In my new role as one of the directors of an internal medicine training program, I help select new interns out of medical school for the three year training stint of residency.

At the end of residency, many graduates go on to subspecialty fellowships, another two to four year period of intensive training in fields like cardiology, nephrology, critical care etc.

For those that don’t choose a subspecialty, one choice remains: traditional internal medicine (opening or joining a medical practice) versus becoming a hospitalist.

At this point, it’s no contest. Hospitalists earn  more money. North of $200k.  One standard job format involves fourteen hour shifts, seven days on followed by seven days off. Our graduates are unanimously choosing this path.

I fear that young doctors don’t see value in primary care careers. With health care reform set to kick in in 2014, there will be a tremendous shortage of available doctors for newly-insured patients to see.

I’m reposting a story I wrote about one couple’s painful experience learning about what a hospitalist is. In future posts, I plan to explain the competing tensions between the alternate job pathways in internal medicine and examine the health care workforce as a whole.

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A place many internists no longer see.

A few weeks ago I got a call from Frank Wilson (not his real name).

He told me he and his wife were looking for a new doctor and a new hospital.

Mr. and Mrs. Wilson had been with the same doctor for nearly 20 years. The relationship had been warm, and, he explained, “We trusted him to follow us through thick and thin.”

I could sense the hurt in his voice. Why, I wondered, would they give up on a doctor who knew them so well? Among people of my generation, doctors are switched more than toothpaste.

At a time of need, Mrs. Wilson became sick enough to need the hospital. They called their doctor, let’s call him Dr. Gonomore, and he agreed to see her right away.

Mrs. Wilson was short of breath, and would need to be hospitalized, to figure out exactly what was wrong with her and to offer her the most aggressive treatment.

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