Journal of General Internal Medicine最新文献

Background: High-quality primary care is paramount for health equity and cost containment, yet many individuals lack access to a usual source of care. Since 2017, Covered California, the ACA Marketplace, has required all health plans to match enrollees with a PCP to serve as a first point of contact to promote high-value primary care.

Objective: To understand primary care and overall healthcare utilization patterns for enrollees on ACA marketplace plans.

Design: This study analyzed primary care utilization patterns across 1.1 million Covered California enrollees in 2022 under this policy and examined differences in usage of assigned and non-assigned PCPs across product types.

Participants: In total, 1,112,292 Covered California enrollees aged 18 years or older in 2022.

Main measures: Our main measures included utilization rates for assigned primary care providers (PCPs), utilization rates of other PCPs, utilization of all non-primary care services, and rates of non-utilization of healthcare services.

Key results: Results indicated that while enrollees in PPO or EPO plans had higher overall rates of PCP utilization, differences in PCP usage disappeared after correcting for demographic and clinical differences between enrollees in HMO and PPO/EPO plans. However, visits to non-assigned PCPs are common in all plan types. And, 43% of adult enrollees with 12-months continuous enrollment did not have any primary care visits.

Conclusions: We recommend that policy makers promote consistent utilization of any PCP regardless of PCP assignment, as we found that many people use other-than-assigned PCPs even when current policies intend to proactively steer them towards one main point of contact.

U.S. global health experienced marked growth over the last 25 years; however, within internal medicine in the U.S. there has been an absence of coordination across global health initiatives in different specialty groups. This contrasts with U.S. pediatricians, who have fostered connections across their specialty leading to impactful research, guidelines, and resources for pediatricians engaging in global health. We argue that U.S. internists with global health programs would benefit from increased collaboration, and believe this could specifically help to: 1) promote best practices across the field, including in ethics and advocacy; 2) share ideas to amplify the impact of individual programs; 3) increase multilateral global health projects that bring together multiple institutions or organizations; and 4) simplify the processes for international organizations seeking internal medicine partnerships. We provide potential next steps and hypothesize that other specialties across academic medicine could also benefit from such networking, especially given recent reductions in financial and political support for global health within the U.S.

Background: Imposterism-also known as imposter syndrome or imposter phenomenon-has become an increasingly well-known concept within academic medicine, yet there is relatively limited data in the GME population to assess prevalence and/or risk factors.

Objective: To assess the prevalence of imposterism among internal medicine residents across multiple academic medical centers, and to examine its relationship with various demographic groups, as well as psychosocial and experiential factors.

Design: We conducted a national study of internal medicine residents from six major academic institutions. Residents across all sites were invited to participate in this voluntary survey.

Participants: A total of 373 residents (overall response rate 48.4%) completed the survey. Participants were 54.5% female and 49.9% white, with a mean age of 29.52 years (SD 3.47).

Interventions: The survey consisted of two measures of imposterism-the Clance Imposter Phenomenon Scale (CIPS) and the Young Imposter Scale (YIS)-in addition to experiential and demographic questions.

Main measures: The primary outcome was the prevalence of imposterism among internal medicine residents, using the total score from CIPS. Secondary outcomes included comparison of the prevalence of imposterism of various demographic cohorts, as well as associations with potential risk and protective factors. In addition, we examined the association between CIPS and YIS.

Key results: Overall prevalence of imposterism across all sites was 62.7%, with no significant differences in prevalence between institutions. Imposterism was associated with female gender and depression and/or anxiety. Additionally, the CIPS and YIS were strongly correlated.

Conclusions: Our study demonstrated a high prevalence of imposterism among internal medicine residents, consistent across all institutions surveyed. Imposterism was associated with female gender, anxiety, depression, and possibly IMG status. Future research is crucial to develop and identify effective interventions to target imposterism for all trainees.

AI systems are rapidly approaching expert-level diagnostic reasoning; however, management reasoning -the art of translating diagnoses into personalized care-remains distinctly human. While both are forms of clinical judgment, they emphasize different skills: diagnosis is a categorization task that answers "what's wrong?"; management is a prioritization task that answers "what should we do?" Medicine has long privileged diagnostic virtuosity. We drill differential diagnosis in morning report but rarely teach with equal rigor how to navigate real-world trade-offs for patients who value independence over longevity. This imbalance leaves us vulnerable as AI masters pattern recognition. Management reasoning requires what AI cannot currently replicate: integrating human values, navigating system constraints, and building therapeutic relationships. These fundamentally human skills-not diagnostic prowess-should anchor our professional identity. To secure medicine's future, we argue for a deliberate reorientation of medical education and clinical culture. Making space to teach and showcase management reasoning is not just an educational priority; it is essential for defending clinician judgment, relational care, and public trust as AI reshapes medicine's social contract. The goal is not merely finding the "right" answer but preparing clinicians to find the best answer for each unique patient. This is how human care remains truly human.