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The Future of Internal Medicine
- Robert G. Petersdorf, MD; and
- Lara Goitein, BA
- Requests for Reprints: Robert G. Petersdorf, MD, Association of American Medical Colleges, 2450 N Street, NW, Washington, DC 20037. Disclaimer: The opinions expressed in this paper are solely those of the authors and do not reflect policies of the Association of American Medical Colleges. Acknowledgments: The authors thank Ms. Linda Blank, American Board of Internal Medicine; Mr. Christopher Lyttle, The University of Chicago, Center for Health Administration and Studies; and Mr. Charles Killian, Association of American Medical Colleges, for valuable information and criticism; and Ms. Sandra Gordon for assistance in preparation of the manuscript.
Abstract
Internal medicine may be in its twilight because it has failed to address the shortage of primary care physicians by training more general internists. Data from several sources indicate that progressively fewer persons are entering general internal medicine as opposed to its subspecialties. The reasons for this decline include adverse experiences in medical school, an unfavorable patient mix, declining incomes, and increasing hassles in caring for patients. A series of reforms, such as improving the teaching in medical school, strengthening divisions of general medicine, and establishing financial incentives, are proposed to reverse this trend. Other actions that must be taken include stopping the proliferation of subspecialty certificates, designating and accrediting primary care tracks, and cutting subspecialty positions. Internal medicine's fate is in its own hands, and the discipline must reorient itself to conform to societal needs.
- Copyright 2004 by the American College of Physicians
