Friday, December 7, 2012

Fwd: qotd: Decline in general medicine career choices

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-------- Original Message --------
Subject: qotd: Decline in general medicine career choices
Date: Fri, 7 Dec 2012 11:52:34 -0800
From: Don McCanne <>
To: Quote-of-the-Day <>

December 5, 2012
General Medicine vs Subspecialty Career Plans Among Internal Medicine
By Colin P. West, MD, PhD and Denise M. Dupras, MD, PhD

This study of a large national sample of internal medicine residents
confirms that general medicine remains a less common career plan overall
than subspecialty medicine. Combined with the fact that only a small
minority of medical students express interest in general medicine and
primary care careers, the small number of internal medicine residents
reporting plans for generalist careers means a very limited number of
generalists can be expected to enter practice each year.

Comment: This update confirms that internal medicine residents are
selecting the subspecialties in preference to general medicine and
primary care. In light of the pressing need for improving our primary
care infrastructure, what policies should we support?

Since family medicine residents almost always eventually enter primary
care, should training programs de-emphasize general internal medicine
and place more emphasis on family medicine, while relegating internal
medicine to the subspecialties? That would improve the allocation of
residency slots since you would not be losing general medicine residents
to the subspecialties after their residencies began. This is not to
suggest that subspecialists should skip all training in general
medicine. The purpose would be to stem the loss of generalists from the
training programs.

Also many agree that the role of nurse practitioners in primary care
should be expanded. This would be especially valuable in integrated
health systems and medical homes. If so, the expansion should be
coordinated with the family medicine programs to achieve an optimal
balance of primary care professionals.

Since we aren't getting the numbers right, shouldn't we consider an
alternative approach? If we had a federally funded national health
program, wouldn't we be striving to improve the use of our resources to
be sure that our health care infrastructure is better balanced? Our
current dysfunctional, fragmented method of financing our health care
system doesn't seem to be doing the job very well.

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