future of general internal medicine??

[chatstew]

I am a PGY-2 in categorical internal medicine - my understanding is that internal medicine training across the nation is in a state of change- for example, procedures are probably going to be made optional for residents to accomplish. And there is talk of starting specialization after the second year itself.
This all makes me think if 15 years down the road general internists would be like the bottom-feeders in the field of medicine. Probably FP may come up in future. No one is going to pay us for only thinking...

---

Members don't see this ad.

 

[duncan11]

I am a PGY-2 in categorical internal medicine - my understanding is that internal medicine training across the nation is in a state of change- for example, procedures are probably going to be made optional for residents to accomplish. And there is talk of starting specialization after the second year itself.
This all makes me think if 15 years down the road general internists would be like the bottom-feeders in the field of medicine. Probably FP may come up in future. No one is going to pay us for only thinking...

I don't think all of general IM is doing poorly. Hospitalist medicine is very popular with new medicine grads, some grads going into hospitalist medicine as a career, others doing a year or two before fellowship. It makes sense from an expertise standpoint. Most well trained medicine grads are very good at inpatient care as it comprises the majority of our training. This part of IM is flourishing, this just leaves outpatient general IM as less popular. I think this represents the bias of our training (much more inpatient care) and our preferences (we went into medicine thinking of inpatient care or subspecialties).

FP seems to be doing the opposite, many FPs no longer do inpatient care, hospitalists groups take care of their patients.

Just like all other areas of medicine, there is more specialization of care, in this case, inpatient and outpatient care are being divided up. There will probably always be internists who still do outpatient primary care, there are still a couple each year, so that is still an option for those who want it.

 

[NDESTRUKT]

General IM is mostly thinking but there are plenty of procedures to be done if you want to learn them. The key is IF you want to learn them. I think a lot of people shy away from them, which I don't know why. If GIM ever became purely thinking, then one could just do a critical care fellowship - just 2 years and you'll be doing some major intensive work, no pun intended.

 

[elwademd]

I am a PGY-2 in categorical internal medicine - my understanding is that internal medicine training across the nation is in a state of change- for example, procedures are probably going to be made optional for residents to accomplish. And there is talk of starting specialization after the second year itself.
This all makes me think if 15 years down the road general internists would be like the bottom-feeders in the field of medicine. Probably FP may come up in future. No one is going to pay us for only thinking...

back in the 60s and 70s, there was an option (granted, it was apparently for high performing residents) to go into specialty training after the pgy-2 year. of course, this was also at the same time as taking the american boards for internal medicine (abim) only once, and never having to take it again. i have an attending who did 2 years, then went into rheumatology fellowship, sat for the abim after 1 year of fellowship, and then took rheum boards after fellowship in the early 70s.

it's funny, as i've been hearing a different opinion, and that there will continue to be a requirement for procedures.
i've also heard talk of lengthening im residency from 3 years to 4 years (with the caveat of less work hours)- which sounds patently false to me, but the head of our gme swears its being considered.

also, from what i'm seeing, some institutions are expecting their hospitalists to have some ability to perform some procedures (intubation, paracentesis, thoracentesis, lumbar puncture).

 

[Otto Octavius]

the pendulum between subspecialties and general will always swing back and forth and is largely driven more by payment/reimbursement issues then anything. with all of the action/or inaction in congress and medicare forcasted to go broke by 2020 (in the prime of your career) and the baby-bommers retiring with not nearly enough physicians or nurses to care for them, I wouldn't trust what anybody would say about what general internal medicine or primary care is going to look like in the near future. I too heard from my program director that the procuedre requirement may be falling out of general internal medicine and that people are going to be allowed to "subspecialize" earlier. This is actually a good thing if you stop and think about it. As a general internist out there in the community: you will never do your own lp's, thoracenteses, central lines etc in the age of VIR and with the private surgeons out there picking up the rest. all procedures have been shown to be safer with some sort of imaging and I think that hospitals will start requiring image-guided procedures instead of the poke and prod at bedside when they start getting sued for complications for non-image guided procedures, and all procedures have been shown to be more safely performed in someone who does many of them all the time rather then the internist who does one thoracentesis every few months.