Background: Chronic kidney disease (CKD) is a strong risk factor for cardiovascular events, and there are consistence evidences about worse short- and long-term outcomes in CKD patients with acute ...

Internal medicine plays a critical role in providing comprehensive healthcare; however, in recent years, there has been a significant decline in the number of young doctors choosing this specialty. This trend is not limited to Korea but is also observed globally, which raises concerns about the sustainability of core healthcare systems. The declining interest in internal medicine reflects not merely a shift in preference, but a complex issue that is influenced by workload, insufficient compensation, and the high legal risks associated with critical care responsibilities. Younger generations prioritize work-life balance, financial stability, and lower legal exposure, which leads them to select specialties that offer better conditions. Transparency in working environments, compensation, and legal risks through online networks allows young physicians to make informed decisions. In addition, increasing societal expectations and legal burdens in medical practice discourage them from choosing internal medicine. Addressing this issue requires comprehensive and systematic changes, including reducing workload, improving compensation, and implementing measures to mitigate legal risks for healthcare professionals. The Korean Association of Internal Medicine must lead these reforms with a clear roadmap and tangible strategies to restore the appeal of internal medicine to young doctors as a rewarding and sustainable career path.

Many patients with angina or evidence of myocardial ischemia on noninvasive tests have no obstructive coronary artery disease. Ischemia with non-obstructive coronary arteries (INOCA) has been underrecognized despite its association with poor quality of life and effect on cardiovascular events. Two major mechanisms, coronary microvascular dysfunction (CMD) and coronary vasospasm, are keys to INOCA pathophysiology. Although noninvasive tests, such as stress echocardiography, cardiac positron emission tomography, and cardiac magnetic resonance imaging, offer evidence of CMD, the gold standard for diagnosing INOCA is coronary angiography with a comprehensive physiological assessment and provocation test of coronary vasospasm. Here, we provide the etiology and pathophysiology of INOCA and guide for the diagnostic approach and treatment of INOCA.