Internal medicine reformation

Abstract

The number of young United States physicians pursuing a career in primary care continues to decline. From a peak Match year in 1985 when 3884 U.S. graduate physicians matched in categorical internal medicine, the number has decreased by 33%, to 2602 in 2004 (1). In primary care internal medicine, the number of United States Medical Graduates (USMGs) matched in 2004 was only 188, down 51% since 1997 (1). Internal medicine continues to experience a decrease in USMGs entering the specialty. In 2003, approximately 60% of categorical internal medicine slots were filled by international medical graduates (IMGs) (2,3). In contrast, less than 20% of preliminary (1 year) internal medicine slots in 2003 were filled by IMGs (2,3). In the 2004 National Residency match, 54% of internal medicine residency positions were filled with USMGs, a percentage that represents only a minimal decrease from 2003. Many positions in internal medicine training programs are filled by IMGs outside of the national matching process; as a result, the actual percentage of IMGs enrolled in categorical internal medicine programs is above 50% of trainees. Furthermore, anecdotal accounts suggest that the number of academically superior U.S. students choosing a career in internal medicine is also declining, except for perhaps in the more prestigious training programs. A corollary of this phenomenon is that fewer top students enter medical subspecialty training. Family medicine, the other major primary care discipline, has experienced a 49% decline in interest by U.S. senior medical students over the past 8 years.