Firsthand Accounts of Practicing Generalists-Internal Medicine Residency and the 'Leap of Faith' into Primary Care

The shortage of primary care physicians in the United States continues to grow and more internal medicine-trained physicians choose careers as hospitalists than as PCPs. Understanding how and why IM-trained PCPs chose their career path, with a specific focus on their IM residency training, is key to revamping IM graduate medical education training in the primary care setting and to graduating more PCPs.

To identify factors associated with residency training at a categorical IM residency program that positively and negatively impacted recent graduates' decisions to become either a PCP or a hospitalist.

Qualitative semi-structured interviews based on the careership sociological theory conducted in April-May 2024.

Sixteen graduates of a large, academic, urban, categorical IM residency program who completed training within the past seven years; eight work primarily as PCPs and eight as hospitalists.

Interviews were conducted online and transcribed verbatim. The codebook was developed inductively and co-coding of all 16 transcripts was completed. Inductive thematic analysis was completed with the themes triangulated among the study team.

Participants in both the PCP and hospitalist groups identified hybrid careers such as clinician-educator and clinician-investigator as major drivers towards general internal medicine careers. PCPs reported that beginning their career as a PCP was challenging and filled with uncertainty; this was eased by their mentors and the community of physicians with whom they worked. Hospitalists, on the other hand, noted confidence in their abilities upon beginning their careers, likely due to their extensive inpatient training as residents.

PCPs and hospitalists trained in academic programs desire variety in their professions. Revamping GME training to support hybrid careers may drive more graduates into GIM and strengthen the primary care pipeline, but this shift will require healthcare systems to create structures that embrace and sustain such careers.