Letters to the Editor
To the Editor:
I belong to a species facing extinction: I am a general internist. Each year, I watch the majority of internal medicine residency graduates turn away from general practice to start fellowship training. Jolly et al1 recently studied primary care selection in residency and reported that 57% of new internal medicine residents in 2010 were predicted to subspecialize, leaving 43% to remain in general internal medicine. While this number is more optimistic than other reports, how can the generalist survive if less than half of graduating residents are choosing this profession, which is already facing a serious shortage? I propose leveraging the Patient-Centered Medical Home (PCMH) model to implement two interventions at the graduate medical education (GME) level to explicitly encourage internal medicine residents to remain in general practice.
The PCMH may help alleviate the provider shortage through increased use of midlevel providers and decreased frequency of patient visits. For PCMHs to be successful, however, physicians will need to be outstanding clinicians, leaders, and educators. So, what can be done at the GME level to retain the top residents in general practice?
Many generalists value their unique role and holistic approach to patient care. It is time to make our values clear by sharing them explicitly with our residents. To achieve this, I propose melding two recommended GME interventions in the PCMH model to increase interest in general practice: (1) improvements in ambulatory supervision and (2) increased mentorship from experienced faculty. New internal medicine residents should be welcomed at the door of a PCMH by an experienced general internist, who will serve as the resident’s clinical and professional mentor throughout his or her residency. Consistent supervision in the clinic may improve the ambulatory experience with more accurate assessment and timely feedback on milestone achievement. Combining mentorship with a strong and longitudinal ambulatory experience is the key to explicitly supporting our future generalists.
It is time for all clinicians to honor the important role played by primary care. If we utilize the PCMH framework to structure consistent mentorship, we may be able to save the general internist from extinction.
Mark P. Tschanz, DO
Senior medical officer, USS Essex, and general internist, US Navy, San Diego, California; firstname.lastname@example.org.
1. Jolly P, Erikson C, Garrison G. U.S. graduate medical education and physician specialty choice. Acad Med. 2013;88:468–474