Workforce Needs for Internists in the Islamic Republic of Iran until 2021

Internists contribute to the care of sizable populations for a vast variety of conditions. However, despite the importance of the need assessment for these specialists in Iran remains uncharted. The purpose of this paper is to address this issue and to recommend further actions related to training of internists.Internal Medicine is a 4-year specialty program, for which candidates can take a specialty entrance examination only after finishing their medical school, including an18-month Internship, and registration as medical doctor (M.D) by the Iranian Medical Council. The entrance examination is held in two stages, a multiple choice question- and an oral examination. Currently in 2009, approximately 3000 internists are working in the I.R. Iran. Since the year 2000, number of yearly admissions for specialty training of internal medicine has ranged between 180 and 213. Based on the population needs of hospital care , ambulatory care ,population growth, there is a need to have 6700 positions available for clinically trained internists in the Islamic Republic of Iran which yields a ratio of 1 internist for every 11,000 population (6700 for 74 million), a ratio that is much lower than the mean ratios of internists in many countries. It is estimated that Iran will reach a population of 90 million by the year 2021, at which time the country will need the services of 8200 internists. If the yearly admission rate of 220 internal medicine residents continues, in the next 13 years, only 2860 internists will enter the practice and total number of internists will reach 5860, by the year 2021. However, since during the next 13 years, approximately 1430 internists will enter subspecialty trainings, making the total number of those practicing pure internal medicine 4430, i.e. 3770 less than the 8200 internists needed. It is vital that these estimates be urgently analysed in greater detail to emphasize the criticality of the dilemma to the public and the government, and to identify solutions to avert the enormous consequences that the shortage of internal medicine and its subspecialties may have for public health