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Generating More Generalists: An Agenda of Renewal for Internal Medicine
- Federated Council for Internal Medicine*
- *See Acknowledgments section for a list of organizations and representatives. Requests for Reprints: Linda L. Blank, American Board of Internal Medicine, 3624 Market Street, Philadelphia, PA 19104. Acknowledgments: The member organizations of FCIM and their representatives in 1992-93 who prepared this statement were as follows: American Board of Internal Medicine: Jordan J. Cohen, MD; Harry R. Kimball, MD; Arthur H. Rubenstein, MD; Gerald E. Thomson, MD; and Linda L. Blank (staff). American College of Physicians: John R. Ball, MD, JD; Paul F. Griner, MD; Rolf M. Gunnar, MD; Eugene A. Hildreth, MD; Willis C. Maddrey, MD; Jack A. Ginsburg (staff); and Howard B. Shapiro, PhD (staff). American Society of Internal Medicine: Yank D. Coble, Jr., MD; Alan R. Nelson, MD; Eugene S. Ogrod II, MD; Richard D. Ruppert, MD; Mark A. Leasure (staff); and Susan L. Rupli (staff). Association of Professors of Medicine: J. Claude Bennett, MD (FCIM Chair); Robert M. Glickman, MD; James P. Nolan, MD; Tod Ibrahim (staff); and James G. Terwilliger (staff). Association of Program Directors in Internal Medicine: Donald E. Girard, MD; Barbara L. Schuster, MD; Herbert S. Waxman, MD (FCIM Vice Chair); and Dema C. Daley (staff). Society of General Internal Medicine: Robert H. Fletcher, MD; Wishwa N. Kapoor, MD; Mack Lipkin, Jr., MD; and Elnora M. Rhodes (staff).
The Federated Council for Internal Medicine (FCIM) comprises the American Board of Internal Medicine, American College of Physicians, American Society of Internal Medicine, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, and Society of General Internal Medicine. The Council was established in 1975 to speak with a collective voice for the specialty of internal medicine. This paper is part of a series prepared by FCIM to address specific actions that the internal medicine community must take to produce more practicing general internists in order to meet the nation's health care needs.
The importance of general internists to the U.S. health care system and the critical role they play in effecting reform in health care delivery has long been recognized by the profession, by the nation's policymakers, and by society [1]. Through the FCIM, the internal medicine community has developed an agenda of renewal that is dedicated to increasing the number of general internists in practice.
Defined as a specialist in the care of adults, the general internist combines the characteristics of a humanistic clinician, diagnostician, primary care physician, consultant, and expert in disease prevention, health promotion, continuing care, and the management of patients with advanced disease. The general internist must be prepared to meet the demands of a rapidly changing and complex health care system while serving as the patient's advocate, being a wise manager of costly resources, and adapting to a constantly changing medical practice environment [2].
This position paper describes the major factors that directly affect the selection, education, training, and practice of general internists and proposes actions that the internal medicine community must take soon if our specialty is to play its proper role in health care system reform. Our goal is to foster the needed action to produce more practicing …
