Tuesday, October 25, 2005

'Why I did not become an internist"

Through the incredible-almost most endless- amount of material that reverberates through the internet I came across a now 10 year old letter to the Annals of Internal Medicine. It is short and expresses much of what I have thought over the last 10 years. Twenty plus years ago, the author did not become an internist to A) be a family doctor, B) to lead the way in informatics C) to master systems and lead quality programs. He learned to take care of sick patients, sometimes very sick patients and quarterback the details of complex, multisystem clinical situations and to try and unravel difficult clinical problems.The author, Dr. Michael Pauszek, receiving his four years of post medical school education in the late 70s, was trained, as was I , to take care of sick patients and have the breath and depth of medical knowledge to diagnose difficult cases. General internists are still needed to do such things but the economic and structural landscape of medicine has changed even more since his 1995 letter that now more than then internists may well not be able to make a living doing what they do best and more and more are relegated to being more like family doctors and would-be office gynecologists and amateur dermatologists in the office while fighting underfunded turf battles with hospitalists and intensivists (words that were not coined when he and I trained) in the hospital (the long ago domain of the internist.) We read of more straw grasping for internists. For example, recently a IM newspaper touted the virtues of an internists developing a niche in sports medicine to supplement income.I recently injured my knee while running. The first thought I had was not "Let me try a find a good internist who dabbles in sports medicine". Another was for internists to consider becoming expert in ob cases with complicated medical problems providing - in my opinion-a unique opportunity to combine physician stress, the same relatively low internist compensation rates plus probably malpractice premiums closer to those of the high risk ob warriors than the procedureless general internist.Of the two suggestions at least the second involved what internists do best, taking care of complicated sick patients, not pretending to be something else.

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