Hospital medicine a top career choice among new general internal medicine physicians
The percentage of internists seeing patients both in and out of the hospital declined by more than half between 1990 and 2017, according to an analysis of American Board of Internal Medicine certifications and Medicare claims.
Hospital medicine is a top career choice among new internists, a study found.
Researchers studied American Board of Internal Medicine certification data for 67,902 general internists, making up 80% of all general internists initially certified from 1990 to 2017 (n=84,581). Their practice setting types were measured annually using Medicare fee-for-service claims from 2008 to 2018 and were defined as hospitalist (>95% of evaluation and management [E&M] claims for inpatient care), outpatient only (100% outpatient E&M claims), or mixed. The study results were published by Annals of Internal Medicine on May 17.
From 2008 to 2018, the percentages of general internists in hospitalist practice and outpatient-only practice increased (from 25% to 40% and from 23% to 38%, respectively). This was accompanied by a 56% decline in the percentage of mixed-practice physicians (52% to 23%). The study authors observed that these physicians largely migrated to outpatient-only practice. Of the internists certified in 2017, 71% practiced as hospitalists compared with only 8% practicing as outpatient-only physicians.
Most physicians had the same practice type at the end of follow-up, for example, 86% of hospitalists certified in 2013 were still in the field five years later. This retention rate was similar across early-career and more senior physicians (86% and 85% for the 1999 and 2012 initial certification cohorts, respectively) and for the outpatient-only practice type (95%) but was only 57% for the mixed-practice type.
The study authors observed that the results show a major decline in mixed practice, where physicians see patients in both the hospital and outpatient settings, and that physicians who choose outpatient-only careers tend to stay with them.
They wrote, “[I]n addition to the continued increase in the popularity of hospital medicine as a career choice for newly certified physicians, we also observe that more senior physicians have concentrated their practice in the outpatient setting. This shift by more senior physicians has obscured the falloff in outpatient primary care that would have been seen solely based on career choices by newly certified internists.”