THE ROLE OF THE FUTURE GENERAL-INTERNIST DEFINED

In this position paper, the American College of Physicians Task Force on Physician Supply examines the current and future roles of the ideal general internist. Discussed are the characteristics shared by all in ternists, whether engaged in general or subspecialty practice; current trends and the growing crisis in the supply of primary care physician s; and the practices and patient characteristics of both general inter nists and family physicians. The Task Force considered four options fo r the future general internist but rejected them because they either m aintained the status quo or were retrogressive: 1) allowing the commun ity-based general internist to disappear; 2) strengthening the general ist's identity as a primary care-oriented physician who provides no su bspecialty care; 3) becoming hospital-based generalists who act princi pally as consultants; or 4) becoming fully trained subspecialists who also provide primary care. The Task Force proposes a new definition th at reaffirms fundamental characteristics of today's general internists and adds characteristics that should be the hallmark of the general i nternist of the future. The paper describes characteristics that are s hared by other generalist physicians and those that are distinctive to today's general internist. It then addresses characteristics that wil l be needed to prepare for the environment of medical care in the futu re. The new definition reaffirms that the general internist is an expe rt in the general care of the adult, but it also revives the concept o f the general internist as a local authority on a specific topic in wh ich he or she has special expertise. The paper concludes with a discus sion of some of the questions that its definition poses for graduate m edical education. The Task Force suggests that changes in the educatio nal system to produce the desired mix of skills required for the gener al internist of the future will increase the attractiveness of general internal medicine.