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A Generation Gap for Internists: New Doctors Choose Hospital Medicine, While More Senior Internists are in Outpatient Settings


A Generation Gap for Internists: New Doctors Choose Hospital Medicine, While More Senior Internists are in Outpatient Settings

While More Senior Internists are in Outpatient Settings
Most extensive Hospitalists study is published in the Annals of Internal Medicine

Philadelphia, PA – May 17, 2022 – Hospital medicine is a hot field for early career internists.

According to an extensive new study, internists newly certified by the American Board of Internal Medicine (ABIM), and their late career colleagues are on a divergent path where they see patients and with increasingly less crossover.

In overwhelming numbers, newly certified internists are choosing to practice medicine in hospitals versus in outpatient settings – becoming hospitalists – sharply contrasting with more experienced doctors who previously saw patients in both the inpatient and outpatient settings who are now choosing to solely focus their practices on outpatient medicine.

Published in the Annals of Internal Medicine, a team from ABIM, Beth Israel Deaconess Medical Center and Harvard Medical School studied almost 70,000 general internists certified between 1990-2017 in an extensive look at the growth of the hospitalist field since its inception.

According to the study, there was a large increase from 2008 to 2018 in the percentage of the workforce employed as hospitalists (25% to 40% of the internist workforce) with a similar growth in physicians who limited their practice only to outpatient settings, from 23% to 38% of internists. The two extremes contributed to a big decline in mixed practice where physicians see patients in both the hospital and outpatient settings, dropping from 52% to 23%.

By 2018, the move to the mixed location practice of medicine had hardened. The vast number of new internists were hospitalists, 71%, with only 8% as outpatient-only doctors.

At the same time, 95% of more experienced outpatient doctors were seeing patients in outpatient-only practices, never seeing patients in the hospital.

The data suggests the career choices are not fleeting as 86% of hospitalists in 2013, for example, had been in the same type of practice five years later.

“We are concerned that this trend is not sustainable and that outpatient primary care physician shortages will accelerate as outpatient-only physicians begin to retire with few additional mixed practice physicians who have been bolstering the outpatient capacity over the past decade to replace them,” says Bradley Gray, Ph.D., Senior Health Services Researcher at ABIM. He adds, “the study is part of ABIM’s ongoing effort to better understand the physicians we serve.”

“The physician-created boundaries between hospital and outpatient care creates urgent problems for health systems and private practices to ensure seamless patient care between settings,” says Bruce Landon MBA, MSc, Professor of Health Care Policy, Harvard Medical School and Professor of Medicine and Practicing Internist, Beth Israel Deaconess Medical Center.


To complete the study, the authors used the American Board of Internal Medicine’s board certification database to identify all active general internists certified between 1990 and 2017, linking to Medicare fee-for-service claims data that was available for 91% of these physicians.  The authors examined data through 2018, the most current Medicare data available at the time.

Evolving Practice Choices by Newly Certified and More Senior General Internists, a Cross-sectional and Panel Comparison,by Bradley M. Gray (1), Jonathan L. Vandergrift (1), Jennifer P. Stevens (2), Bruce E. Landon (2, 3) was published in Annals of Internal Medicine. The article may be found online.

Board Certified Doctors Make a Difference
Internists and subspecialists who earn and maintain board certification from the American Board of Internal Medicine (ABIM) differentiate themselves every day through their specialized knowledge and commitment to continual learning in service of their patients. Established as an independent nonprofit more than 80 years ago, ABIM continues to be driven by doctors who want to achieve higher standards for better care in a rapidly changing world. Visit ABIM's blog to learn more and follow ABIM on Facebook, Twitter and Instagram. ABIM is a member of the American Board of Medical Specialties.

Media Contact
Lisa Finnegan 215.399-3992