Internists' View of the Future

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) Touring the last decade, there have been major changes in the environment in which medicine is practiced. These changes have usually been initiated from outside the physi¬ cian community by insurers, government regulatory bodies, and the Joint Commission on Accreditation of Healthcare Organizations. The increasing presence of preferred care programs and prospective payment organizations has brought competition for patients as well as direct financial pressures. For editorial comment see 1723.