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REPLY
The Domain of General Internal Medicine: A Perspective from Trainees
Eric B. Larson, MD, MPH, for the SGIM Task Force on the Domain of General Internal Medicine
5 October 2004 | Volume 141 Issue 7 | Page 578
IN RESPONSE:
We agree wholeheartedly that it is crucial that trainees be included in this conversation and are encouraged that ACP, SGIM, the American Board of Internal Medicine, and other organizations have included trainees in deliberations since the release of the SGIM Task Force report. We also agree that from a purely economic viewpoint there are downsides for both trainees and academic training programs in today's training configuration. However, the concept of the optional fourth year to train a master clinician transcends economics; it drives to the heart of what future internists need to optimally treat patients individually and to function as team leaders. If we do not stake out a bold position, our specialty risks becoming indistinguishable from all other primary care providers, including non-MD providers. We envision the future as being led by master internists. The principle driving the SGIM Task Force's strong statement advocating for training reform was based on the notion that training truly should prepare graduates with the skill sets that internists' patients will require, as outlined in our paper.
We agree that the current payment system, especially combined with high student debt, makes the proposed training reform challenging, and we qualified our recommendation with a call for reimbursement reform to reflect this reality. We hope, however, that internists in training and all of internal medicine will continue this dialogue (1, 2) to discover and implement innovative solutions for the challenges facing our patients and the field of internal medicine today. These include reimbursement reform, delivery systems designed around the principles stated in "Crossing the Quality Chasm" (3), and loan forgiveness for persons pursuing generalist careers, among others.
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Author and Article Information
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From Group Health Cooperative Center for Health Studies, Seattle, WA 98101-1448.
1. Larson EB, Fihn SD, Kirk LM, Levinson W, Loge RV, Reynolds E, et al. The future of general internal medicine. Report and recommendations from the Society of General Internal Medicine (SGIM) Task Force on the Domain of General Internal Medicine. J Gen Intern Med. 2004;19:69-77. [PMID: 14748863].[Medline]
2. Starting a conversation about the future of internal medicine [Editorial]. Ann Intern Med. 2004;140:659.[Free Full Text]
3. Committee on the Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Pr; 2001. Accessed at http://www.iom.edu/report.asp?id=5432 on 17 February 2004.
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Perspectives
Health Care System Chaos Should Spur Innovation: Summary of a Report of the Society of General Internal Medicine Task Force on the Domain of General Internal Medicine
Eric B. Larson AND the Society of General Internal Medicine (SGIM) Task Force on the Domain of General Internal Medicine*
- Annals 2004 140: 639-643.
[ABSTRACT][Full Text]
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