Several organizations, including the Council on Graduate Medical Education, the Physician Payment Review Commission, and the Association of American Medical Colleges, have noted an approaching oversupply of specialist physicians and have called for more medical students to follow generalist, rather than subspecialist, career paths.
Factors known to influence career decisions include age, gender, and medical school attended.
Little is yet known about whether market conditions, such as managed care penetration, are influencing the number of physicians who elect to pursue subspecialty training. This question was explored by examining whether the proportion of internal medicine residents who elect to subspecialize is related to the intensity of managed care in the areas where they train. Included in the sample were 2,263 graduates of U.S. allopathic medical schools who completed general internal medicine residency training in 1993. The Interstudy definition of managed care was used in this analysis. A logistic regression analysis showed that at managed care levels above 15 percent, there is an inverse relationship between the level of managed care and the decision to specialize.