I read somewhere on this board that that te internal medicine generalist is pretty much useless, and to have any kind of success or future in IM, you have to subspecialize. Are there any thoughts on this? Will an IM generalist have anything to do?

There is definitely a long future for the general internist. Besides the fact that most people with any level of education will ask to see a doctor and refuse to just see nurse practioners or physician assistants for their complaints, insurance companies know that there is still a large role for good general internists who can decide when a specialty referral is indicated and when it is not necessary. It's also not legal for insurance companies to reimburse mid-level practioners less then primary care physicians if they are doing the same job, so there's no real incentive for them to make that transition. Don't get me wrong, I do think that the role of mid-level practioners is rising and will continue to rise in primary care and all of medicine, but they will always need physician supervisors to handle the complicated cases or to consult with. And there also is currently a shortage of nurses, so I don't think that could even produce enough nurse practioners to take over all of primary care even if they wanted to. Anyways, I don't know of any long term studies comparing outcomes between people seeing physicians versus midlevel practioners, but I'm sure that there are some underway, but even if there doesn't turn out to be much of a difference, most midlevel practioiners acknowledge that even if they are able to work fairly indepently, a physician should always be close by. I personally hope that there is greater delegation of a primary care physician's workload to midlevel practioners in the future as I think that this will improve a physician's efficiency without compromising healthcare. There's no real reason why a physician must see everyone who comes in with a runny nose. Anyways, ~50% of internists stay in primary care.