Shortage of internists leads to neglect of medical fundamentals
By Ross Tomlin
As healthcare costs continue to climb, the one person who can provide oversight of specialty care and keep down costs is often the least recognized, consulted, and compensated player in the whole scheme of things, said Steve Rosenbaum, M.D., assistant professor of medicine and medical director of Baylor Clinic's internal medicine, and Paul Remmers, M.D., associate professor of medicine at BCM.
"So often, I will see patients who have a cardiologist, who have a gastroenterologist, who have this –ologist, and that –gist, but who don't have a coordinator," said Rosenbaum. "The internist should be coordinating because if not, you have a bunch of pages in their book laying around, scattered. It's like a loose leaf binder that's fallen over."
Changing medical practice
Much has changed in the roughly 30 years that Rosenbaum and Remmers have each been practicing medicine. For starters, says Remmers, internists must contend with "insurance companies, difficulty with reimbursement, more paperwork and greater liability for lawsuits."
Nearly 30 years ago, close to 20 percent of all medical students in the United States made internal medicine their career choice. Now, that percentage has dropped to less than five. With medical school loan debts in the six digits in some cases, better paying specialties such as cardiology, gastroenterology, dermatology – attract more and more graduates.
With this trend towards specialty care comes a void of internists that leads to decentralized healthcare and neglect of certain medical fundamentals, said the two internists.
"Whether we're seeing someone for a sore throat or we're doing an extensive, complete diagnostic evaluation, it's important to realize the interplay with any other physicians the patient is seeing," said Rosenbaum.
Furthermore, internists help keep patients' care on an even keel.
"I try to keep the big picture and focus for the patient and make sure that unnecessary testing or prescriptions aren't recommended or prescribed," said Remmers. "I can also reinforce certain medical recommendations that perhaps they've forgotten and help keep their major health issues clearly in focus for them."
Rx for a solution
One way to improve communication among doctors is already being implemented across the country – the electronic medical record, a network-based tool that centralizes and continually updates a patient's medical history.
"Everything is right there at your fingertips," said Rosenbaum. "There are far fewer mistakes in terms of medication errors, and you have an instantaneous record of where the patient's last visit was, what was done, and what was said. You know exactly where that patient is in terms of his or her care."
Rosenbaum also believes political solutions are in order, both in terms of increasing reimbursement to internists and recruitment of medical students. For example, he said, several of his Medicare patients came to him after they were turned away from doctors who could no longer afford to treat them.
"There needs to be better reimbursement for this type of care," said Rosenbaum. "At the same time there needs to be a more coordinated push in terms of piquing the interest of medical students into internal medicine."
