More on good business vs good medicine

Here’s a cynical letter from an internal medicine physician found on Internal Medicine News:

The headline, “Internal Medicine Seen as Unmanageable Career Choice,” hit home.  One of the last sentences, however, demonstrated that someone missed the boat:

“The initial results suggest that students respond to a structured curriculum, which gives them the sense that internal medicine is a manageable career.”




As a solo internist since 1985, I have seen my modest income from the mid-90s drop like a stone at a time when I need to be most productive, as I look to educate my four children.  The fact is, internal medicine is not a manageable career choice. We are forced to see too many patients, many adults with chronic diseases, and we get paid too little to do this.  In addition, we must either give up hospital care to hospitalists (and see a decline in income) or continue to provide in-hospital care at a time when inpatients are sicker, residency coverage is more limited, paperwork is more burdensome, and risks are much higher.

When on call, because we have so many patients (often around 3,000 for a busy doctor), we are usually peppered with calls, making lifestyle issues a major concern.  The result is burnt out internists telling medical students and residents not to choose internal medicine (primary care) as a career.

The solution is very simple: better compensation for internists. Since that will never happen, internal medicine as a career choice will fall right off the chart in the next 5 years.  So really, the goal should not be to fool seniors into making silly choices.  The reality is, primary care internal medicine is a silly choice for a career.

It is just that simple.

A bleak prediction on the future from someone on the front lines. For someone like me who has only recently been in practice, it isn’t encouraging. The sad thing is, I can’t argue with anything that has been said.  I think your outlook depends on how you approach primary care.  As I have stated before, you have two spectrums – good business on one end and good medicine on the other.  If you think you can practice purely good medicine in today’s environment, you’re sadly mistaken.  If you accept a little bit of good business when you practice (granted, that’s a big if for some physicians), then one can thrive and survive.   

The key point – it’s impossible to practice purely good business with purely good medicine.  The decision is where on the spectrum you choose to fit in.