Practice hassles are threatening our profession

Do you know anyone who has tried to find an internist recently? Good luck. Internists are either overflowing with patients, switching to retainer medicine, switching to hospital medicine or quitting. Internists are frustrated, burned out, and unhappy with the external transformation of our wonderful profession.

We spend 20 years in school, and then 3 years of residency training. We learned to think and apply our cognitive expertise to the diagnosis and treatment of our patients. We did not choose our profession to rush through appointments, author uninformative notes or use EMRs that create unreadable notes. We did not choose our profession to solely tinker with medications for diabetes, hyperlipidemia and hypertension. We went through training to first make a proper diagnosis, and then to individualize a treatment regimen that takes into consideration the patient’s multiple diagnoses, their personal desires and goals, and their socioeconomic situation.

Fee for service has transformed internal medicine in undesirable ways. We worry about RVUs, productivity, and do our best to streamline patient visits. We do not have time to properly investigate the patient’s complaints, or to have important conversations about preferences. No one pays us to do the right thing (or at least how I define the right thing).

Practice hassles are threatening our profession. They got me 15 years ago. I switched to solely teaching inpatient medicine. 2013 inpatient medicine has a better chance of matching the Oslerian ideal than does outpatient medicine. And yet inpatient medicine has many of the same challenges as outpatient medicine.

And who really suffers? The patients too often receive less than our best effort. We hurry between patients, short change the time spent with patients, and stare too long at computer screens. Patients want, and need our attention. They need us to have conversations not brief question and answer sessions. They need us to understand them and treat the patient who has the disease.

Unless we can change the various hassles that current rules impose on billing and EMRs, outpatient internal medicine will continue to die a slow death. Patients need excellent internists who enjoy their profession and love caring for patients. We must extinguish the concept of RVUs and meaningful use. We must return to the principles of good patient care defined by Osler, Tumulty, Harrison and the other giants of clinical internal medicine.

But is anyone listening?

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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