Promote the Generalists

Isn’t it ironic that just as America is waking
up to the importance of primary care
medicine, our own representative organizations
are selling us down the river?
The training of primary care physicians
has for decades allowed us to
branch out and follow our patients in
multiple sites of care. We are the masters
of managing care across this continuum.
Government and big business are
finally recognizing that they need to bolster
primary care to manage patients in
the new chronic care medical home
models. They are finally recognizing the
need to better supply, equip, and finance
primary care physicians.
The American College of
Physicians (ACP), the American
Academy of Family Practice (AAFP), and
the American Medical Association all
appear to support this concept. So where
is the irony?
The American Board of Internal
Medicine (ABIM), along with the aforementioned
groups and others, continues
to carve medicine into ever increasing
sub areas, based on sites of care and interests.
Hospitalists (who already have three
branches—general hospitalists, proceduralists,
and nocturnists) are seeking special
certification recognition through
ABIM. Palliative care is a new certification.
These branches of medicine deserve
recognition, but do we need all these
fractured certifications?
Soon, no primary care physicians
will be certified as capable of practicing
in multiple sites of care without multiple
certifications for each separate site and
individual function. Soon there will be
no "general" primary care physicians.
Can hospitalists equally manage the
whole continuum of care, or will they
need to become generalists again to do
the job?
Medicine teaches us to care for the
whole person—body, mind, and spirit—
not just individual parts. I urge the
ABIM, the ACP, the AAFP, the AMA,
SHM, and others to stop this fracturing
of primary care. Now is the time to promote
the generalists. Now is the time to
lift all primary care-related areas of medicine
together, leaving no one behind.
John M. Colombo, MD
HAN/Colombo