The future of general internal medicine

Article Abstract:

Internal medicine physicians are broadly trained specialists who deal with the health needs of adults. These physicians must combine basic science with humanistic aspects of medicine and a thorough understanding of the signs and symptoms of diseases in their scientific treatment. Twelve different subspecialties are included with in this group of physicians. In 1986 there were 70,000 physicians, including 18,000 residents, actively practicing internal medicine, composing approximately 12 percent of all physicians. The field of internal medicine has grown by 47 percent, and the subspecialties have increased by 138 percent between 1975 and 1986. At present 42 percent of all general internists are younger than 35 years old. The number of women in this group increased from 6,164 or 12 percent in 1980, to 12,259 or 17 percent in 1986. Pay in 1986 averaged $93,200 for internists as compared with the average for all physicians, which was $119,500. From 1981 to 1986 the overall compensation of internal medicine generalists increased 19 percent, less than 5 percent per year. A persistent problem for internists is that the fee structure continues to compensate more for surgical and diagnostic procedures than for the rendering of medical care. The current average fee for an office visit by an established patient is $35.30. Insurance rates for the practice of internal medicine are not nearly as high as for surgery or other specialties; however, the present average annual insurance premium of $5,580 represents an 86 percent increase from 1981. The average overall insurance rate for all specialties is $12,500, a 150 percent increase over the same period. General trends in medical education include a decline in the number of internal medicine faculty positions available and a precipitous fall in the number of positions filled by United States medical graduates, from 74 percent in 1985 to 63 percent in 1987. Recent legislative changes in many states have decreased the maximum number of hours that residents can work (in most cases below 80 hours per week), and the number of patients per resident. There have also been profound reductions in length of stay of the average patient, increased use of both intensive care and outpatient services, and a demographic change of the patient base of hospitalized patients to older more chronically ill individuals.

Analysis, Reports, Internal medicine, Medical specialties, Society of General Internal Medicine, American College of Physicians, American Medical Association. Council on Long Range Planning and Development, American Society of Internal Medicine

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Practice policies - guidelines for methods

Article Abstract:

The issues involved in designing practice policies for physicians are discussed. A medical practice policy is a standard for performing a particular service, such as a screening test or a vaccination. In recent years, methods for designing practice policies have been proposed in many different forms, from a simple one-page document generated by a brief meeting of professionals, to a long report compiled by international teams of experts at great expense. In choosing a method for creating practice policies, one should consider whether the approach will meet the ultimate goals. The method is effective if it allows people to predict the health outcomes and costs of applying the policy, and also enables people to follow the rationale behind the policy. These criteria and others may appear logical and easy to achieve, but in reality, practice policies rarely fulfill these objectives. Some guidelines for designing practice policies are reviewed. When a standard of practice is evaluated, probable outcomes should be predicted, and then the desirability of these results should be weighed. The outcomes of applying the policy to various patient groups need to be defined. The information on outcomes should be based on actual clinical experience and should be analyzed objectively. Preferences of patients must also be considered. These and other issues relating to clinical practice policies are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Standards, Management

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Medicine's position is both pivotal and precarious in assisted-suicide debate

Article Abstract:

The debate over physician-assisted suicide appears likely to become as significant and difficult an issue as a woman's right to choose an abortion. Voters in Oregon approved a measure legalizing physician-assisted suicide for patients with six months or less to live. Similar measures were defeated in California and Washington. However, the National Right to Life Committee filed suit to stop implementation of the Oregon law. Assisted suicide happens every day, according to some physicians who cite the increasingly large doses of morphine administered to terminally ill patients. Public opinion polls indicate there is widespread public support for the legalization of physician-assisted suicide. Some physicians view passage of the Oregon law as a signal of public dissatisfaction with terminal care and are calling for a re-evaluation of medical care of the dying.

Assisted suicide, Ethical aspects

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