The healthcare marketplace has changed substantially since the last assessment of demand for internal medicine physicians in 1996.
We reviewed internal medicine employment advertisements published in 4 major medical journals between 1996 and 2004. The number of positions, specialty, and other practice characteristics (e.g., location) were collected from each advertisement. We then used multivariable modeling techniques to determine relative changes in medical specialty advertising rates over time.
Summary of Results:
4224 advertisements posted 4992 positions. Of these positions, jobs in the Northeast (31% of positions), or single specialty groups (36.8% of positions) were most common. The relative proportion of advertisements for nephrologists fell (p <0.001), and the relative proportion of advertisements for critical care (0.5% in 1996 to 2.8% in 2004, p = 0.004) and hospitalists (1.0% in 1996 to 12.1% in 2004, p < 0.001) rose. The relative proportion of advertisements for outpatient‐based generalist positions (i.e. Primary Care and Internal Medicine) fell (−3.90% relative annual change, 95%CI −6.14%, −1.60%, p = 0.001) during this same time period, but the combined proportion of advertisements for all generalists (e.g. hospitalists and outpatient‐based generalists) did not change (0.92% relative annual change, 95%CI −1.49% to 3.39%, p = 0.4573). Most of the relative decrease in advertisements for outpatient generalists appeared to take place between 1999 and 2001 (−25.5% compared to 1996‐1998, 95% CI −35.5% to −13.8%); there was no significant change relative proportion of advertisements for outpatient generalists after 2001.
Statement of Conclusions:
Since 1996, the relative demand for medical subspecialties overall has remained constant while relative demand has risen for hospitalists and critical care. Rise in demand for generalist‐trained hospitalists appears to have offset falling demand for outpatient generalists, although recent trends suggest that market demand for outpatient generalists is stabilizing. How these marketplace demands can be used to plan education and training requirements should be the topic of future research.
Author Disclosure Block:
A.D. Auerbach, None; R. Chlouber, None; J. Singler, None; J. Lurie, None; R.M. Wachter, None.