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American Board of Internal Medicine's workforce data: Residents, fellows and practicing physicians.

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Grosso L, Iobst W, Lipner RS, Jacobs C. — American Board of Internal Medicine

Presented: Association of American Medical Colleges Physician Workforce Research Meeting, May 2010

Abstract: Data was presented from two American Board of Internal Medicine's (ABIM) workforce data sources examining physician trends through their careers, beginning in residency training through practice 10 years later.

The ABIM tracking program was started in 1989 to collect clinical competence evaluation data annually for internal medicine residents and fellows in internal medicine subspecialty training. These evaluations are required for admission to the certification process. These data are also useful in estimating the numbers of internists and internal medicine subspecialists entering the profession. They show that from academic year 1998/1999 through 2007/2008, the number of third-year internal medicine residents has been relatively stable with the extremes varying by 6%, from a low of 6,724 in 2002/2003 to a high of 7,126 in 2006/2007. Over this period, the numbers entering a subspecialty fellowship increased by 29%, from a low of 3,140 in 1998/1999 to a high of 4,053 in 2007/2008. These data also indicate that, over the past few years, nearly 60% of those who complete internal medicine residency are entering a subspecialty fellowship. This is up from 47% in academic year 1999/2000.

Internists and subspecialists enrolled in the ABIM Maintenance of Certification (MOC) program are asked to complete a practice survey every 18 months. The survey was launched in 2006 and asks a variety of questions about the physician's activities (e.g., clinical versus non-clinical time). These data provide an overview of the current activities of practicing internists and subspecialists. The current data set includes responses collected from about 56,473 physicians from January 2006 through September 2009. Respondents across all disciplines reported that 70% of their professional time was spent in direct patient care. They also reported that 54% of their direct patient care activity is provided in ambulatory or office settings. Most (65%) spend at least 80 hours a month in direct patient care. General internists (i.e., those with only internal medicine certification) report that 60% of their direct patient care activity is primary care. At the same time, with the exception of geriatric medicine, subspecialists reported that on average 2 – 14% of their direct patient care activity was primary care. Geriatricians report 56%. With regard to the type of practice, a little more than half (56%) reported that they work in a single-specialty practice and overall about 15% are in solo practice.

The key advantage of these data sources over many others is that both are direct data about and/or from individual physicians in training and in the MOC process. The major limitation, as with many data sources, is the lack of full participation as well as delays in getting data. In turn, it may take several years to get the most accurate picture of the workforce.

For more information about this presentation, please contact Research@abim.org.