Comments on: Not happy with internal medicine’s direction http://www.kevinmd.com/blog/2007/01/not-happy-with-internal-medicines.html medical blog Mon, 23 Nov 2009 01:35:28 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2007/01/not-happy-with-internal-medicines.html/comment-page-1#comment-70791 Anonymous Wed, 24 Jan 2007 04:58:00 +0000 http://clients.emmense.com/kevinmd/2007/01/not-happy-with-internal-medicines-direction.html#comment-70791 Internal Medicine IS taking the wrong direction and the ACP is not helping by cedeing hospital medicine to the hospitalists movement and promoting primarycare as the central care model for the internist. I do truly believe that hospital medicine requiring distinct, unique skills different from primary care. But this is where the internist's excel. This is what give's Internal Medicine its unique dual role identity. Most FPs don't get trained in inpatient medicine and hence don't practice it. Internal Medicine training at it's core is hospital based training. By practicing optimal inpatient medicine and primary care, the internist is, correction was, at the top of the interlectual medical pyramid. I understand the evolution of the field, both from a financial standpoint (why we can't afford to keep running around providing both inpatient and outpatient care) and increased complexity of chronic outpatient care coupled with the agewave. If we can restore the financial model, build a team based chronic care disease model, internal medicine can once again reclaim it's identity. But until then, it will continue to be only a path towards fellowship. Internal Medicine IS taking the wrong direction and the ACP is not helping by cedeing hospital medicine to the hospitalists movement and promoting primarycare as the central care model for the internist. I do truly believe that hospital medicine requiring distinct, unique skills different from primary care. But this is where the internist’s excel. This is what give’s Internal Medicine its unique dual role identity. Most FPs don’t get trained in inpatient medicine and hence don’t practice it. Internal Medicine training at it’s core is hospital based training. By practicing optimal inpatient medicine and primary care, the internist is, correction was, at the top of the interlectual medical pyramid. I understand the evolution of the field, both from a financial standpoint (why we can’t afford to keep running around providing both inpatient and outpatient care) and increased complexity of chronic outpatient care coupled with the agewave. If we can restore the financial model, build a team based chronic care disease model, internal medicine can once again reclaim it’s identity. But until then, it will continue to be only a path towards fellowship.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/01/not-happy-with-internal-medicines.html/comment-page-1#comment-70781 Anonymous Wed, 24 Jan 2007 02:45:00 +0000 http://clients.emmense.com/kevinmd/2007/01/not-happy-with-internal-medicines-direction.html#comment-70781 You mean you can stop training after 3 years of medicine residency?<br/><br/>What does that make me?<br/><br/>I know. A quiter. You mean you can stop training after 3 years of medicine residency?

What does that make me?

I know. A quiter.

]]> By: Gasman http://www.kevinmd.com/blog/2007/01/not-happy-with-internal-medicines.html/comment-page-1#comment-70762 Gasman Tue, 23 Jan 2007 17:36:00 +0000 http://clients.emmense.com/kevinmd/2007/01/not-happy-with-internal-medicines-direction.html#comment-70762 When I was plotting my future career in med school in 1990 internists were still the big men on the ward. The senior teaching staff was a group of which we all stood in awe. Most of the great ones had areas of clinical expertise carved out by years of academic practice, but it was rare that they were specialty trained and boarded. They were masters of medicine first and subspecialists second. But, even then the writing was on the wall. Even then it was common for new grads to seek a fellowship, develop a niche and never become a great well rounded internist. The specialty then needed to more training than three years to become a well rounded general internist. They met this challenge by turning medicine instead into a preliminary position to use as a stepping stone toward fellowship application. When I was plotting my future career in med school in 1990 internists were still the big men on the ward. The senior teaching staff was a group of which we all stood in awe. Most of the great ones had areas of clinical expertise carved out by years of academic practice, but it was rare that they were specialty trained and boarded. They were masters of medicine first and subspecialists second. But, even then the writing was on the wall. Even then it was common for new grads to seek a fellowship, develop a niche and never become a great well rounded internist. The specialty then needed to more training than three years to become a well rounded general internist. They met this challenge by turning medicine instead into a preliminary position to use as a stepping stone toward fellowship application.

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