Friday, March 16, 2018

Internal Medicine Needed for Future

It's almost Spring and that means the "Match" has occurred for medical school doctors-to-be.  As American med students go through their four years of post-graduate training, they try to decide what type of doctor they want to be for the rest of their career.  Many things factor into this decision.
How were they treated on specialty rotation? Did they have a mentor? What do they know about the life-style and future earnings of that specialty? How much debt do they carry? And finally, what is intriguing and interesting about that line of work.  Once that decision is made, they apply for residency positions around the country.

I am a comprehensive Internal Medicine doctor, (now known as PCP), so I've always been interested in the fact that we need more physicians to work in primary care to care for the aging baby boomers and complexity of population growth and changes in medicine. Unfortunately, we are far from keeping up with the need.

In the 2018 Match, only 374 primary care residency positions were available across the country.  The remainder (7,542) of the Internal Medicine positions were for doctors who would specialize in Internal Medicine subspecialties (Neurology, Cardiology, Gastroenterology, Rheumatology, Dermatology etc).  International Medical Graduates filled 66% of these positions.  How many of these doctor will remain in the US after training is a big question, especially with current immigration policies.  The US graduates choosing primary care training positions have been declining every year.

The benefits of patients having a personal primary care physician that can help a patient navigate the complexities of care has been proven repeatedly.  Episodic care with a specialist has been shown to be more expensive, poorer quality and fragmented. The high cost of health care in the US correlates with the decline of primary care physicians. 

Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment and compassionate care of adults across the spectrum from prevention to complex illness. 

We are seeing increased training and hiring of allied health practitioners to fill the primary care gap. As much as I value the contributions of nurse practitioners and physician assistants, they do not have the training or expertise to substitute for an Internal Medicine doctor. They are not interchangeable.

How can we remedy this?  National health policies that include complete loan forgiveness and decreasing the burgeoning administrative burdens (paperwork that is now done on computer) would help.  Increasing reimbursement to account for the time spent with patients would help.  High ranking PCP mentors for medical school trainees would help.  National health policies that relieve the reporting and documentation requirements would help.

This problem has taken decades to get us to this critical point in time.  The solutions are complex but if we don't address it head-on, the US will continue to lag in health outcomes and cost.


Anonymous said...

I wonder if there are things European Countries are doing to keep a healthier number of future Internists graduating that can be used as a model for the US and also Japan. Since France and Japan have been high ranking health care by the WHO what they do might maybe help us. I have worried what I will do when my long time Internist retires, since it is comfortable and reassuring to continue seeing a PCP who knows you and canbec trusted for correct and quality care if health issues arise.

Anonymous said...

Have you ever had a vitamin K deficiency case? I'm wondering, if you haven't, would you recognize it when you see it? None of my specialists did, nor my PCP. Neither did about 20 different ER doctors. What do you think? Would you catch it?

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