IM physician salaries always have been significantly less than the salaries of procedure-based specialists, Dr. Wiese says. “But now the workload of general internists has grown, and it hasn’t grown proportional to compensation, as compared to other specialties,” he says. “That’s compelling to students.”
Dr. Weinberger agrees the compensation disparity is disconcerting to medical students who consider IM because “they are choosing a harder lifestyle. It doesn’t help that the doctors who are practicing internal medicine complain about the hassles and the problems with reimbursement. The role models medical students look up to are not as happy as they used to be.”
—Daniel Dressler, MD, FHM, Emory University School of Medicine, Atlanta
HM Holds Its Own
Hospitalists seem to be surviving relatively well in these difficult times, according to data compiled by the American College of Physicians. In 2002, 4% of third-year IM residents surveyed said they were choosing HM. That number has risen steadily, to 10% in 2007 and 2008, Dr. Weinberger notes.
HM compensation varies widely, Dr. Wiese says; however, the mean salary for HM physicians was $196,700 in 2007, according to SHM survey data. That puts hospitalist salaries at the mid- to lower end of the scale when compared with all medical specialties but smack in the middle of IM specialties.
A 2008 study published in the Annals of Internal Medicine suggests that U.S. categorical IM residents with educational debt of $50,000 or more are more likely than those with no debt to choose a HM career, possibly because they can enter the work force right after residency training, as opposed to continuing with fellowship training for a subspecialty at substantially less compensation.1
For HM to continue gaining ground, many say the specialty has to go on the offensive and not wait for medical students and residents to decide to become hospitalists. “It will be more difficult to recruit from residency programs if there are fewer people going into internal medicine,” Dr. Dressler says. “Hospital medicine will simply be competing for a smaller pool of residents.”
Dr. Wiese says academia can contribute by providing a solid foundation in medicine and a clear path to HM careers as next-generation physicians and leaders. “Hospitalists assuming more of a teaching role are good not only for hospital medicine, but internal medicine education,” Dr. Wiese says. “The stronger the mentors, the more internal medicine students you’re going to recruit.”
The same can be said of medical practice settings, Dr. Weinberger explains. Many ambulatory settings in which medical students and residents work are among the most poorly supported and operated, even though they have the sickest patients, he says. That can be a huge turnoff for medical students. To counter that negative, students must be exposed to higher-quality ambulatory settings, Dr. Weinberger says.
Medical schools can help the cause by admitting students who show an inclination to go into primary care and IM, says Dr. Rosenthal, of Thomas Jefferson University. Those students are more likely to leave medical school in pursuit of a generalist career—especially if they’re matched with good IM mentors.
Federal and state governments should consider paying the educational loans of medical students who promise to practice primary care or IM for a certain period of time, especially in high-need communities, Dr. Rosenthal says. Fifteen years ago, he was a lead author in a study published in the Journal of the American Medical Association that found a significant number of fourth-year medical students would go into primary care, including general IM, if positive changes were made to income, hours worked, and loan repayment.2 Dr. Rosenthal says he’s not surprised physicians and researchers are writing about the same topic today.