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Rapid Responses to:
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Electronic letters published:
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif){kind=icon}
Regarding residency reform
Still Missing the Main Attraction
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Stephen E. Sandroni, MD Allegheny General Hospital
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sandroni{at}pol.net Stephen E. Sandroni
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Reform requires reality. Current reimbursement for cognitive work in internal medicine is insufficient relative to current resident debt levels, and no reform that fails to address this will be successful. Philosophically we must return to the concept that service to our fellow citizens is one of the great satisfactions of being a physician. It is troubling to see the semantic shift that now links the idea of service to the institution's benefit--and therefore something we must not use as a basis for training-- instead of to the patient who needs our help. "Patient-centered" is only half of the story; physician commitment is the core of professionalism and must be linked for satisfying encounters to occur. Conflict of Interest:None declared |
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David C. Beck, M.D., Ph.D. University of Cincinnati
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david.beck{at}cchmc.org David C. Beck
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Dear Editor, I read with interest another discussion of what ails internal medicine residencies. It seems that few are willing to accept the apparent. Most competitive applicants are choosing internal medicine as a bridge to the medical subspecialties. The best way to attract the best and brightest to internal medicine is to facilitate an easy transition to the subspecialties for those who choose to pursue them. I would propose a model where internal medicine training is limited to two years for all those interested in pursuing a subspecialty; the third year would be reserved for those residents interested in general internal medicine. The third year could be tailored to either an extensive inpatient experience for those interested in a hospitalist position or ambulatory medicine for those interested in outpatient medicine. Internal medicine would immediately become more attractive. As indirect evidence, I propose a thought experiment. How competitive do you suppose dermatology would be if it required three years of internal medicine first? Similarly, how competitive do you suppose anesthesia or radiology would be if they required three to five years of general surgery first? It is certainly time to rethink how we train internists. I simply feel the authors have missed the best solution. Sincerely, David C Beck Conflict of Interest:None declared |
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