The United States is the only country in the Western world that has 3 separate tracts for generalist medicine: pediatrics, internal medicine, and family practice.

Is it time for some consolidation? Prominent physician bloggers debate the issue over at Medscape.

There are significant differences between family practice and internal medicine training, but it boils down to the fact that internal medicine residents spend more time in a hospital setting.

That said, I think the question should be rephrased, “Should general, outpatient, internal medicine be merged with family practice?”

And the answer is, perhaps. With the numbers of internal medicine residents choosing primary care declining at such an alarming rate, before long, the whole issue may be moot. The lack of applicants will lead to the eventual extinction of the primary care internist.

I predict that, with the hospitalist boom, general internists will soon be synonymous with an inpatient doctor, ceding outpatient medicine to family practice.

So, as long as hospital medicine is thriving, general internal medicine will continue to be strong, distinct specialty, albeit one solely associated with hospital-based care.