Internal Medicine Shifts Toward Primary Care

Preparation of papers from national studies of the internal medicine workforce

In 1996, the University of Chicago Center for Health Administration Studies developed and published two papers: one on barriers to primary care training in internal medicine and the other on a comparison of major databases on graduate medical education.

The project was part of the Robert Wood Johnson Foundation (RWJF) national program Generalist Provider Research Initiative.

Key Results

  • In the first paper, The Production of Generalist Physicians for Practice in Internal Medicine: Results from the National Study of Internal Medicine Manpower, the investigator reported:

    • The objective of reaching a 50-50 mix of generalists and specialists in graduate medical education training was widely accepted by directors of training programs in internal medicine in 1993.
    • The rates of subspecialty placements declined, respectively, by about 4 percent and 3 percent in 1994–95 and 1995–96.
    • The principal barriers to a more rapid shift to primary care were a combination of institutional constraints and limited program resources.
  • In the second paper, A Comparison of Graduate Medical Education Databases: Internal Medicine, the investigator reported:

    • There is agreement on the total number of internal medicine residents.
    • There is variation in the reported numbers of first-year internal medicine residents.
    • The reported number of subspecialty fellows varies from 11 percent to 28 percent for the years 1987–93.
    • The universes included in each database are different.
    • The completeness of data collection varies.