Young Y, Skinner EA, et al. Quality of care and outcomes of adults with asthma treated by specialists and generalists in managed care. Arch Intern Med. 2001;161:2554–60.

    PubMed  Article  CAS  Google Scholar 

  11. Lindenauer PK, Pantilat SZ, Katz PP, Wachter RM. Hospitalists and the practice of inpatient medicine: results of a survey of the National Association of Inpatient Physicians. Ann Intern Med. 1999;130(part 2):343–9.

    PubMed  CAS  Google Scholar 

  12. Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Engl J Med. 1996;335:514–7.

    PubMed  Article  CAS  Google Scholar 

  13. Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J. Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA. 2000;284:2762–70.

    PubMed  Article  CAS  Google Scholar 

  14. Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002;288:2151–62.

    PubMed  Article  Google Scholar 

  15. Pronovost PJ, Jenckes MW, Dorman T, et al. Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery. JAMA. 1999;281:1310–7.

    PubMed  Article  CAS  Google Scholar 

  16. Milstein A, Galvin RS, Delbanco SF, Salber P, Buck CR Jr. Improving the safety of health care: the leapfrog initiative. Eff Clin Pract. 2000;3:313–6.

    PubMed  CAS  Google Scholar 

  17. Pronovost PJ, Waters H, Dorman T. Impact of critical care physician workforce for intensive care unit physician staffing. Curr Opin Crit Care. 2001;7:456–9.

    PubMed  Article  CAS  Google Scholar 

  18. Young MP, Birkmeyer JD. Potential reduction in mortality rates using an intensivist model to manage intensive care units. Eff Clin Pract. 2000;3:284–9.

    PubMed  CAS  Google Scholar 

  19. Seifer SD, Troupin B, Rubenfeld GD. Changes in marketplace demand for physicians: a study of medical journal recruitment advertisements. JAMA. 1996;276:695–9.

    PubMed  Article  CAS  Google Scholar 

  20. Kwok YS, Kim C, Bernacki R. Changes in demand for internal medicine specialists and generalists in the 1990s. Am J Med. 2003;115:254–5.

    PubMed  Article  Google Scholar 

  21. Friedlich DL, Feustel PJ, Popp AJ. Workforce demand for neurosurgeons in the United States of America: a 13-year retrospective study. J Neurosurg. 1999;90:993–7.

    PubMed  CAS  Article  Google Scholar 

  22. Gottfried ON, Rovit RL, Popp AJ, Kraus KL, Simon AS, Couldwell WT. Neurosurgical workforce trends in the United States. J Neurosurg. 2005;102:202–8.

    PubMed  Google Scholar 

  23. Shipman SA, Lurie JD, Goodman DC. The general pediatrician: projecting future workforce supply and requirements. Pediatrics. 2004;113(part 1):435–42.

    PubMed  Article  Google Scholar 

  24. Lurie JD, Goodman DC, Wennberg JE. Benchmarking the future generalist workforce. Eff Clin Pract. 2002;5:58–66.

    PubMed  Google Scholar 

  25. Lurie JD, Wachter RM. Hospitalist staffing requirements. Eff Clin Pract. 1999;2:126–30.

    PubMed  CAS  Google Scholar 

  26. Lurie JD, Miller DP, Lindenauer PK, Wachter RM, Sox HC. The potential size of the hospitalist workforce in the United States. Am J Med. 1999;106:441–5.

    PubMed  Article  CAS  Google Scholar 

  27. Crittenden R, Schaad D, Coombs J. Surveying graduates of one school to determine regional workforce demand. Acad Med. 2001;76:623–7.

    PubMed  Article  CAS  Google Scholar 

  28. Preston N. The Help-Wanted Index: Technical Description and Behavioral Trends, New York, NY. 1977 (Conference Board).

  29. Abraham K, Wachter M. Help-wanted advertising, job vacancies, and unemployment; comments and discussion. Brookings Papers on Economic Activity. 1987;1:207–48.

    Article  Google Scholar 

  30. Saketkhoo DD, Sunshine JH, Covey AM, Forman HP. Findings in 2002 from a help wanted index of job advertisements: is the job-market shortage of diagnostic radiologists easing? Am J Roentgenol. 2003;181:351–7.

    Google Scholar 

  31. Saketkhoo DD, Covey AM, Sunshine J, Forman HP. Updated findings from a help wanted index of job advertisements and an analysis of the policy implications: is the job-market shortage for diagnostic radiologists stabilizing? Am J Roentgenol. 2002;179:851–8.

    Google Scholar 

  32. Osinski M. If there is a nephrologist shortage, where are the jobs? Nephrol News Issues. 2004;18:33–5.

    PubMed  Google Scholar 

  33. Mitch W, McClellan WM. Patterns of patient care reported by nephrologists: implications for nephrology training. Am J Kidney Dis. 1998;32:551–6.

    PubMed  CAS  Google Scholar 

  34. Kletke PR. The changing supply of renal physicians. Am J Kidney Dis. 1997;29:781–92.

    PubMed  CAS  Google Scholar 

  35. Escarce JJ, Polsky D, Wozniak GD, Kletke PR. HMO growth and the geographical redistribution of generalist and specialist physicians, 1987–1997. Health Serv Res. 2000;35:825–48.

    PubMed  CAS  Google Scholar 

  36. Auerbach A, Nelson E, Lindenauer P, Pantilat S, Katz P, Wachter R. Physician attitudes towards the hospitalist model of care: results of a national survey. J Gen Intern Med. 2000;15(suppl 1):99.

    Google Scholar 

  37. Society of Hospital Medicine Website. Available at: www.hospitalmedicine.org. Accessed January 5, 2006.

  38. Devers KJ, Brewster LR, Casalino LP. Changes in hospital competitive strategy: a new medical arms race? Health Serv Res. 2003;38(1 part 2):447–69.

    PubMed  Article  Google Scholar 

  39. Goldman L. Modernizing the paths to certification in internal medicine and its subspecialties. Am J Med. 2004;117:133–6.

    PubMed  Article  Google Scholar 

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Author information

Affiliations

  1. Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Andrew D. Auerbach MD, MPH

  2. School of Medicine, University of Wisconsin, Madison, WI, USA

    Richard Chlouber BS

  3. San Francisco School of Medicine, University of California, San Francisco, CA, USA

    Jennifer Singler BA

  4. Dartmouth Medical School, Hanover, NH, USA

    Jon D. Lurie MD

  5. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

    Alan Bostrom PhD & Robert M. Wachter MD

Authors
  1. Andrew D. Auerbach MD, MPH
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  2. Richard Chlouber BS
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  3. Jennifer Singler BA
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  4. Jon D. Lurie MD
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  5. Alan Bostrom PhD
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  6. Robert M. Wachter MD
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Corresponding author

Correspondence to Andrew D. Auerbach MD, MPH.

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Auerbach, A.D., Chlouber, R., Singler, J. et al. Trends in market demand for internal medicine 1999 to 2004. J GEN INTERN MED 21, 1079–1085 (2006). https://doi.org/10.1111/j.1525-1497.2006.00558.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00558.x

Key words

  • physician workforce
  • primary care
  • hospitalists
  • internal medicine