The New Medical Practice Environment

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Abstract
• There have been many changes in the environment in which internal medicine is practiced in recent years. This has been coupled with reports of internists becoming frustrated and of internists leaving primary care practice. We conducted a survey of 219 internists in academic and private practice in western New York. While internists were generally positive regarding the training of residents, there was a pervasive feeling of frustration and demoralization among practicing internists. This demoralization may affect recruitment of new physicians to internal medicine and cause early retirement of practicing internists. The study demonstrated some of the causes of the demoralization. (Arch Intern Med. 1989;149:1745-1749)

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