Birds, Fish, and Subspecialists

Many elegant surveys have characterized the future American internist during the past few years. About 75% of residents plan on subspecialty training, and certain characteristics (religion, economic status, and training in or out of their home states) seem to be associated with this decision.¹In addition, we know that two thirds of residents in traditional training programs who were planning general internal medicine careers change their plans in the course of their training,²despite the generally noted conclusion that there are no longer glaring deficiencies of medical subspecialists in this country. What are the reasons for this distribution? Neither future subspecialists nor future generalists selected their fields on the basis of financial rewards.¹One great predictor is the desire for control over working conditions.¹However, there are certainly more reasons than can be explored by surveys. Most internal medicine training programs would state their goal as