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Southern Medical Journal:
doi: 10.1097/SMJ.0b013e3181fcabff
Original Articles

Major Concerns About Internal Medicine: Insights from Program Directors

Record, Janet MD; Beasley, Brent MD; McDonald, Furman S. MD; Wright, Scott MD

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Objective: To better understand and characterize the challenges facing internal medicine from the perspective of internal medicine residency program directors.

Methods: In 2007, internal medicine program directors were surveyed by the Association of Program Directors in Internal Medicine (APDIM). An open-ended question asked: “What are your major concerns regarding internal medicine?” Responses to this question were independently coded by two investigators and compared for agreement. Content analysis identified several major themes related to their concerns.

Results: Of the 236 program directors completing the survey, 186 (79%) answered the question and explained their concerns. Approximately one half of the informants were general internists. There was a fairly even distribution among assistant, associate, and professor ranking. All regions of the country were represented. Five themes emerged as the program directors' major concerns about internal medicine: waning interest in internal medicine, especially primary care; onerous regulatory oversight; economic pressures; the eighty-hour work week; and fragmentation within internal medicine.

Conclusion: By virtue of their role, internal medicine residency directors gain a unique understanding about the core elements that contribute to declining interest in careers in internal medicine, which is particularly relevant given the current primary care workforce crisis. Collaboration among stakeholders that can influence healthcare policy to address these concerns about internal medicine will be necessary to revive interest in the field.

Key Points

* Internal medicine residency program directors are concerned about declining interest in internal medicine among medical students, and in primary care among residency graduates.

* Program directors are concerned about burdensome regulatory oversight of graduate medical education and medical practice, economic pressures affecting medical education and career choice, the eighty-hour work week, and fragmentation within internal medicine.

* The findings related to declining interest in internal medicine careers have implications for health policy reform.

© 2011 Southern Medical Association


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