An Immodest Proposal
I have an idea that's sure to piss off general internists and family docs alike (a sure sign that I'm on to something?): how about if we limit internists to the care of hospital and facility inpatients, and reserve the care of outpatients for the FPs.
Dr. Centor, an academic hospitalist, is obviously excellent at what he does -- in the hospital. He goes out of his way to point out that he doesn't do office care. And much of what he says about internists in offices are, by definition, second hand. If general internal medicine is failing as an outpatient endeavor, the rise of the hospitalist movement seems to be tailor-made as the natural venue for the practice of internal medicine.
I practice exclusively in the office; I don't do hospital or nursing home care. To be sure, there are loudly vocal FPs castigating me as "not a real doctor" for having given those up. Certainly they aren't going to accede to my proposal without a significant fight. But outpatient medicine has its own skill set that includes preventive care, chronic disease management (of multiple concurrent diseases), minor procedures like skin biopsies and lump/bump removal, and acute management of the worried patient with a self-limiting condition, as well as complex diagnostic challenges, among other things. Why not concede that arena to me and my colleagues?
There is a great deal of confusion about the difference between Family Practice and General Internal Medicine. Patients are confused; hell, practitioners are confused. Much of the time, we end up admitting that there really isn't any difference. So why not let Internists concentrate on the "sicker" patients they supposedly excel at caring for -- in the hospital. And let the Family Practitioners specialize in what we do best: keeping people healthy, and out of the hospital.
Let the fur fly...