HealthDay News — Only about one in five graduating internal medicine residents in the United States plan to enter general internal medicine, survey findings show.

Among third-year residents in categorical and primary care programs, 65.3% planned to practice subspecialty medicine vs. 21.5% who said they planned to practice general internal medicine, Colin P. West, MD, PhD, and Denise M. Dupras, MD, PhD, of the Mayo Clinic in Rochester, Minn., reported in the Journal of the American Medical Association.

Residents in primary care programs were significantly more likely to choose a career in general internal medicine compared with those in categorical programs (39.6% vs. 19.9%; adjusted odds ratio [aOR], 2.76), but the majority of residents still opted for other career paths.

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To better understand the general internist shortage in the U.S., West and Dupras surveyed 16,781 third-year internal medicine residents from 2009 to 2011 regarding their career plans.

Women were more likely than men to plan on a general internal medicine career (26.7% vs 17.3%; OR 1.69; 99% CI: 1.53-1.87). And graduates of U.S. medical schools were slightly more likely than graduates of international schools to say they were planning on pursuing a career in general internal medicine (22% vs. 21.1%; OR 1.76, 99% CI: 1.50-2.06).

“Because nearly 60% of residents in primary care training programs are international medical graduates, understanding and addressing the low rates of reported general medicine career plans in this group of residents may be important to efforts to stimulate greater numbers of general internists,” the researches wrote.

Which aspect of primary care practice contributes most to physicians’ decisions to choose other specialties?

Maintaining a general internal medicine career plan from the first year of a residency program through the third year was significantly more frequent among those in a primary care residency program (68.2% vs. 52.3%; OR 1.81, 99% CI: 1.25-2.64), women (62.4% vs. 47.2%; OR 1.75, 99% CI: 1.34-2.29), and graduates of U.S. medical schools (60.9% vs. 49.2%; OR 1.48, 99% CI: 1.13 to 1.93), the researchers found.

Suggestions for making general medicine careers more desirable include reducing administrative burdens, payment reform and medical education debt management, the researchers noted, adding that “learners will need to observe evidence that these measures can be effectively executed to make general medicine careers more desirable.”


  1. West C, Dupras D. JAMA 2012; 308: 2241-2247.