Internal Medicine: No Longer a Primary Care Specialty?

To the Editor.— The 14th installment1of the National Study of Internal Medicine Manpower published in the October 1989 issue of theArchivesprovides interesting data to evaluate the claim that internal medicine training programs are in fact successful at training primary care physicians. Although the point is not clearly made in the authors' analysis of their data, a few simple observations demonstrate that internal medicine training no longer provides the majority of new primary care doctors in the United States. From the data in the article one can see that 28% of all first-year residents will leave internal medicine for another specialty by the end of their second-year residency. Of the remaining 72%, 60% go on to subspecialty training, presumably to practice in a subspecialty environment. Overall then, 71.6% of first-year residents eventually complete at least 2 years of subspecialty training (plus those chief residents who go