Internal Medicine: Whole or in Pieces?

Editorials15 December 1991Internal Medicine: Whole or in Pieces?Robert H. Fletcher, MD, Suzanne W. Fletcher, MDRobert H. Fletcher, MDSearch for more papers by this author, Suzanne W. Fletcher, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-115-12-978 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptInternal medicine has many centrifugal forces. In the last three decades there has been an extraordinary expansion in the knowledge base of internal medicine and with it has come subspecialization (1). Now 43% of internists identify themselves as subspecialists (2), and 60% of internal medicine residents enter subspecialty fellowships directly from residency (3). The subspecialties have established their own certification, societies, journals, meetings, and, in some cases, economic independence. By the year 2000, nearly half of all internists will be subspecialists.Because they have increasingly separate identities, the subspecialties have been drifting away from each other and from internal medicine...References1. Beeson P. The natural history of medical subspecialties. Ann Intern Med. 1980;93:624-6. LinkGoogle Scholar2. Kletke P, Schleiter M, and Tarlov A. Changes in the supply of internists: the internal medicine population from 1978 to 1998. Ann Intern Med. 1987;107:93-100. LinkGoogle Scholar3. Lyttle C, Andersen R, Neymarc K, Schmidt C, Kohrman C, and Levey G. National Study of Internal Medicine Manpower. XVIII: Subspecialty fellowships with a special look at hematology and oncology, 1988-1989. Ann Intern Med. 1991;114:36-42. LinkGoogle Scholar4. Girard R, Mendenhall R, Tarlov A, Radecki S, and Abrahamson S. A national study of internal medicine and its specialties: I. An overview of the practice of internal medicine. Ann Intern Med. 1979;90:965-75. LinkGoogle Scholar5. Farmer R, Hawk W, and Turnbull R. Clinical patterns in Crohn's disease: a statistical study of 615 cases. Gastroenterology. 1975;68:627-35. CrossrefMedlineGoogle Scholar6. Furguson R, Grim C, and Opgenorth T. The epidemiology of end-stage renal disease: the six-year South-Central Los Angeles experience, 1980-85. Am J Public Health. 1987;77:864-5. CrossrefMedlineGoogle Scholar7. Hiatt H. Protecting the medical commons: who is responsible? New Engl J Med. 1975;293:235-41. CrossrefMedlineGoogle Scholar8. Levine S. Professional responsibility [Editorial]. J Gen Intern Med. 1989;4:172-3. CrossrefMedlineGoogle Scholar9. Lipkin M. The Care of Patients: Concepts and Tactics. New York: Oxford University Press; 1974. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Robert H. Fletcher, MD; Suzanne W. Fletcher, MD PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byUnidades de diagnóstico rápido o consultas de atención inmediata en medicina interna. Análisis de los primeros 6 meses de funcionamiento en PalenciaQu’attendent les médecins généralistes de la médecine interne ? Résultats d’une enquête postale sur le secteur de la Loire et des départements limitrophesInternal medicine in BelgiumPhysicians’ reports of focused expertise in clinical practiceResolving the Conflicts between General and Subspecialty Medicine: The Internist as Consulting Physician-ScientistPhysician Relations in Canada: Shooting Inward as the Circle ClosesGeneralist physicians and the new health care systemTask force 4: The relationship between cardiovascular specialists and generalistsDepartments of Medical Specialties: A Solution for the Divergent Missions of Internal Medicine?Preparing generalist physiciansA place for general medicine among the subspecialitiesÉvaluation médicale et médecine interne: quelques perspectivesCardiovascular medicine: Subspecialty or specialtyResponsibilities of medical journals to readersThe General Internist—Another Dinosaur?Norman J. Dreher, MD 15 December 1991Volume 115, Issue 12Page: 978-979KeywordsFellowshipsResidencySub-specialty care ePublished: 1 December 2008 Issue Published: 15 December 1991 PDF downloadLoading ...