General medicine vs subspecialty career plans among internal medicine residents.

CONTEXT: Current medical training models in the United States are unlikely to produce sufficient numbers of general internists and primary care physicians. Differences in general internal medicine (GIM) career plans between internal medicine residency program types and across resident demographics are not well understood.
OBJECTIVE: To evaluate the general medicine career plans of internal medicine residents and how career plans evolve during training. DESIGN, SETTING, AND PARTICIPANTS: A study of US internal medicine residents using an annual survey linked to the Internal Medicine In-Training Examination taken in October of 2009-2011 to evaluate career plans by training program, sex, and medical school location. Of 67,207 US eligible categorical and primary care internal medicine residents, 57,087 (84.9%) completed and returned the survey. Demographic data provided by the National Board of Medical Examiners were available for 52,035 (77.4%) of these residents, of whom 51,390 (76.5%) responded to all survey items and an additional 645 (1.0%) responded to at least 1 survey item. Data were analyzed from the 16,781 third-year residents (32.2%) in this sample. MAIN OUTCOME MEASURES: Self-reported ultimate career plans of internal medicine residents.
RESULTS: A GIM career plan was reported by 3605 graduating residents (21.5%). A total of 562 primary care program (39.6%) and 3043 categorical (19.9%) residents reported GIM as their ultimate career plan (adjusted odds ratio [AOR], 2.76; 99% CI, 2.35-3.23; P < .001). Conversely, 10 008 categorical (65.3%) and 745 primary care program (52.5%) residents reported a subspecialty career plan (AOR, 1.90; 99% CI, 1.62-2.23; P < .001). GIM career plans were reported more frequently by women than men (26.7% vs 17.3%, respectively; AOR, 1.69; 99% CI, 1.53-1.87; P < .001). US medical graduates were slightly more likely to report GIM career plans than international medical graduates (22.0% vs 21.1%, respectively; AOR, 1.76; 99% CI, 1.50-2.06; P < .001). Within primary care programs, US medical graduates were much more likely to report GIM career plans than international medical graduates (57.3% vs 27.3%, respectively; AOR, 3.48; 99% CI, 2.58-4.70; P < .001). Compared with their counterparts, maintaining a first-year GIM career plan over the course of their training was more likely among primary care program residents (68.2% vs 52.3%; AOR, 1.81; 99% CI, 1.25-2.64; P < .001), women (62.4% vs 47.2%; AOR, 1.75; 99% CI, 1.34-2.29; P < .001), and US medical graduates (60.9% vs 49.2%; AOR, 1.48; 99% CI, 1.13-1.93; P < .001).
CONCLUSION: Reported GIM career plans were markedly less common than subspecialty career plans among internal medicine residents, including those in primary care training programs, and differed according to resident sex, medical school location, and program type.