Sunday, October 28, 2007

Hospitalists and primary care

The hectic pace of hospitalist duties last week brought blogging and blog reading to a screeching halt. Today afforded me a little catch up time to comment on some interesting items from the last few days. Bob Wachter and DB wrote three insightful posts about the sorry state of primary care, particularly internal medicine. Is the hospitalist movement to blame? No.

General internists are struggling with two increasing threats to their livelihood and professionalism. First, the existing payment system pressures them to spend inadequate time for quality care of individual patients. Second, various forces have redefined general internal medicine as “family practice minus ob and peds”.

Is anyone advocating for the general internist? Dr. Robert Centor (DB), past president of the Society of General Internal Medicine, has done his part. The American College of Physicians, on the other hand, seems uninterested in promoting internal medicine as a unique specialty, merely depicting general internists as “doctors for adults”.

Although the hospitalist movement didn’t cause these problems it provided internists an alternative career path with reasonable compensation and professional satisfaction, giving them an opportunity to vote with their feet. The resulting mass exodus from primary care will make internal medicine’s doldrums a hot public issue. For that reason the hospitalist movement may ultimately help rather than harm the cause of primary care.

Recommended reading:

Retired Doc asks: Is being a hospitalist the only way to still be an old time internist?

The Happy Hospitalist weighs in.

The American College of Physicians proposals don’t address what’s really wrong with internal medicine.

Med students and pre-meds chat on line and express confusion about the difference between FP and IM, and wonder if there’s any reason in the world to choose IM. (The answer seems to be NO unless you want to sub specialize or be a hospitalist).

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