Mark D. Schwartz, MD; Mark Linzer, MD; David Babbott, MD; George W. Divine, PhD; Eugene Broadhead, MD, PhD
*Collaborating members of the Society of General Internal Medicine Interest Group: University of Arkansas (Little Rock): William Golden, MD; Boston University, Boston City Hospital: James Heffernan, MD; Bowman Gray University School of Medicine: David Schreiner, MD; Brown University, Rhode Island Hospital: Steven Wartman, MD, PhD; Patricia O'Sullivan, EdD; University of California at San Francisco, Clinical Scholars Program: William Kassler, MD; Howard University: Janice Hebert-Carter, MD; Johns Hopkins University School of Medicine: Brent G. Petty, MD; Laura M. Mumford, MD; Medical College of Georgia: Ruth-Marie E. Fincher, MD; New York Medical College: Martha S. Grayson, MD; University of North Carolina (Chapel Hill), Clinical Scholars Program: Adina Kalet, MD; University of Oklahoma (Oklahoma City): DeWayne Andrews, MD; University of Texas (Galveston): Thomas Blackwell, MD; Wayne State University: Ernest Yoder, MD; West Virginia University: Roxann Powers, MD.
Collaborating local coordinators for the national survey: The Albert Einstein College of Medicine: Saul Moroff, MD; Janet U. Gorkin, MD; Baylor College of Medicine: Nelda Wray, MD, MPH; University of Cincinnati School of Medicine: Richard Wyderski, MD; Greg Rouan, MD; University of Colorado School of Medicine: Lawrence Feinberg, MD; University of Connecticut School of Medicine: Thomas Lane, MD; Marshall University School of Medicine: Gretchen E. Oley, MD; Patrick I. Brown, PhD; University of Miami School of Medicine: Arthur Fournier, MD; University of Mississippi School of Medicine: Terry Jackson, MD; University of Missouri School of Medicine: R. Jan Swaney, MD; R. Dennis Marienfeld, MD; State University of New York at Syracuse School of Medicine: David Simon, MD; University of South Alabama College of Medicine: Wanda Kirkpatrick, MD; University of Southern California School of Medicine: John Brodhead, MD; University of Washington School of Medicine: Jan Carline, PhD; Yale University School of Medicine, Clinical Scholars Program: William Shockcor, MD.
American Medical Student Association/Foundation: James Slayton, MD.
American College of Physicians collaborators (Office of Graduate Medical Education): Frank Davidoff, MD; Susan Deutsch, MD.
Grant Support: By the American College of Physicians.
Requests for Reprints: Mark D. Schwartz, MD, Department of Medicine, New York University Medical Center, Gouverneur Hospital, Room 479, 227 Madison Street, New York, NY 10002.
Current Author Addresses: Dr. Schwartz: Department of Medicine, New York University Medical Center, Gouverneur Hospital, Room 479, 227 Madison Street, New York, NY 10002.
Dr. Linzer: Box 1042, New England Medical Center, 750 Washington Street, Boston, MA 02111.
Dr. Babbott: Department of Medicine, Medical Center Hospital of Vermont, Burlington, VT 05401.
Dr. Divine: Box 3038, Division of General Internal Medicine, Duke University Medical Center, Durham, NC 27710.
Dr. Broadhead: Box 2914, Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710.
Schwartz M., Linzer M., Babbott D., Divine G., Broadhead E.; Medical Student Interest in Internal Medicine: Initial Report of the Society of General Internal Medicine Interest Group Survey on Factors Influencing Career Choice in Internal Medicine. Ann Intern Med. 1991;114:6-15. doi: 10.7326/0003-4819-114-1-6
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Published: Ann Intern Med. 1991;114(1):6-15.
Objective: To determine the factors that attract students toward and push students away from a career in internal medicine.
Design: National survey of senior U.S. medical students using a stratified random cluster sampling of medical schools.
Participants: The survey included 1650 U.S. senior students from 16 medical schools, of whom 1244 (76%) responded.
Measurements and Main Results: A survey instrument was developed and pilot tested at 17 medical schools. Twenty-four percent of the respondents to the final survey chose a career in general internal medicine (9%) or subspecialty internal medicine (15%). A career in internal medicine had been "seriously considered" by 608 respondents (50%) who finally chose a career other than internal medicine (the "switchers"). Compared with other specialties, internal medicine was perceived as being more stressful to residents, more demanding of time and workload as a career and a residency, and as an easier residency to enter. Internal medicine was also seen as providing less satisfaction for residents, having lower income potential, and allowing less leisure time. For the 608 switchers, the most important influences leading to their decision to switch were the type of patient seen in internal medicine (for example, chronically ill, alcohol and drug abusing patients) as well as dissatisfaction and stress among internal medicine residents. Factor analysis showed that three factors, "intellectual challenge of internal medicine," "primary care interests," and "the medicine clerkship" attracted students toward internal medicine, whereas three others, "taking care of chronically ill patients," "level of satisfaction among internists and medical residents," and "workload and stress" pushed students away from internal medicine. Factors pushing students away from internal medicine were significantly more negative with regard to a career in general as opposed to subspecialty internal medicine (P < 0.001).
Conclusion: Medical students have serious reservations about internal medicine as a career choice. Perceptions about the medical residency, the patients they expect to see, and the dissatisfaction among residents and internists are foremost in their thinking. Changes to improve the attractiveness of internal medicine should address these adverse perceptions while building on the positive influences identified by the respondents.
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