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 internists, whether engaged in general or subspecialty practice; current trends and the growing crisis in the supply of primary care physicians; and the practices and patient characteristics of both general internists and family physicians. The Task Force considered four options for the future general internist but rejected them because they either maintained the status quo or were retrogressive: 1) allowing the community-based general internist to disappear; 2) strengthening the generalist's identity as a primary care-oriented physician who provides no subspecialty care; 3) becoming hospital-based generalists who act principally as consultants; or 4) becoming fully trained subspecialists who also provide primary care. The Task Force proposes a new definition that reaffirms fundamental characteristics of today's general internists and adds characteristics that should be the hallmark of the general internist of the future. The paper describes characteristics that are shared by other generalist physicians and those that are distinctive to today's general internist. It then addresses characteristics that will be needed to prepare for the environment of medical care in the future. The new definition reaffirms that the general internist is an expert in the general care of the adult, but it also revives the concept of the general internist as a local authority on a specific topic in which he or she has special expertise. The paper concludes with a discussion of some of the questions that its definition poses for graduate medical education. The Task Force suggests that changes in the educational system to produce the desired mix of skills required for the general internist of the future will increase the attractiveness of general internal medicine.