Anastasis

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So I have been getting more and more interested in general internal medicine. I don't (at this point) have any desire to specialize. A GI I was shadowing said that general internal medicine is being phased out and in the future it will be mostly specialists. Does anyone have any thoughts on this? Do you think he's right? Sounds like bull to me, but I could be wrong.
 

deuist

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Without internists, who would act as the primary care physician?
 

Anastasis

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That's what I thought too. Glad to hear I'm not just insane.
 
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Anastasis said:
That's what I thought too. Glad to hear I'm not just insane.
You can be correct and still be insane -- they are not exclusive conditions. I don't believe deuist gave any opinion as to your sanity. :)
 

Anastasis

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You can be right and still be insane? *blink*

This explains so much.
 

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Remember that insane only means you can't tell right from wrong in a legal sense. You can be terribly crazy, still be sane and still be right.
 

LizzyM

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A fellowship in General Internal Medicine in training beyond that in Internal Medicine. The focus is on primary care of adults including preventive services (the ordering of screening tests - for whom, how often, etc), behavioral change for better health (diet, exercise, smoking cessation, seatbelts, alcohol), management of chronic disease that does not require the services of a subspecialist (primary hypertension, high cholesterol, adult-onset diabetes, osteoporosis, seasonal allergies, flu, minor infections). The internist is also the gate-keeper who refers patients to specialists. This means knowing who to recommend when a patient has a suspicious mass or needs a procedure.

You can google Journal of General Internal Medicine and read the table of content if you want an idea of what the specialty does.
 

Anastasis

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Thanks for the info. I never thought of looking at the journal; that could be interesting. One of the docs I shadow gave my Harrison's Internal Medicine and I have been reading it. That's what got me interested in the field but then the GI specialist busts out with that and I'm worried if it will even be an option by the time I go for residencies. Neurotic I know.
 

LizzyM

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I can't imagine that Internal Medicine (and General Internal Medicine as a subspecialty with Internal Medicine) would ever cease to exist. People need someone who can provide "one stop shopping" for annual screening exams (cervix, breast, prostate), immunizations, common acute problems (do you need a ENT for a strep throat?) and management of chronic conditions.
 

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The AAMC has called for more primary care physicians, not less. I doubt that GIM will be phased out anytime soon. There may even soon be financial incentives offered to med students to attract more people into primary care fields. The General internal medicine program here at UASOM is big, despite the fact that the school is absolutely research oriented.
The comments you heard from that MD may be representative of the attitude toward GIM in your school/region, however. Look around to find a residency at a school that is serious about training primary care physicians as well as specialists.
 

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deuist said:
Without internists, who would act as the primary care physician?
Family Practice
 

mustangsally65

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I think that even if medicine did become uber-specialized, in small towns and rural areas there would still be general practictioners (I know that's an older term, but it's still used in rural America). With rural and underserved areas there just isn't a surplus of specialists, so your family doc/internist would still play a huge role in caring for the majority of patients. In my neck of the woods, family docs take shifts regularly in the ED because there aren't enough EM physicians to staff the ED 24/7.

I hope to go into family practice myself, and practice in a small town like the one where I grew up. Go primary care! :p
 

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mustangsally65 said:
I hope to go into family practice myself, and practice in a small town like the one where I grew up. Go primary care! :p
:clap: That's me too! I just like the idea of internal medicine more than FP having gotten a bit of a taste of both. I'm sure I'll get more of an idea in med school.

Rural medicine is such a complicated issue - I wonder how long before that's kinda a field in it's own in a way. Does that make sense?
 

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deuist said:
Without internists, who would act as the primary care physician?
NPs and PAs. I don't think the MD in primary care is going away, but in all but quite rural areas they are certainly taking a somewhat diminished role, or are becoming managers/support to the mid-levels which they hire.
 

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I guess I just don't see the appeal of being a primary care doctor. Especially in a small town :confused: I guess I just see it as more the role of a FNP or PA- just like Sac pointed out.

More power to you guys (and gals).
 

Anastasis

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Praetorian said:
I guess I just don't see the appeal of being a primary care doctor. Especially in a small town :confused: I guess I just see it as more the role of a FNP or PA- just like Sac pointed out.

More power to you guys (and gals).
Are you more into the research side? I like treating patients; I live for those days at the clinic. But I would never become a PA just because I have issues with authority and I would hate to always need to answer to someone. Not to mention that the fact that becoming a doctor is damn hard intellectually is really appealing to me. The rural thing is mainly because it's what I prefer. I've lived both places and the pace of life in a rural setting is more my ideal.
 

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No, actually I love the clinical side of things (although I like research and plan on continuing my research involvement). I just plan on specializing because I find primary care boring, mundane and repetitious. I do not see the point of going through 4 years of undergrad, 4 years of the intellectual challenge of medical school, and 3 years of residency, only to turn around and do a job that can be more than adequately handled by an allied health provider with about half the training.

By the way, I grew up in a town of 125 people and I love living in the country and plan to do so, but I just have no interest in practicing there.
 

LizzyM

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As I see it, General Internal Medicine is more of a subspecialty within academic medicine - not something that someone does a fellowship in so as to practice in a rural location.

GIM appeals to those who are not interested in a practice that includes children and pregnant women. From what I can see where I am in a densely populated urban area, internists are the physicians who care for non-pregnant adults just as pediatricians care for children and OBs care for pregnant women.

There is significant research in GIM that involves such things as policy recommendations, changing physician behavior, tweaking the system to improve patient care, changing patient behavior, preventing illness and injury and early detection and treatment of illness.

There is tremendous variety in the types of problems a internist sees and as the first line there is a lot of diagnostic skill and clinical decision making in ones practice of GIM.
 

Anastasis

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LizzyM said:
There is significant research in GIM that involves such things as policy recommendations, changing physician behavior, tweaking the system to improve patient care, changing patient behavior, preventing illness and injury and early detection and treatment of illness.

There is tremendous variety in the types of problems a internist sees and as the first line there is a lot of diagnostic skill and clinical decision making in ones practice of GIM.
I pointed out the research thing in reply to where he (I'm assuming he's a he! Sorry if I'm wrong) wants to practice. I have no interest in research so I really don't care about being close to a big research hospital. The diagnostic skill is the side of internal medicine that appeals to me. When I've shadowed the specialists, it was then I thought their days had too much repetition for me.

Praetorian - so the growing up in a small town and wanting to treat patients obviously doesn't hold true. It must be mostly a personality thing then. I have the utmost respect for specialists; it's a job someone needs to do. When I said I had no desire to specialize, that's not entirely true: I think cardiology and Endocrinology interest me. The latter only because I'm interested in Diabetes which I would see as an internist. So there's no circumstances that would make your reconsider being a PCP?
 

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I'm new to the terminology, is a family practice doctor a combination of Internist, OB/GYN, and pediatrics?
 

OSUdoc08

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USCguy said:
I'm new to the terminology, is a family practice doctor a combination of Internist, OB/GYN, and pediatrics?
No. They do see all of the patients, but have far less training in each area.
 

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i think it would be a huge mistake for the U.S. to move in the direction of more specialization rather than less. controlling for all other factors, our obsession with specializing is one of the major reasons why our health care costs are so much higher than other industrialized nations. i also think it's vital for patients with multiple medical conditions to have someone coordinating all this care. if they only go to see independent specialists who have minimal communication with each other, quality of care will really suffer.

i have to agree with some of the remarks above, i think primary care doctors are going to have a more managerial/support role in their practices. they won't see routine patients, or do as much preventive care, that will be handled by midlevel providers. what they will do is see more complicated/chronic cases. the drawback is that there won't be as much of the traditional, continuity-of-care going on. as a PCP, the first time you'll see a patient will be when they're very sick. no more following the same patients through both sickness and health, so that you know them as a "whole person"

in any case, i think that if you are very serious about being a rural doc in a small town, you should think about how you'll best serve the community. it may be that you'd be of most use if you got training in family medicine: that way, you'd have the ability to take care of whatever walks in your door, including children and pregnant women, and you'd have more training to do minor procedures and take care of musculoskeletal problems. my impression is that IM residencies are mainly focused on inpatient care, and that's not even what you want to do, right? also, keep in mind that increasingly, internists are getting pigeonhold into seeing mainly geriatric patients. if you love that patient population, great. if you want more variety, family practice may give you more opportunities. there's an interesting post in the FP forum right now by someone who regrets going into IM instead of FP.

finally, while i appreciate that you find the intellectual challenges of IM more intriguing than those of FP, keep in mind that once you're out in the real world practicing, there's not going to be a whole lot of difference in your day-to-day life, and how much intellectual challenge you get. a primary care doctor is a primary care doctor, the major difference is in who you're qualified to see.
 
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