The subspecialization rate of third year internal medicine residents from 1992 through 1998.
BACKGROUND
The appropriateness of U.S. physician workforce size and the proportion of generalists versus specialists have long been debated. Difficulty collecting reliable data and varying methodologies complicate clear analysis of workforce questions.


OBJECTIVE
This work examines the rate at which internists subspecialized during the 1990s. It also compares two approaches for estimating subspecialization rates: (a) following resident classes longitudinally ("cohort" approach), and (b) comparing 1st year fellowship (F-1) class size to the previous year's 3rd-year resident (R-3) class size (F-1/R-3).


METHODS
Data were collected through the American Board of Internal Medicine's tracking program. Physicians completing their R-3 year in 1992 through 1998 were the participants. The proportion of each R-3 group that eventually entered subspecialty training was examined. Demographic data for those entering subspecialty training and those who did not were compared. Subspecialization rate estimates for the cohort and F-1/R-3 approaches were also compared.


RESULTS
The number of internists increased, whereas the number entering subspecialty training declined. Men were more likely to enter a subspecialty than women. International medical school graduates were more likely to enter a subspecialty than U.S. medical school graduates. University-based residency program trainees were more likely to enter a subspecialty than community hospital program trainees. Those entering subspecialty training tended to be younger and score higher on the internal medicine certification examination than those who did not. Almost identical estimates where produced by the cohort and F-1/R-3 approaches.


CONCLUSIONS
There was a downward trend in the rate at which internists entered subspecialty training during the 1990s. The two methodologies examined produced similar results.
Grosso
Louis J
LJ
American Board of Internal Medicine, Philadelphia, Pennsylvania 19106-3699, USA. lgrosso@abim.org
Goode
Leslie D
LD
Kimball
Harry R
HR
Kooker
Donald J
DJ
Jacobs
Carola
C
Lattie
Glenda
G
D002321:Career Choice; D006302:Health Services Research; D006801:Humans; D007396:Internship and Residency; D008511:Medicine / Q000639:trends*; D013038:Specialization; D014481:United States