Comments on: What happened to internal medicine training?

By: Internal-Medicine » Blog Archives » Pseudo Cushings vs Cushings

Internal-Medicine » Blog Archives » Pseudo Cushings vs Cushings — Wed, 24 Oct 2007 01:03:44 +0000

[...] What happened to internal medicine training?The Wall Street Journalâ€™s Health blog has a review of an article published in the Archives of Internal Medicine regarding the perspective us â€œold-timersâ€ have on residency training. The comments that ensued on that blog demonstrate the … Posted in Internal-Medicine | Trackback | del.icio.us | Top Of Page [...]

By: Dr. C

Dr. C — Thu, 04 Oct 2007 17:21:59 +0000

I am from the traditional IM training program of the late 80′s; we were perpetually tired but learned a great deal. I am now 18 years in private practice of general internal medicine in the Washington DC suburbs. My partner of 13 years just quit to become a hospitalist (“I need more time with my family”); my call group has just decided to give up hospital admission and coverage of our patients to the hospitalist group. We anticipate a patient revolt over this decision. I cannot find a “new” physician to replace my partner that does not want to make more than me, work as hard as me or take call.
General Internal Medicine is in its last days….

By: adaptadoc

adaptadoc — Fri, 27 Jul 2007 14:22:59 +0000

Internists, by the thousands, have left primary care and have become hospitalists.

Residents rarely choose primary care as a career move. For those who do choose, they do not last too long.

This reality will change training programs, until some thing compells practictioners to want to go back to office based medicine.

By: RealistDoc

RealistDoc — Thu, 26 Jul 2007 03:43:48 +0000

(That is, society does not deserve the quality of clinicians of the past.)

By: RealistDoc

RealistDoc — Thu, 26 Jul 2007 03:42:22 +0000

Considering my early 1980′s I.M. internship was the House of God incarnate, I think reduction in hours would have provided nothing but improvement.

This may sound brutal, but:

With median medical educational debts now at $250K at the medical school I attended, and high at most non-state schools as well, lawsuits up, respect for physicians down, and for-profit healthcare organizations making their executives and stockholders rich off the backs of clinicians, one must ask the question if society deserves the selflessness of a great many physicians of former generations, or deserves a more inferior quality of care.

I believe the answer is no.

By: anonymous

anonymous — Thu, 26 Jul 2007 02:37:00 +0000

db, what percent of your im graduates go into traditional im jobs? hospitalists? outpatient only? subspecialty fellowships?
thanks

By: Dr. Wes

Dr. Wes — Wed, 25 Jul 2007 16:03:45 +0000

The challenge of strattling the balance between “educational benefits” and shunting patients away from training programs is a formidable one. Take Cardiology services for instance. This service, as a whole, tends to be high turnover. As such, the service is often “ignored” by training programs who perceive they are the brunt of too much “scut.” There seems to be a perception that “all cases are the same.” So what happens? The ER doctors refer to the hospitalists because they will willingly accept the patient and the ER docs don’t have to hear for the 10th time that the residents’ service is “capped.” Unless the program director strives to direct educationally beneficial cases to the training program from the ER’s, the trainees will ultimately lose out.

Initially, hospitalist coverage of the ER began as two days a week at our institution – soon it will move to five…

By: James Gaulte

James Gaulte — Wed, 25 Jul 2007 15:11:42 +0000

From what you describe of your program,you and your associates have make lemonade.From the comments in the Archive Int. Med. article made by some others involved in house staff teaching, that experience does not appear to be universal. It is reassuring , though, to learn that at least in some settings IM resident education programs are doing quite well and I feel sure that at your program residents still learn the prime directive of placing patient welfare first.