Evolving Practice Choices by Newly Certified and More Senior General Internists : A Cross-Sectional and Panel Comparison.

ABSTRACT

BACKGROUND: Hospital medicine has grown as a field. However, no study has examined trends in career choices by internists over the past decade. OBJECTIVE: To measure changes in practice setting for general internists. DESIGN: Using Medicare fee-for-service claims (2008 to 2018) and data from the American Board of Internal Medicine, practice setting types were measured annually for general internists initially certifying between 1990 and 2017. SETTING: General internists (non-subspecializing) treating Medicare fee-for-service beneficiaries. PATIENTS Medicare fee-for-service beneficiaries aged 65 years and older with at least 20 evaluation and management (E&M) visits annually. MEASUREMENTS Practice setting types were defined as hospitalist (>95% inpatient E&M), outpatient only (100% outpatient E&M), or mixed. RESULTS: 67 902 general internists, comprising 80% of all general internists initially certified from 1990 to 2017 (n = 84 581), were studied. From 2008 to 2018, both hospitalists and outpatient-only physicians increased as percentages of general internists (25% to 40% and 23% to 38%, respectively). This was accompanied by a 56% decline in the percentage of mixed-practice physicians (52% to 23%) as these physicians largely migrated to outpatient-only practice. By 2018, 71% of newly certified general internists practiced as hospitalists compared with only 8% practicing as outpatient-only physicians. Most (86% of hospitalists in 2013) had the same practice type 5 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. LIMITATION: Practice setting measurement relied only on Medicare fee-for-service claims. CONCLUSION: Newly certified general internists are largely choosing hospital medicine as their career choice whereas more senior physicians increasingly see patients only in the outpatient setting. PRIMARY FUNDING SOURCE This study did not receive direct funding.