Tuesday, February 01, 2005

Internists as "the doctors for adults"

The American College of Physicians published results of surveys that indicated that around half of those iterviewed said they did not know what an internist was and some of the other half had it wrong.The College has had a "Doctors for Adults" slogan for a number of years and uses it in its advertising,an effort whose aim, at least in part is to correct this ignorance.
One wonders how this slogan differentiates internists from family physicians who also see adults with the same range of medical problems as an internists.Actually,the typical family practice doctor sees and treats more adult problems because of their training in and presumably comfort in managing office orthopedic and office gynecology problems.
At least some in the American College of Physicians want internists to be more like family practioners if the content of some of the recent ACP meetings is any indication.The offerings have including reviews of office gynecology, and woman's health issues and even a mini course in how to do skin biopsies. If an internist is concerned with a nevus on his arm,how likely is it he will say "I think I need to go to an internist to get a biopsy"? Will an internist with irregular periods likely consult with an another internist rather than a gynecologist?
Surveys show the average incomes from family practice doctors and general internists are about the same. So the third payer distorted "market place" does not seem to value internists services more than FPs and surveys indicate many patients do not know the differences anway- if there are any.
As there is more and more pressure to treat hypertension, diabetes etc with guidelines,what extra can the internists offer as any physician presumably can read and carry out the guides? As an internist,I want to believe there are "extras".
The medical landscape has changed so much since I received my internist credentials over thirty years ago that it is hard to rationalize a career choice in general inernal medicine today.There is mananged care pressure from one side and competition from family practice-not to mention nurse practioners and physicians assistants- from the other side.The American College of Physicians offers only a lame slogan,courses in how to be more like a family practice doctor,and exhorts its members to somehow help achieve "social justice" i.e. a "fair" distribution of "scarce" health care resources.


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