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An overview of internal medicine manpower: impact of the increased need for primary care physicians.

Recent discussions of the physician workforce emphasize the shortage of primary care physicians in the United States (1-3). Internal medicine is by far the largest primary care specialty. It trains more than one-third of all first year residents (Rls) (4). However, onequarter of the first year residents are in preliminary tracks that lead to training in other specialties and more than 60% of third year residents subspecialize (5). Internal medicine is therefore one of the principal targets ofreforms directed at the graduate medical education system in order to facilitate an increased supply of primary care physicians. The major internal medicine organizations including the Federated Council of Internal Medicine, The American College of Physicians, and the Association of Professors of Medicine have endorsed a goal of50% of internal medicine residents pursuing careers in primary care (6, 7). Achieving this goal will require an understanding of the factors affecting the residents and the training programs. For example, in 1992 we found that the proportion of a program's residents entering general internal medicine was negatively associated with the number of subspecialty programs located in the training hospital, the percent of international medical graduates in the program and the presence of a preliminary track in the program (8). This presentation from the National Study of Internal Medicine Manpower (NaSIMM) provides an update concerning the demographic characteristics of internal medicine residents and has been published in more complete form elsewhere (9).