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United We Stand
- Robert M. Glickman, MD;
- James P. Nolan, MD;
- Arthur H. Rubenstein, MD;
- J. Claude Bennett, MD;
- John D. Stobo, MD;
- Maurice A. Mufson, MD; and
- James Terwilliger, MD
- Association of Professors of Medicine, Washington, DC. Requests for Reprints: James Terwilliger, Executive Director, Association of Professors of Medicine, 1001 Connecticut Avenue, Suite 700, Washington, DC 20036.
In recent decades, departments of medicine have grown enormously. More recently, however, there have been suggestions that certain subspecialties (that is, cardiology and oncology) reconfigure as categorical disease centers with an eventual weakening of ties to departments of medicine. Recent trends in health care make such a change undesirable. More and more, general internists will direct and coordinate the care of patients, and fragmentation of departments of medicine will make this task more difficult. The need to practice and teach cost-effective medicine and analyze patterns of care will require a closer working relationship between general internists and specialists. To accomplish these goals, a unified, rather than a fragmented, department of medicine is required.
At the very time when internal medicine and its subspecialties are being asked to act in unison to cope with a rapidly changing health care environment, one increasingly hears of efforts to fragment internal medicine. At some institutions, separate categorical centers (for example, cardiology and oncology) are being formed, often with separate hospital beds, training programs, and finances. The role of a department of medicine as the home for internal medicine and its sub-specialties is being questioned. In this editorial, we examine the implications of fragmentation and conclude that it would be an unwise course for internal medicine.
In every academic medical center, one can find faculty who wistfully recall earlier days, when departments of medicine were administered by a single departmental secretary, the faculty all had contiguous offices, and departmental budgets were a small fraction of today's. Integration was easier then.
In recent decades, however, centripetal forces have grown. Departments of medicine have been transformed because of the dramatic growth of subspecialty medicine, which followed the development of new knowledge leading to improved ways of caring for patients. Departments of medicine have grown to become the …
