Internists
Official title General Internal Medicine Physicians (SOC 29-1216)
Also called Internal medicine physician, General internist, Attending physician, Outpatient internist, Adult primary care doctor
In brief
In May 2025, BLS counted 67,150 US internists, with median pay of $256,560 a year. Of the BLS counts since 2021, the highest was 67,220, in May 2022, close to the May 2025 count. The earliest figure here is an estimate of 41,000 from 1970, not measured the same way as today's count. The current technology era for internists: Ambient AI clinical documentation, since 2022.
What the sources say
Official outlook
BLS projects employment to grow 4% from 2025 to 2035.
AI exposure studies
- 37.1% of this job's tasks are exposed to large language models. Not a forecast of job losses. Eloundou and others, 2023
Data as of BLS OEWS May 2025; BLS Employment Projections 2025-35. BLS publishes these counts as yearly survey snapshots and cautions against reading them as a precise trend.
Last updated .
Cite this page
Future History. (2026, October 11). Internists: jobs and pay since 1970 [Data set; data as of BLS OEWS May 2025; BLS Employment Projections 2025-35]. https://futurehistory.earth/timeline/29-1216
Future History. "Internists: jobs and pay since 1970." Data as of BLS OEWS May 2025; BLS Employment Projections 2025-35. Last modified October 11, 2026. https://futurehistory.earth/timeline/29-1216.
@misc{futurehistory_29_1216, author = {{Future History}}, title = {Internists: jobs and pay since 1970}, year = {2026}, month = oct, howpublished = {\url{https://futurehistory.earth/timeline/29-1216}}, note = {Last updated 2026-10-11. Data as of BLS OEWS May 2025; BLS Employment Projections 2025-35}, }
The access date is today's date on your device.
≈ $249,982 in 2024 prices (derived by us, CPI-adjusted)
September 16, 1889: Johns Hopkins Hospital opens in Baltimore with William Osler as physician-in-chief. Osler, born in Ontario and trained at McGill, the University College Hospital (London), and the Vienna schools, had been professor of medicine at Penn for five years before John Billings recruited him to Baltimore. At Hopkins, Osler created the first American housestaff residency training system, moved medical education from the lecture hall to the bedside, and began writing "The Principles and Practice of Medicine" (published 1892). The book ran to sixteen editions over 40 years and was the world's most widely read medical text for two generations. Osler coined "internal medicine" in American usage in 1895 at the annual meeting of the American Association of Physicians.
Abraham Flexner publishes "Medical Education in the United States and Canada" (the Flexner Report), commissioned by the Carnegie Foundation. In 1907 there were 134,402 physicians in the US, providing one physician per 56 people, which Flexner argued was a dangerous oversupply of poorly trained practitioners. His report found most American medical schools providing inadequate education and recommended closing all proprietary schools and tying medical education to universities with laboratory and clinical facilities. Between 1910 and 1935, more than half of all American medical schools merged or closed. Physician quality rose substantially; physician supply contracted; internal medicine's research-based, university-affiliated model became the standard.
February 28, 1936: the American Board of Internal Medicine is established by the AMA and the American College of Physicians to issue specialty certification to physicians who complete a formal residency in internal medicine and pass a written examination. The inaugural certification examination is administered in December 1936. The first subspecialty examinations follow in 1941, covering cardiovascular disease, gastroenterology, and pulmonary disease. ABIM has since issued more than 425,000 initial certificates and certifies approximately one in four physicians in the United States. The board certification process crystallized internal medicine's identity as a distinct specialty with defined training standards, separating the board-certified internist from the general practitioner and laying the groundwork for the subsequent subspecialty explosion.
Medicare becomes effective July 1, 1966. The AMA had vigorously opposed Medicare, fearing government control of physician fees. Congress appeased physicians by allowing them to bill "customary, prevailing and reasonable" rates, effectively letting physicians set their own fees. For internists who managed the chronic diseases that dominate Medicare utilization (heart disease, hypertension, diabetes, COPD), Medicare created a new and reliable payment stream. The structural problem proved durable: Medicare's fee schedule undervalued cognitive work (the history-taking, reasoning, and counseling that defines general internal medicine) relative to procedural work (colonoscopy, cardiac catheterization, surgery). This structural payment asymmetry drove the specialty income divergence that would thin the general internist pipeline for the next 50 years.
August 15, 1996: UCSF physicians Robert Wachter and Lee Goldman publish "The Emerging Role of Hospitalists in the American Health Care System" in the New England Journal of Medicine, coining the term "hospitalist" and describing a physician whose professional focus is the general medical care of hospitalized patients. The concept had been developing informally as managed care organizations pressured community internists to spend more time in their offices (which drove revenue) and less time making hospital rounds (which did not). The hospitalist specialty grew from near-zero in 1996 to an estimated 44,000 physicians by the mid-2010s, becoming the fastest-growing medical specialty in US history. The Society of Hospital Medicine was formally named in April 2003. The hospitalist movement bifurcated internal medicine into inpatient (hospitalist) and outpatient (general internist) streams, reshaping the workforce composition of the specialty permanently.
The HITECH Act (Health Information Technology for Economic and Clinical Health), signed into law February 17, 2009, appropriated $27 billion to incentivize EHR adoption by hospitals and physician practices through a Meaningful Use payment program, with Medicare and Medicaid payment penalties beginning in 2015 for non-adopters. EHR adoption in US hospitals rose from approximately 10% in 2008 to over 95% by 2017. For internal medicine physicians, EHR adoption meant that the documentation of each patient encounter, previously done by dictation or handwritten notes, became a structured data-entry task performed in a complex software interface. Studies published in the 2010s found that primary care physicians spent over 2 hours on EHR work per each hour of direct patient care, with a substantial share of this documentation occurring after clinic hours. The "pajama time" epidemic became the dominant driver of physician burnout and the leading reason internal medicine residents cited for not pursuing general internal medicine careers.
By early 2025, ambient AI clinical documentation tools have been deployed at a majority of large US health systems. Abridge reports deployment at over 250 health system clients including UPMC, Mayo Clinic, and Johns Hopkins. Microsoft Dragon Copilot (rebranded from Nuance DAX Copilot in March 2025) is deployed at over 750 US health systems. The JAMA 2025 multi-site RCT found that ambient scribes reduced after-hours EHR documentation by 62% with no loss of note quality. For the first time since the HITECH Act, general internal medicine has a credible technology intervention that directly addresses its most acute workforce crisis. Whether this reverses the pipeline decline remains to be seen: the structural economic argument for subspecializing (substantially higher compensation for procedural subspecialties) is unchanged by AI documentation tools.
Will AI replace internists? What the research says
Each figure is stated by the named source; we publish no forecasts of our own. Where sources disagree, we show the disagreement rather than an average.
Each figure is stated by the named source; we publish no forecasts of our own. Where sources disagree, the spread is the honest signal.
What's changing day to day for internists
Three parts of your work where AI is already doing real lifting, and what stays yours.
AI is sitting alongside you hereReview and approve AI-drafted SOAP notes and After Visit Summaries (AVS) generated by ambient documentation tools (Dragon Copilot, Abridge) after patient encounters, verifying each clinical data element against the Linked Sources conversation transcript, correcting diagnostic inaccuracies or omitted findings, and signing the finalized note as the physician of record before it is filed to the EHR.
Review and approve AI-drafted SOAP notes and After Visit Summaries (AVS) generated by ambient documentation tools (Dragon Copilot, Abridge) after patient encounters, verifying each clinical data element against the Linked Sources conversation transcript, correcting diagnostic inaccuracies or omitted findings, and signing the finalized note as the physician of record before it is filed to the EHR.[5],[10],[6]
Ambient AI now handles the drafting step for clinical notes: JAMA's 2025 multi-site RCT found ambient scribes cut "pajama time" (after-hours EHR work) by 62%. Your value shifts to expert clinical review and final attestation. Develop a fast, systematic review practice: treat AI note drafts as a first-pass transcript summary and scan for the specific errors these tools make (omitted pertinent negatives, imprecise symptom timing, and incorrect medication dosing) so your review is faster and more accurate than re-dictating from scratch.
AI is sitting alongside you hereManage prior authorization submissions and clinical appeals, completing EHR-native prior authorization workflows using Surescripts Prior Authorization Automation or Latent Health AI for qualifying medications and procedures
Manage prior authorization submissions and clinical appeals, completing EHR-native prior authorization workflows using Surescripts Prior Authorization Automation or Latent Health AI for qualifying medications and procedures; authoring clinical justification narratives for non-automated PA requests; and reviewing and signing AI-drafted medical necessity letters for insurer appeals.[11],[7]
The complex, high-stakes cases (specialty drugs, off-label use, devices) still require a physician-authored clinical narrative with specific diagnostic justification. Build fluency with your health system's PA tracking tools and develop efficient templates for the recurring PA types in your specialty: the physician who can turn around a complex PA narrative in several minutes rather than many minutes captures significant time back.
AI is sitting alongside you hereConduct AI-assisted pre-visit preparation, reviewing Notable Health AI-gathered patient-reported outcomes (PROs), pre-visit questionnaire responses, and automatically-populated intake data in the EHR before the encounter
Conduct AI-assisted pre-visit preparation, reviewing Notable Health AI-gathered patient-reported outcomes (PROs), pre-visit questionnaire responses, and automatically-populated intake data in the EHR before the encounter; identifying care gaps, abnormal values, and outstanding referral results pre-loaded by the AI; and using this structured pre-charting to focus the encounter on complex clinical judgment rather than data collection.[12]
AI pre-visit tools like Notable Health are reducing the data-collection burden of outpatient encounters significantly: physicians at Providence Health report arriving at encounters with intake already in the chart, allowing more time for the diagnostic conversation and exam. Build a protocol for efficiently reviewing AI-structured pre-visit summaries and train yourself to immediately recognize which pre-populated values are clinically actionable vs. routine: this is where the time savings materialize.
Where internists go next
Natural next steps for someone with your foundation: not exits, evolutions.
- Computer and Information Systems Managers
- US median pay
- $175,140 (May 2025)
- BLS outlook 2025-35
- +15.8%
- Medical and Health Services Managers
- US median pay
- $123,860 (May 2025)
- BLS outlook 2025-35
- +24.2%
- Natural Sciences Managers
- US median pay
- $167,220 (May 2025)
- BLS outlook 2025-35
- +8.2%
What each move takes
Computer and Information Systems Managers
General internists who develop depth in EHR configuration, clinical AI governance, and health informatics are positioned for Chief Medical Information Officer (CMIO), VP of Clinical Informatics, or medical director of digital health roles. As ambient AI scribes (Dragon Copilot, Abridge), clinical decision support tools (Glass Health, Epic Cosmos), and AI patient engagement platforms (Hippocratic AI) become core clinical infrastructure, health systems urgently need physician leaders who can bridge the clinical and technology domains. CMIO base salaries range. Internists have a natural advantage over pure IT managers because they bring lived clinical workflow knowledge that is essential for evaluating AI tool safety and efficacy. A graduate certificate in health informatics or a formal biomedical informatics degree accelerates this path.
- · Health informatics credentials: AMIA 10×10 certificate (online) or Master of Biomedical Informatics for formal entry; ABPM Clinical Informatics board certification (fellowship pathway)
- · EHR platform expertise: Epic build certification (Epic EpicCare Ambulatory or Inpatient Analyst course) to understand configuration levers and AI module architecture
- · Clinical AI evaluation: model validation methodology, clinical safety metrics (sensitivity, specificity, alert precision rates), algorithmic bias auditing
- · HL7 FHIR interoperability: understanding health data exchange standards that underpin AI tool integrations and population health pipelines
- · Healthcare cybersecurity: HHS OCR HIPAA Security Rule compliance for AI systems, risk analysis for PHI in AI workflows
How has the work of internists changed since 1858?
The tools that defined the work, one line per era. Select an era to see how it reshaped the work.
Stethoscope + percussion (Laennec 1816; post-Civil War clinical adoption)
Before the electrocardiograph, the X-ray, or the clinical laboratory, the internist's primary diagnostic instrument was the stethoscope, which Rene Laennec had invented in Paris in 1816 by rolling paper into a tube to listen to a patient's heart without direct contact. The binaural stethoscope reached American medicine by the 1850s. By the time Johns Hopkins opened in 1889, auscultation, percussion (tapping the chest to map resonance), and careful physical inspection were the entire toolkit of the physician of internal diseases. The clinical examination was everything: what you heard, felt, and saw at the bedside was the totality of diagnostic information available. Osler's great contribution was not new technology but a new discipline of observation, teaching residents that a careful physical examination could resolve most diagnostic questions that a subsequent autopsy would confirm. This era established the "physical diagnosis" tradition that remains the foundational skill of every internist trained today.
X-ray + clinical laboratory (Roentgen 1895; Einthoven EKG 1895-1924)
Wilhelm Roentgen announced X-rays in November 1895, and within months hospitals were using them to visualize bones, foreign bodies, and pulmonary lesions. Willem Einthoven's string galvanometer (the first practical electrocardiograph) recorded the first clinical ECG in 1895, with his landmark 1903 paper establishing the P-QRS-T notation still in use today; Einthoven received the Nobel Prize in 1924. These technologies transformed internal medicine from a purely bedside discipline into one that integrated objective instrumental data into clinical reasoning. The clinical laboratory extended this further: blood glucose measurement, bacteriological cultures, and serological tests for syphilis all arrived in the first decade of the 20th century. For the first time, the internist's diagnosis could be anchored in a number that the patient and referring physician could see. The downside was an early form of cognitive overload: clinicians debated throughout this era whether laboratory data should guide diagnosis or whether bedside judgment should remain primary.
Penicillin + cortisone + the therapeutics revolution (1940s-1960s)
Penicillin entered clinical medicine in 1941, fundamentally changing the internist's relationship to infectious disease: bacterial pneumonia, endocarditis, and syphilis, which had been leading causes of death managed with supportive care and hope, became curable. Cortisone followed in 1948 (Philip Hench, Mayo Clinic). Isoniazid arrived in 1952 to treat tuberculosis. Chlorpromazine (1952) began transforming psychiatry, which had been part of general medical practice. Oral diuretics (hydrochlorothiazide, 1958) and beta-blockers (propranolol, 1964) gave internists their first effective tools for hypertension and angina. This therapeutics revolution repositioned the internist from a careful diagnostician with limited treatment options to the manager of a rapidly expanding pharmacological arsenal. It also began the subspecialization pressure: the growing complexity of cardiac disease, gastrointestinal disease, and endocrine disease was generating knowledge that was too deep for any single generalist to hold.
Medicare + fee-for-service expansion (1966) and the specialist income divergence
Medicare became effective on July 1, 1966, and transformed the economics of American medicine. Because Congress included a provision allowing physicians to bill their "customary, prevailing and reasonable" fees, Medicare effectively let physicians set their own reimbursement for the first time within a government program. For internists, Medicare created a new and reliable payment stream for managing the chronic diseases of the aging population (hypertension, diabetes, heart disease, COPD) that dominated Medicare utilization. The structural problem was that fee-for-service payment in the Medicare fee schedule paid cognitive work (history-taking, diagnosis, counseling) at far lower rates than procedural work (colonoscopy, cardiac catheterization, surgery). This payment asymmetry drove the subspecialty income divergence: an internist who subspecialized in gastroenterology or cardiology could earn two to three times as much performing procedures as a general internist managing the same patient's underlying disease. The income gap widened every decade from the 1970s through the 1990s, creating the persistent general internal medicine workforce shortage.
Effect on the workReal physician net income for internists declined from 1975 to 1983-84 despite nominal wage increases, while surgical subspecialties gained.
Hospitalist movement (Wachter + Goldman NEJM 1996; Society of Hospital Medicine 2003)
On August 15, 1996, Robert Wachter and Lee Goldman published "The Emerging Role of Hospitalists in the American Health Care System" in the New England Journal of Medicine, naming and formalizing a practice pattern that had been developing informally. The hospitalist, an internist who specializes entirely in inpatient care, would manage admitted patients full time rather than having community-based internists follow their patients into the hospital between office appointments. The Society of Hospital Medicine was named in April 2003. By the mid-2000s there were an estimated 44,000 hospitalists in the United States, most of them trained in internal medicine residency but now practicing under a distinct identity and billing code. The hospitalist movement had profound effects on the general internist role: it created a new subspecialty that absorbed a substantial share of internal medicine trainees, further reducing the pipeline to traditional outpatient general internal medicine, while simultaneously improving the coordination of inpatient care and allowing outpatient internists to focus entirely on clinic-based chronic disease management.
Effect on the workThe hospitalist specialty grew from near-zero in 1996 to an estimated 44,000 physicians by the mid-2000s, becoming the fastest-growing medical specialty in US history. Most hospitalists hold internal medicine board certification; their reclassification into hospital medicine reduced the apparent headcount of "general internists" even as the total internal-medicine-trained physician workforce grew.
HITECH Act + EHR mandates (2009): documentation burden and "pajama time"
The Health Information Technology for Economic and Clinical Health (HITECH) Act, signed in February 2009, funded incentives for the adoption of electronic health records and penalized non-adopters. Within a decade, EHR adoption in US hospitals rose sharply. For internal medicine physicians, the EHR was simultaneously a clinical improvement (structured data, computerized prescribing, population health dashboards) and a catastrophic documentation burden: studies found that physicians spent two minutes at the computer for every one minute with patients, and that a typical primary care encounter generated a few hours of EHR work per day outside of clinic hours. This "pajama time" -- documentation done at home in the evening on a laptop -- became the defining quality-of-life crisis of a generation of internists, driving burnout and accelerating the workforce exodus from general internal medicine to better-compensated or less administratively intensive positions. The JAMA Internal Medicine 2018 paper "Physician Burnout in the Electronic Health Record Era" (Shanafelt, Dyrbye, et al.) identified EHR use as the strongest independent predictor of burnout among all physician specialties.
Effect on the workEHR-driven documentation burden is the single most commonly cited factor in the decline of internal medicine residency graduates choosing to practice general internal medicine. Studies in the 2010s found that most of US internist time was spent on tasks other than direct patient care, with documentation consuming the largest non-clinical share.
Ambient AI clinical documentation (Abridge, Dragon Copilot; JAMA 2025 RCT)
Ambient AI documentation tools, led by Abridge and Microsoft Dragon Copilot (formerly Nuance DAX), began mainstream clinical deployment in 2022 to 2024. These tools listen to patient-physician conversations during encounters and automatically generate SOAP notes, after-visit summaries, and specialist referral letters. The JAMA 2025 multi-site randomized controlled trial found that ambient scribes reduced after-hours EHR documentation by 62%, with physician satisfaction scores improving significantly and note quality rated equivalent or better. For general internists, this is the most consequential technological change since the EHR itself, running in the opposite direction: the same technology platform that imposed several hours of daily administrative burden is now being used to give that time back. Abridge received KLAS Best in KLAS for Ambient AI in both 2025 and 2026, deployed at UPMC, Mayo Clinic, and Johns Hopkins; Dragon Copilot is deployed at hundreds of US health systems. The secondary AI layer -- clinical decision support tools (Glass Health, OpenEvidence) and chronic disease management agents (Hippocratic AI) -- extends the augmentation further into the diagnostic and panel management tasks that are the core of general internal medicine practice.
Effect on the workThe Feinstein Institutes study warns of a general internal medicine physician shortage by 2032; ambient AI is being explored as a tool that could make the specialty sustainable enough to reverse the pipeline decline.
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Browse all rolesGeneral Internal Medicine Physicians employment and pay by year
View all 13 years of cited US data, each linked to its source
| Year | US employment | Annual pay (median unless marked) | Source | Report |
|---|---|---|---|---|
| 1970 | 41,000 | n/a | Est., Dartmouth Atlas of Health Care Researched context | Report |
| 1975 | n/a | $53,900 | Est., Health Care Financing Review / CMS Researched context | Report |
| 1983 | n/a | $93,451 | Est., Health Care Financing Review / CMS Researched context | Report |
| 1993 | 65,800 | n/a | Est., Dartmouth Atlas of Health Care Researched context | Report |
| 1998 | n/a | $148,000 | Est., Center for Studying Health System Change Researched context | Report |
| 2015 | 114,089 | n/a | Est., American Journal of Medicine (2017) Researched context | Report |
| 2019 | 44,610 | $201,590 | BLS OEWS May 2019 Official statistic | Report |
| 2020 | 50,600 | n/a | BLS OEWS May 2020 Official statistic | Report |
| 2021 | 58,260 | n/a | BLS OEWS May 2021 Official statistic | Report |
| 2022 | 67,220 | $214,460 | BLS OEWS May 2022 Official statistic | Report |
| 2023 | 67,210 | $223,310 | BLS OEWS May 2023 Official statistic | Report |
| 2024 | 66,640 | $236,350 | BLS OEWS May 2024 Official statistic | Report |
| 2025 | 67,150 | $256,560 | BLS OEWS May 2025 Official statistic | Report |