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The Domain of General Internal Medicine: A Perspective from Trainees
- Eric B. Larson, MD, MPH; and
- for the SGIM Task Force on the Domain of General Internal Medicine
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•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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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.
Eric B. Larson, MD, MPH, for the SGIM Task Force on the Domain of General Internal Medicine
Group Health Cooperative Center for Health Studies; Seattle, WA 98101-1448
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
