Abstract / Summary
Abstract Background: In an era driven by hyper-subspecialization and disruptive digital health technologies, the professional identity, operational workload, and career sustainability of non-subspecialized general internists require critical evaluation worldwide. Emerging evidence underscores a global surge in clinical burden and occupational burnout among the frontline medical workforce operating under centralized healthcare systems. This cross-sectional study evaluated professional identity perceptions, operational burdens, socioeconomic equity, artificial intelligence (AI) attitudes, and 20-year survival projections among active general internists. Methods: A nationwide cross-sectional survey compliant with STROBE and CHERRIES guidelines was conducted among 354 active, non-subspecialized internal medicine specialists. Workload metrics, job satisfaction, income proportionality, and AI attitudes were analyzed using Chi-square tests, Spearman correlations, and multivariable logistic regression models. Results: Nearly half of the respondents (48.1%, n = 169/351) conceptualized their systemic role as an "Orchestra Leader (Holistic Manager)", while 24.5% and 12.5% aligned with general practitioner equivalent or triage officer descriptions, respectively. Severe operational density was observed: 76.6% (n = 268/350) examined ≥600 outpatients monthly, and 69.4% (n = 243/350) allocated ≤5 minutes per consultation. Perceived income was deemed disproportionate to clinical liabilities by 61.4% (n = 216/352). Regarding technology, 58.0% (n = 204/352) viewed AI as a helpful but error-prone assistant, with only 3.7% predicting physical physician replacement. Overall, 71.5% (n = 253/354) projected that the systemic necessity of General Internal Medicine (GIM) will increase over the next 20 years due to multimorbidity; however, only 13.8% (n = 49/354) would unconditionally recommend GIM to new medical graduates. In multivariable modeling, perceived income inequity (aOR = 2.95, 95% CI: 1.78–4.89) and non-1st choice specialty preference (aOR = 1.74, 95% CI: 1.05–2.89) independently predicted professional dissatisfaction. Conclusions: While frontline internists maintain robust confidence in the long-term survival and clinical necessity of General Internal Medicine, compressed consultation times and widening financial disparities pose critical challenges to workforce satisfaction and international recruitment.