Career Changes in Medicine: Part II

We have known for some time that fewer medical students (1) and internal medicine residents (2) are deciding on careers in primary care. Of the several factors contributing to this trend, experiences during medical school and residency are probably important, but we have a limited understanding of which experiences are decisive. Experiences in practice also contribute. Earlier this year, Annals of Internal Medicine published an article showing that many board-certified internists were leaving general internal medicine (GIM) (3, 4). As we try to transform primary care into a desirable career choice, we need to know more about when students and residents make their decisions and why they choose primary care (or why they do not). An article in this issue by West and colleagues (5) helps fill this important gap. It allows us to follow the career preferences of a large cohort of residents in each of the 3 years of residency. The findings suggest to me that GIM starts at a disadvantage but competes well over the 3 years of residency training.

West and colleagues surveyed residents taking the In-Training Examination (ITE). The ITE consists of a comprehensive written examination and a brief optional survey. Most residents take the ITE during their second year of training, but some take it in all 3 years. The examination takes place in November. The authors studied a cohort of 2638 residents taking the examination and filling out the survey in 2002, 2003, and 2004. In each year, the survey contained this question: “What is your ultimate career plan?” Residents who replied “Subspecialty” then answered a question about their intended subspecialty. In …