THE PRACTICE OF GENERAL INTERNAL-MEDICINE BY SUBSPECIALISTS

To determine the proportion of specialists in internal medicine at a u niversity medical center practicing general internal medicine in addit ion to their specialty, full-time and voluntary faculty were asked to complete a questionnaire concerning their practice patterns. In additi on, the directories of two of the largest managed-care groups in the a rea were reviewed to identify physicians who were also faculty members , to determine whether faculty in these directories self-identified as general internists. Excluding those with primary research appointment s, 303 faculty in the Department of Medicine were asked to participate . Of these, 187 (62%) responded, of whom 86 (46%) were full-time and 1 01 (54%) voluntary faculty. Of the respondents, 183 (98%) were either board certified (152; 81%) or board eligible (31; 17%) in a subspecial ty. Both general internal medicine and specialty medicine were practic ed by 116 (65%), with full-time faculty being more likely to have sole ly subspecialty practices (P < .001). The majority of faculty (150; 80 %) participated in managed care. A review of directories of two manage d-care groups revealed that 100 (87%) of the 115 faculty with appointm ents within subspecialty divisions of the Department of Medicine were listed as general internists. Subspecialists in internal medicine alre ady spend considerable time practicing general medicine and are increa singly willing to identify themselves as generalists. Unless this is r ecognized, the future need for generalists may be overestimated consid erably.