Worklife and Satisfaction of General Internists

BACKGROUND: Prior studies have reported relatively low job satisfaction for general internists. We used data from a large US physician survey to assess correlates of satisfaction of general internists. METHODS: The Physician Worklife Survey was mailed to a national random stratified sample of 5704 US physicians. General internists were assessed for their satisfaction, training, patient mix, work hours, the likelihood of recommending their specialty to medical students, and job stability. We then compared them with a specialist sample (internal medicine subspecialists IMSSs) and a primary care sample (family physicians FPs). Logistic regression was used to model predictors of satisfaction, stress, and medical student recruitment. RESULTS: There were 2326 respondents (adjusted response rate, 52%): 450 (19%) were general internists; 502 (22%), FPs; and 438 (19%), IMSSs. General internists were less satisfied than were IMSSs with their relationships with colleagues and with patient care issues (P<.01 for both) and less satisfied than were FPs with community ties (P =.001). Global job, career, and specialty satisfaction were significantly lower for general internists vs FPs and IMSSs (P<.05). General internists spent proportionately more of their work week in the hospital than did FPs (20% vs 13%; P<.001) and more time providing outpatient care than did IMSSs (56% vs 42%; P<.001). General internists had more patients with complex medical and psychosocial problems than did FPs (P<.01) but fewer patients with complex medical problems than did IMSSs (P<.001). Higher satisfaction for general internists was associated with older physician age, less time pressure during office visits, fewer work hours, and fewer patients with complex psychosocial problems (P<.05 for all). General internists were less likely than were FPs to recommend their specialty to medical students (P<.001). Specialty satisfaction, female gender, and control of hassles predicted medical student recruitment by general internists. CONCLUSIONS: General internists' role of caring for patients with complex problems is associated with lower levels of satisfaction than for IMSSs and FPs. Adjusting caseload for patient complexity, expanding time for office visits, and additional training in the care of patients with psychosocially complex problems may improve the job satisfaction of general internists and medical student recruitment into the specialty.