Leaving (Internal) Medicine

Medical workforce planning is inexact but consequential. One current planning model predicts that the United States will have 200 000 too few physicians by 2020 (1). If the nation responds to this forecast by increasing its production of physicians, we will have short-term consequences (we will need to build new medical schools and expand existing schools) and long-term consequences (with more doctors, we will have a larger health care enterprise with its additional recurring costs). With so much at stake and so much uncertainty about the future demand for physician services, some are counseling against rapid expansion (2). Because we rely on workforce models to guide these important decisions, we need accurate estimates of the key influences on the size of the medical workforce. The number of physicians who enter the workforce is important, but so is the number who leave.

A comprehensive workforce model must do more than predict total physician requirements. It must also take account of the distribution of physicians among the specialties of medicine. A well-functioning health care system needs the right balance between primary care physicians and specialists. According to recent evidence, more U.S. medical students are entering specialties and fewer are entering primary care (3). We do not have data about the numbers of physicians leaving medicine altogether or moving between primary care and specialty medicine.

An article by Lipner and colleagues (4) in this issue contains a serendipitous but important finding: Young physicians are leaving general internal medicine much faster than they are leaving the subspecialties of internal medicine. …