The agenda to dissolve general internal medicine

---is moving forward, and will get a big boost as a result of a recently published paper in Health Affairs which compared resource utilization by FPs and internists. (Conflict of interest alert: According to Bob Doherty’s ACP Advocate Blog the study was conducted by a subsidiary of the American Academy of Family Physicians).

From the abstract:

Use of and spending for subspecialists were similar to those for general internists, and both were significantly higher than those for family physicians.

That horribly confusing sentence structure leaves one guessing at exactly what is meant (where were the proofreaders?) but according to Bob Doherty, who apparently has access to the full text article, they’re saying internists spend more than FPs.

The premise in many discussions about this article will be that spending less is better. But less is better only if achieves comparable clinical outcomes, and outcomes were not addressed in the study.

There’s a more basic and equally faulty premise behind the discussions at Doherty’s blog and DB’s thread on this topic: that internists should be no different from family practitioners. The corollary is that internal medicine training should be more like family practice training, specifically that more training time be devoted to the out patient side. I find a great deal wrong with that thinking. The short version of what’s wrong is that it diminishes general internal medicine as a unique specialty. I wrote a longer version here, where I also linked to two important primary sources in the journal Academic Medicine.

I’m a little disappointed but not surprised that Dr. Doherty didn’t address that point. After all, he is writing for the ACP, which no longer seems interested in promoting internal medicine as a unique specialty.