The internist as consultant-generalist

In what would appear an attempt at being fair and balanced Academic Medicine has published a counterpoint to an earlier proposal to dissolve the specialty of general internal medicine. The authors note a rising agenda to differentiate internal medicine house staff, early in training, into ambulatory care providers, hospitalists or subspecialists:

Many changes now proposed would likely damage if not destroy the consultant-generalist ideal of traditional internal medicine training which remains critical to effective medical care in the 21st century.

In my many postings on internal medicine’s lost identity I’ve groped for a term to describe the original ideal of the internist. I think the authors of this piece may have found it: the consultant-generalist. It’s admittedly clunky but it’s a whole lot better than doctors for adults.

My internal medicine training followed the old ideal. When I started practice I was fortunate. I found a group that gave me the opportunity to function as a consultant-generalist. I was the only internist in a primarily family practice group. My patient population, largely filtered through the family practitioners, was a select group of referred patients with particularly complex problems. In return for taking more than my share of the hard cases I virtually never had to see the sprains, cuts, snotty noses and boils. The group, appreciative of my unique training and skills, paid me for what I was rather than what I produced. It was a wonderful experience which provided excellent training for my hospitalist career years later. (Now, mind you, my professional nirvana was gradually undermined by the economic realities of prospective payment, Stark rules and managed care. When that hospitalist job offer came along I was more than ready to jump).

The article, available as free full text, is a must read. It explains internal medicine.

DB weighs in here.