General Internists and Subspecialists

Internal medicine is profoundly challenged by urgent needs for changes in the nation's physician work force. The problems and solutions have implications for the identity and role of internal medicine and its survival as a united discipline.

Virtually every analysis and review, including those by government agencies, foundations, and professional organizations, have concluded that there are not enough practicing generalist physicians and too many highly specialized physicians for a rational health care system. Internal medicine is a crucial part of physician manpower, with more than one fifth of the country's practicing physicians and one quarter of the residents in training.

It is difficult to estimate just how many of the various categories of physicians are needed, but the one third of American physicians who are general internists, family practitioners, or general pediatricians is a much smaller proportion than that in other developed countries, such as Canada and Germany (50%) and Great Britain (> 70%).

The United States has set a national goal of 50% of physicians in generalist disciplines, and the federal advisory Council on Graduate Medical Education recommends that this be approached by having 50% of all residency graduates enter practice as generalists [1]. Recently, the Federated Council for Internal Medicine stated its goal that 50% of graduates of internal medicine residency programs should enter the practice of general internal medicine [2]. These proposals are not new, but it is an important consensus for internal medicine at a critical time.

This issue of Annals includes two articles addressing the issue of internal medicine manpower. The first examines the implications of the national consensus that 50% of physicians be generalists [3]. …