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General Medicine: A Dwindling Practice

Posted Sep 26 2008 5:17pm 1 Comment

by Mike Stephens

I had the occasion the other day to visit my primary physician for my annual physical. He is a respected general medical internist practicing in a two-physician office. While I was waiting I couldn’t help but observe the frenetic pace surrounding me as the office personnel answered the phone, responded to questions and scrambled for information from a large file of medical records. All this caused me to wonder how my physician could deal with all the demands of his practice and still cover the overhead expenses, which were so apparent.

If we examine the trends in the choices medical school graduates make in selecting residencies, it is clear they share my concern. It is projected that the number of Americans 65 years of age and older will double by the year 2030. Yet the percentage of third year internal medicine residents who intended to pursue a career in general medicine dropped from 54% in 1998 to 27% in 2003. More recent data has that percentage at 20% with some residency programs reporting even less than that. This is a crisis that must be addressed.

The reasons for this pronounced lack of interest in a general medicine practice can be attributed to financial and lifestyle choices. Historically, patients, insurers and government payers have valued payment for surgical or diagnostic procedures more highly than the medical management of preventative measures or chronic disease. It should not be surprising that rather than practice general internal medicine, those completing internal medicine residencies in increasing numbers select medical subspecialties where there is a procedure for which higher payment can be billed.

Lifestyle preferences also influence the decision to avoid a general medicine practice. As attitudes surrounding work-life balance are changing, many physicians are unwilling to work more to assure a higher income. A 2006 AAMC survey of physicians under the age of 50 showed that 66% of those surveyed were not willing to work longer hours in order to increase income. As a consequence, more primary physicians have moved to aesthetic procedures such as Botox injections and laser procedures to enhance income without increasing the hours of practice. Perhaps the most striking choice has been the adoption of the concierge practice model by some general medical internists. In this way the physician receives a retainer from the patient, which assures the physician the opportunity to practice medicine at a more measured pace while the patient who values preventative and chronic disease management is able to receive it.

Well, I completed my physical with my general medical internist. I left feeling quite secure in my knowledge that my doctor still practiced medicine in the traditional manner, untouched by the pressure to augment his income in untraditional ways. When I stopped at the reception desk, the clerk reviewed with me a computer-generated profile of my vitamin supplement requirements. Apparently the second page of the health profile I completed had been submitted electronically and a printout of my recommended supplements had been generated. All this and a mail order form to take with me… how clever.

Comments (1)
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Obama has made a new pick for Surgeon General, Dr. Regina Benjamin.  Regina Benjamin, MD, graduated from Morehouse School of Medicine, and ran a practice dedicated to low income families around Bayou La Route since the early 90s, and moonlighted in clinics and ER's to fund her practice.  Her practice in Louisiana was destroyed by Hurricane Katrina, and again by a fire almost a year to the day afterwards, and she used a cash loan or two to rebuild.  Her position on socialized medicine is unknown.  Regina Benjamin is a credit to the human race, a great pick for SG – and many would give a cash advance to see someone as qualified take the post.

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