THE FUTURE OF INTERNAL-MEDICINE

Internal medicine may be in its twilight because it has failed to addr ess the shortage of primary care physicians by training more general i nternists. Data from several sources indicate that progressively fewer persons are entering general internal medicine as opposed to its subs pecialties. The reasons for this decline include adverse experiences i n medical school, an unfavorable patient mix, declining incomes, and i ncreasing hassles in caring for patients. A series of reforms, such as improving the teaching in medical school, strengthening divisions of general medicine, and establishing financial incentives, are proposed to reverse this trend. Other actions that must be taken include stoppi ng the proliferation of subspecialty certificates, designating and acc rediting primary care tracks, and cutting subspecialty positions. Inte rnal medicine's fate is in its own hands, and the discipline must reor ient itself to conform to societal needs.