Internal and Hospital Medicine: Workforce, Demand and Access in the United States

Summary

US internal medicine and hospital medicine rely on a physician workforce that the latest available federal projections describe as short ¹². HRSA projects a general internal medicine shortage of 20,660 full-time equivalent physicians, and a nonmetro physician shortage far larger than the metro shortage ¹. Hospitalist-specific estimates, reported through a secondary source, show a shortage of 2,860 hospitalists meeting 93 percent of national need, with a forecast of 5,350 meeting 88 percent ². The training pipeline is expanding. Internal medicine offered 11,632 positions in the latest Match and filled 95.2 percent of them ³⁴. Pay is high, with a median wage of 256,560 US dollars for general internal medicine physicians in wage-and-salary jobs ⁹. The source pack contains no verified data on quality, safety, waiting times, digital adoption, reimbursement or burnout, so this report cannot assess those areas. The principal risks are persistent nonmetro shortages and workload pressure. The outlook is that pipeline growth is real, projected shortages are likely to persist in part, and stakeholders need better benchmarks.

Key findings

1. 1

   Projected shortages are concentrated outside metro areas

   HRSA projects a general internal medicine shortage of 20,660 full-time equivalent physicians and a primary care shortage of 70,610 full-time equivalent physicians. The nonmetro physician shortage is reported at 58 percent, far larger than the metro shortage. These are forecasts, relayed through a secondary source.

   Confidence: Medium
2. 2

   Hospitalist shortage estimates point to a growing gap

   A secondary report of HRSA data gives an observed hospitalist shortage of 2,860, meeting 93 percent of national need, and a forecast of 5,350, meeting 88 percent of need.

   Confidence: Medium
3. 3

   The training pipeline is growing and filling well

   Internal medicine offered 11,632 categorical and primary positions in the latest Match, an increase of 1,823 over the prior Match. It filled 11,078 of them, a 95.2 percent fill rate, down 1.6 points from the prior year.

   Confidence: High
4. 4

   Pay for general internal medicine physicians is high

   BLS OEWS data cited by IM Career Source report a median annual wage of 256,560 US dollars for general internal medicine physicians in wage-and-salary jobs. The pack does not split this figure by employer type.

   Confidence: High
5. 5

   Quality, safety, digital adoption and burnout cannot be assessed from the pack

   SHM's workforce experience report covers burnout, workload, autonomy and workplace violence, and SHM added an emergency department boarding question to its state report. The pack gives no figures for these topics, and no verified data on waiting times, readmissions, digital adoption or reimbursement.

   Confidence: Qualitative

1Industry definition and scope

This report covers internal medicine, the specialty of adult general medicine, and hospital medicine, the inpatient practice of hospitalists. The source pack uses general internal medicine for the broad specialty and hospitalist for physicians who work mainly in hospitals ¹². Outpatient primary care appears only where the pack reports it, namely as a projected shortage ¹.

Geographic scope is the United States at national level. The brief named Israel as a non-US comparison, but the pack contains no Israel source. The only non-US source is a Swiss peer-reviewed survey on internists' career choice, which covers a Swiss certification policy ¹⁰. It is used here as a qualitative comparison only. The reporting period is the latest available data: HRSA projections released in the latest period, the most recent NRMP Main Residency Match results, and recent Society of Hospital Medicine (SHM) reports.

Terminology matters. HRSA shortages are expressed in full-time equivalent (FTE) physicians, while the hospitalist estimates are expressed as headcounts ¹². These figures should not be added together or compared directly. The segments covered are the training pipeline, workforce projections, hospitalist staffing and pay, and workforce experience. Care pathway position, service volumes and cost of specific hospital services fall outside the verified pack.

Scope follows the source pack. The non-US comparison named in the brief (Israel) has no supporting source, so the Swiss source is used instead.

2Market size, structure and value chain

The source pack contains no verified market size, revenue, spending or growth rate for internal or hospital medicine. This report therefore does not estimate a market value. Where a figure is missing, the gap is stated rather than filled.

The value chain runs from medical school to residency, certification, and employment in hospitals, hospitalist groups or other practices. Residency is the main entry point for internal medicine. In the latest Match, internal medicine offered 11,632 categorical and primary positions out of 44,344 positions offered across the Match ³.

Hospitalist groups are one organized unit of the workforce. SHM's earlier state report drew on 373 hospital medicine groups, which SHM estimated to represent about 20 percent of practicing hospitalists nationwide ⁷. Group-level surveys therefore capture only part of the workforce, and the pack contains no national census of hospitalists.

Revenue models, billing and reimbursement arrangements are not covered by any verified source in the pack. Key stakeholders include HRSA as the federal workforce analyst, NRMP as the match administrator, professional societies such as the American College of Physicians (ACP), SHM and IM Career Source, and the hospitals and groups that employ physicians. Their roles here are informational. The pack does not show their market shares.

• Median annual wage, general internal medicine physicians (wage-and-salary jobs) 256560US dollars per year Observed United States, Latest available BLS OEWS data (May) [9]

No market size is reported because the pack has none. The wage figure is an occupational median, not a hospitalist-specific pay figure.

3Customers, demand and adoption

The main end users are patients who need inpatient and general adult care, hospitals and health systems that staff hospital medicine services, and physicians choosing a career path. The pack gives no patient volumes, admission counts or prevalence data for hospital medicine, so demand cannot be measured directly. Workforce projections serve as a proxy for capacity.

HRSA projects a general internal medicine shortage of 20,660 full-time equivalent physicians and a primary care shortage of 70,610 full-time equivalent physicians ¹. Both are forecasts. The nonmetro physician shortage is reported at 58 percent and is far larger than the metro shortage ¹. Secondary reporting of HRSA data gives an observed hospitalist shortage of 2,860, meeting 93 percent of national need, and a forecast of 5,350, meeting 88 percent ². The observed figure relates to an earlier period, so the two figures are not a trend measured on one basis.

Purchasing criteria are not well documented in the pack. IM Career Source cites pay benchmarks for job seekers and notes that it does not publish a current burnout rate for all physicians or for internal medicine ⁹. The pack therefore contains no verified survey result on what hospitalists value beyond pay.

Barriers and changing expectations are visible in two areas. SHM's latest workforce experience report covers well-being and burnout, workload and autonomy, workplace violence, and leadership support ⁸, but the pack does not include its findings. SHM also added a question on emergency department boarding to its state report ⁶, which signals that hospitalist programs face access pressure at the point of admission. The pack gives no figures for boarding.

• Projected general internal medicine physician shortage 20660full-time equivalent physicians Forecast United States, Latest HRSA projection [1]
• Reported nonmetro physician shortage 58percent Forecast United States (nonmetro), Latest HRSA projection [1]
• Observed hospitalist shortage 2860hospitalists (headcount) Observed United States, Earlier period, reported by a secondary source [2]

Shortage figures are projections or secondary reports and should be read as estimates of need, not as measured unmet demand.

4Competitive landscape and key players

The pack contains no company-level market share, revenue or ranking for hospitalist staffing firms, hospital systems or physician groups. A fair competitor comparison is therefore not possible. The provider types the pack describes are physicians employed in hospital medicine groups, with nurse practitioners and physician assistants whose presence in hospital medicine continued to expand ⁷.

The brief asks for a comparison of public, private and community providers. The pack contains no verified data on hospitalist staffing or quality by ownership type. Comparable examples are therefore limited, and the gap is recorded in the limitations.

Competitive pressure appears most clearly in the labor market. Internal medicine filled 11,078 of its 11,632 positions, a fill rate of 95.2 percent, down 1.6 points from the prior Match ⁴. A high fill rate shows that programs are still attracting candidates, while the decline suggests recruitment is becoming somewhat harder. This interpretation rests on two observed figures.

Pay is an important lever. BLS OEWS data cited by IM Career Source report a median wage of 256,560 US dollars per year for general internal medicine physicians in wage-and-salary jobs ⁹. The pack does not split this by employer type, so it cannot show how pay differs between hospital employment, hospitalist groups and community practice.

• Internal medicine fill rate, latest Match 95.2percent of categorical and primary positions filled Observed United States, Latest Main Residency Match [4]

No company ranking is reported. The fill rate and wage are workforce indicators, not measures of provider competitiveness.

5Technology, operations and workforce

The pack contains no verified adoption data for electronic health records, telehealth, AI tools or other digital health in internal or hospital medicine. Digital health is therefore not assessed here, and any adoption rate would be unsupported.

The main operational issue visible in the pack is emergency department boarding, which SHM added as a survey topic ⁶. Workload and autonomy are also named as workforce concerns ⁸. The pack gives no length-of-stay, waiting-time or throughput figures, so operational performance cannot be measured.

The table sets out the latest Match indicators. The sources use different definitions. NRMP's count covers categorical and primary positions ³, while ACP's figure covers categorical positions only, across 788 participating programs ⁵. The two counts are not contradictory, but they should not be merged.

A record number of categorical positions and a majority of those seats matched by US medical school seniors suggest domestic graduates are a large share of the pipeline ⁵. The pack does not show how many positions become practicing hospitalists, so the link between training and staffing shortfalls is an inference rather than a measured result.

Table values are shown as reported. Counts are not summed or reconciled because their definitions differ.

6Regulation, standards, risk and sustainability

Jurisdiction: US federal and state rules apply to physicians and hospitals, but the pack includes no verified binding rule on hospital medicine staffing, licensure, scope of practice or accreditation. Binding requirements therefore cannot be identified from the pack. Readers should consult the relevant federal and state authorities for current rules.

Proposed rules and voluntary guidance: none are verified in the pack. Professional society materials from SHM and ACP describe practice trends and workforce data ⁵⁶⁸. They are not binding standards, and the pack does not present them as such.

Quality and safety: the pack has no verified waiting-time, length-of-stay, readmission or hospital-acquired harm indicators for hospital medicine. Evidence standards for quality in this specialty cannot be assessed from the sources.

Privacy and ethics: this report uses aggregate workforce statistics only. It contains no patient data and does not give individual medical advice.

Workforce risk is the main verified risk: projected shortages, concentrated in nonmetro areas ¹², and workplace concerns including burnout and workplace violence ⁸. Environmental and sustainability factors are not covered by the pack.

International comparison: a Swiss study describes a policy that merged general medicine and internal medicine board certifications into one general internal medicine certification to counter subspecialization ¹⁰. The pack does not state whether the policy is binding or voluntary, and it does not report outcomes.

No binding US rule is cited because none is in the pack. Regulatory status must be verified against primary government sources before use.

7Challenges, opportunities and case examples

Major constraints: the sharpest constraint is the projected shortage of 20,660 full-time equivalent general internal medicine physicians, with a nonmetro shortage reported at 58 percent ¹. Hospitalist estimates point to a shortfall of 2,860 observed, rising in the forecast to 5,350 ². Emergency department boarding ⁶ and workload pressure ⁸ add operational constraints.

Opportunities: pipeline growth is the clearest opportunity. Internal medicine offered a record number of categorical positions across 788 programs ⁵, and nurse practitioner and physician assistant roles in hospital medicine continued to expand ⁷. These developments suggest team models can widen capacity, but the pack does not quantify their effect.

Case example one: Switzerland merged its general medicine and internal medicine certifications into one general internal medicine certification to counter subspecialization ¹⁰. This is a national policy example, not a US model, and its effect on supply is not reported in the pack.

Case example two: NRMP's latest Match results and ACP's report on the same cycle show a record pipeline for internal medicine ³⁵. The example shows how a central match body and a professional society report the same workforce from different angles. Their counts differ by definition.

Case example three: SHM's latest state report added a question on emergency department boarding ⁶. It shows a professional association widening its benchmarking to cover access pressure. Company-level examples are not in the pack, so comparable examples were limited.

Examples are drawn only from the pack. Company examples are absent, and the examples given are professional, national or policy sources.

8Outlook and strategic implications

Near term: pipeline capacity is growing. The rise of 1,823 positions in the latest Match ³ and a fill rate of 95.2 percent ⁴ suggest entry-level supply will continue to increase. This is an interpretation of observed figures, not a forecast in the pack.

Medium term: HRSA's projections still show shortages in general internal medicine and primary care, with the largest gaps in nonmetro areas ¹. Hospitalist estimates forecast the shortfall growing to 5,350, meeting 88 percent of need ². The most defensible view is that added training capacity may narrow shortages only in part, leaving rural gaps. Uncertainty is high because the hospitalist figures rely on secondary reporting and the pack lacks demand volumes.

Practical implications: employers should track full-time equivalent and headcount measures separately and target recruitment at nonmetro markets. Workforce policy should address workload and burnout with evidence the pack does not supply. Professional societies should publish verified benchmarks for staffing, quality and digital adoption. Stakeholders should treat the absence of quality, reimbursement and digital data as a priority evidence gap.

The outlook is interpretation based on the projections and observed figures in the pack. It is not a forecast of the market and not individual medical or investment advice.

9Conclusion

The verified evidence supports a clear workforce conclusion. Internal and hospital medicine face projected shortages concentrated outside metro areas, while the training pipeline is growing and filling well. The pack cannot support conclusions on quality, safety, digital adoption, reimbursement or equity. The most defensible takeaway is that workforce supply is the main verified constraint, and that stakeholders need better indicators.

How this was built

Sources

1. 1

   How Many Hospitalists Are in the US? Workforce Size and Job Outlook for Employers

   American Association of Internal Medicine (IM Career Source) citing HRSA National Center for Health Workforce Analysis Industry association

   careersource.im.org
2. 2

   Physician shortage: What will the hospitalist shortage look like in 10 years?

   Today's Hospitalist (citing HRSA National Center for Health Workforce Analysis) News report

   todayshospitalist.com
3. 3

   Main Residency Match results and data (NRMP)

   National Resident Matching Program Official statistics

   nrmp.org
4. 4

   NRMP Releases Results of the Main Residency Match for More Than 38,000 Future Residents

   National Resident Matching Program Official statistics

   nrmp.org
5. 5

   Record High Internal Medicine Residency Match Reflects Vital Role of the Internal Medicine Physician Workforce

   American College of Physicians Industry association

   acponline.org
6. 6

   SHM's State of Hospital Medicine Report

   Society of Hospital Medicine Industry association

   the-hospitalist.org
7. 7

   SHM's State of Hospital Medicine Report release

   Society of Hospital Medicine Industry association

   hospitalmedicine.org
8. 8

   Hospital Medicine Workforce Experience Report and SHM resources

   Society of Hospital Medicine Industry association

   hospitalmedicine.org
9. 9

   What Hospitalists Want in a Job: Survey Data to Shape Your Offer

   American Association of Internal Medicine (IM Career Source) Industry association

   careersource.im.org
10. 10

    Internists' career choice towards primary care: a cross-sectional survey

    PMC (peer-reviewed cross-sectional study, Switzerland) Peer-reviewed

    ncbi.nlm.nih.gov