Primary Care Research

Demand for primary care internists has decreased, while demand for hospital-based internists has increased

Overall demand for internal medicine doctors has changed little in the past 10 years. However, the decline in demand for outpatient-based general internists has been offset by increased demand for hospital-based internists (hospitalists), according to a new study. Like primary care internists, the vast majority of hospitalists have no additional board certification or fellowship training beyond internal medicine residency. However, as the physician marketplace continues to differentiate between outpatient and hospital-based physicians, segmenting internal medicine residency training into outpatient or inpatient tracks may be reasonable, suggests Andrew D. Auerbach, M.D., M.P.H., of the University of California, San Francisco.

Dr. Auerbach and colleagues reviewed medical advertisements for internal medicine physicians published in four medical journals between 1996 and 2004. They found that demand for most subspecialties remained stable, while demand for outpatient generalists decreased modestly. Over the same time, demand for inpatient-based critical care physicians and hospitalists jumped markedly. These findings suggest that, barring new changes in the marketplace for physicians, overall demand for generalist-trained physicians will not change, at least in the short term.

During the review period, the researchers calculated a total of 4,224 advertisements posted for 4,992 internal medicine positions. Jobs in the Northeast (31 percent of positions) or for single specialty groups (37 percent) were the most common. The relative proportion of ads for nephrologists declined while the relative proportion of ads for critical care specialists increased from 0.5 percent in 1996 to 1.7 percent in 2004. Ads for hospitalists jumped dramatically from 1 percent in 1996 to 12.1 percent in 2004, but ads for outpatient-based primary care and internal medicine positions declined by about 2.7 percent per year between 1996 and 2004. The study was supported by the Agency for Healthcare Research and Quality (HS11416).

See "Trends in market demand for internal medicine 1996 to 2004," by Dr. Auerbach, Richard Chlouber, B.S., Jennifer Singler, B.A., and others, in the October 2006 Journal of General Internal Medicine 21, pp. 1079-1085.

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