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Sunday, January 29, 2006

More things I did not become an internist to do

The Jan-Feb issue of the ACP Observer in its "the Business of Medicine" section has a number of suggestions to improve the bottom line for internists who are being squeezed by decreasing reimbursements.

Recently, I wrote about a piece by an internist who talked about things he did not become an internist to do. This article makes the list longer, at least for me.The author suggests group weight loss session and group smoking sessions clinics as well as group stress reduction clinics.Group therapy for whatever was somehow left out of my training program in internal medicine-we seemed to be hung up on mainly learning how to take care of sick patients with complicated medical problems- and even with the new program I somehow doubt internists are particularly trained so that they would consider the skills and knowledge base for those activities part of their "core competencies".

 In my opinion the list gets worse.They mention pulmonary function testing and "breathing treatments". Spirometry makes sense-it is a great tool.Breathing treatments for what? In my years of practicing with 4 other pulmonary docs, we seemed to have no indications for bring folks in for breathing treatments.Another was "dermatological procedures".Again, when did internists begin to think that have any business doing skin biopsies and skin tag removals.At an ACP meeting not too long ago, they offered a mini-course in how to do skin biopsies.The trick there is not so much the technical expertise but the clinical judgment of what lesions to biopsy.That is why we have dermatologists.

Let me end with one more of their suggestions made that will certainly thrill the aunt Suzys and grandmother Marys as they wait in your office. Their suggestion of doing court order drug screening will certainly bring some interesting folks into your waiting Nothing like dealing with unhappy people who are ordered to be tested and who suddenly develop shy bladder.The ACP at its meetings and in its publications seems to insist on trying to make internists more like family docs and in this article more like dermatologists,and psychologists and occupational docs. We will probably hear more of this until and unless major changes occur in how primary care doctors are reimbursed.


Anonymous said...

Good point!

110/70 said...

It seems to me that in densely populated urban areas with good numbers of subspecialists internists are directly competing with family physicians for the same patients. I have not seen a family physician refer a patient to an internist. Maybe I haven’t been around long enough to see it since I’m only a medical student. My subspecialist MD cousin feels that it’s the family docs who are losing in this competition. She says that most adults want to go see an internist, rather than a family physician, while most parents want to take their children to a pediatrician, rather than a family physician. The picture must be different in less urban areas where fewer subspecialists want to set up shop.

sydney said...

My experience in both an urban/suburban practice and small town rural practice is that most people don't know the difference between an internist and a family physician. They think everyone (except the pediatrician) is a family doctor. Look at how the media portrayed internist Howard Dean during the election. They referred to him constantly as a family doctor from Vermont.

Truthfully, as far as reimbursement goes, family physicians and internists are in the same boat. There are endless articles and seminars on learning to do procedures - including the cosmetic only - and offering group visits in order to boost the income directed at family physicians, too.