TRAINING IN SUBSPECIALTY INTERNAL-MEDICINE - ON THE CHESSBOARD OF HEALTH-CARE REFORM

Many reform-minded observers of the U.S. health care system have asked recently whether we are training too many subspecialists in internal medicine. Of course, the answer to this question may not be the same f or all subspecialties or all manners of professional career, but any p roposed answer has extended consequences for the entire health care sy stem and the patients it serves. Some have even begun to advocate a fi rm ceiling on the numbers of subspecialty training positions in the fu ture. Who, in fact, should be deciding such matters? These decisions a re complex and not easily made by government, consumers, or insurance companies on their own, nor should they. These decisions are best made by a profession willing to examine and regulate itself where necessar y. Recent legislative initiatives have made it abundantly clear that o thers are more than willing to act on our behalf, if we cannot. Whatev er process is adopted for making such decisions, it needs to be fair, efficient, flexible, and responsive to unexpected demands in the futur e, including new practice economics, the availability of research fund s, and medical innovation.