Friday, June 24, 2005
retired doc wonders if there will be general internists in the future
"Tremendous growth and development of the subspecialist domains of expertise has changed the landscape. Cardiologists are now called in to treat coronary syndromes, pulmonary docs for respiratory failure, etc etc. Oncologists take care of the cancers, kidney doctors the ESRD cases and it is the rheumatologists now giving the disease modifying treatments for rheumatoid arthritis. In short, the areas in which the internist was the expert have largely disappeared and the experts are the IM subspecialists."
"Tremendous growth and development of the subspecialist domains of expertise has changed the landscape. Cardiologists are now called in to treat coronary syndromes, pulmonary docs for respiratory failure, etc etc. Oncologists take care of the cancers, kidney doctors the ESRD cases and it is the rheumatologists now giving the disease modifying treatments for rheumatoid arthritis. In short, the areas in which the internist was the expert have largely disappeared and the experts are the IM subspecialists."
Posted by Kevin |
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Comments:
Someone still has to advise the patient on which subspecialist to see and help make sure that the various subspecialists don't overmedicate if they don't know about each other.
I try very hard not to go to subspecialists. If my internist can handle something, she does. I just don't have time to see multiple docs when one will get the job done satisfactorily.
I try very hard not to go to subspecialists. If my internist can handle something, she does. I just don't have time to see multiple docs when one will get the job done satisfactorily.
What has happened is that both internists and family practitioners have "retreated" to their offices, due to economic issues.
At least where I am (Louisville, KY), subspecialists don't want to see patients for routine things.
What's very true is that you have to be very much a medical businessperson to make it work. The trend I see is that part of what's happening is that the tradeoff for many purely office-based physicians is to see patients only during office hours, and not necessarily be available all hours of the day, seven days a week for phone calls -- you are likely to be referred to an immedicate care center or ER.
At least where I am (Louisville, KY), subspecialists don't want to see patients for routine things.
What's very true is that you have to be very much a medical businessperson to make it work. The trend I see is that part of what's happening is that the tradeoff for many purely office-based physicians is to see patients only during office hours, and not necessarily be available all hours of the day, seven days a week for phone calls -- you are likely to be referred to an immedicate care center or ER.
greg p is right. I have made many calls to FPs and internists during regular office hours and get an answering machine which directs pts. to an ER if they are acutely ill.This leaves the doc (me) at the walk in clinic to make all the decisions unilaterally and the PCP is out of the loop.Sometimes, several hours later, and after the fact,a NP will call back.Office based practice sometimes has "evolved" to mean office based practice on the non-sick.
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