A Practicing Internist's View of the Future of Internal Medicine
Article Outline
To the Editor:
I read with interest the recent article in The American Journal of Medicine concerning the future of internal medicine.1 I have been a practicing internist for almost 30 years and can see that the practice of medicine has changed substantially. We, as doctors, have not kept up with these changes in both training and the delivery of medicine. These changes have been brought about chiefly by economic, malpractice, insurance, politics, and quality-of-care issues. For good or bad, the practice of medicine has been realigned, very similar to the practice of medicine in Britain. I propose that, rather than a complete revamping of our old training programs, we change the new training programs thusly—replace family medicine programs with a program specifically geared toward training a physician who cares for ambulatory adults. This track would be called ambulatorists. I would propose that the internal medicine track be replaced and be, specifically, training grounds for hospitalists, intensivists, and specialists. This means that ambulatorists would care for outpatients and never go to the hospital. Hospitalists, intensivists, and most sub-specialists would be hospital based. I would suggest then, that students align themselves into either ambulatorists or hospitalists/intensivists/specialists. This means that they would probably spend 2–3 years in family medicine programs that would now be called ambulatory programs geared specifically for ambulatory medicine. Most family medicine programs now are undersubscribed for various reasons. I would suggest that we eliminate from the family medicine programs general surgery, orthopedics, and obstetrics/gynecology because most family doctors, unless they are practicing in a very rural setting, for malpractice reasons do not practice any of these specialties in their daily care patients. If a physician became an ambulatorist in a primary care setting that was very rural, he or she could take electives in these areas.
I realize that this is a substantial change in the training of future physicians, but I think it is better aligned with what we actually do. I also think that quality of care would not be impacted and perhaps be improved, and it would satisfy the various insurances and economic gatekeepers who watch what we do daily.
The numbers of students going into primary care medicine has been dwindling of late and will continue to do so. Perhaps dividing this into ambulatory and hospital care may attract more students, and, by shortening their training, they may be able to recoup faster some of the monies that they have spent on their medical education. I would be very interested in your thoughts concerning this revision of medicine and care by primary care physicians as well as hospitalists, intensivists, and specialists.
Reference
PII: S0002-9343(08)00247-7
doi:10.1016/j.amjmed.2008.02.029
© 2008 Elsevier Inc. All rights reserved.
