title: Major concerns about internal medicine: insights from program directors.
abstract: OBJECTIVE
  To better understand and characterize the challenges facing internal medicine from the perspective of internal medicine residency program directors.
  
  
  METHODS
  In 2007, internal medicine program directors were surveyed by the Association of Program Directors in Internal Medicine (APDIM). An open-ended question asked: "What are your major concerns regarding internal medicine?" Responses to this question were independently coded by two investigators and compared for agreement. Content analysis identified several major themes related to their concerns.
  
  
  RESULTS
  Of the 236 program directors completing the survey, 186 (79%) answered the question and explained their concerns. Approximately one half of the informants were general internists. There was a fairly even distribution among assistant, associate, and professor ranking. All regions of the country were represented. Five themes emerged as the program directors' major concerns about internal medicine: waning interest in internal medicine, especially primary care; onerous regulatory oversight; economic pressures; the eighty-hour work week; and fragmentation within internal medicine.
  
  
  CONCLUSIONS
  By virtue of their role, internal medicine residency directors gain a unique understanding about the core elements that contribute to declining interest in careers in internal medicine, which is particularly relevant given the current primary care workforce crisis. Collaboration among stakeholders that can influence healthcare policy to address these concerns about internal medicine will be necessary to revive interest in the field.
authors.affiliation: Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA. jrecord2@jhmi.edu
authors.forename: Janet
authors.initials: J
authors.lastname: Record
authors.forename: Brent
authors.initials: B
authors.lastname: Beasley
authors.forename: Furman S
authors.initials: FS
authors.lastname: McDonald
authors.forename: Scott
authors.initials: S
authors.lastname: Wright
mesh_terms: D002321:Career Choice; D003625:Data Collection; D006801:Humans; D007388:Internal Medicine / Q000191:economics / Q000193:education / Q000458:organization & administration; D007396:Internship and Residency / Q000191:economics / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration; D012577:Schools, Medical / Q000191:economics; D014481:United States; D000078329:Workforce