IM & Pedi phasing out primary care?

[lowbudget]

So, I picked up a copy of Osteopathic Family Medicine News (Nov/Dec 2006) and thumbed through it. And, in the 3rd paragraph of the President's Perspective, Thomas Told DO wrote:

"This year, two major primary care specialties, Pediatrics and Internal Medicine, announced they are phasing-out primary care in favor of producing subspecialists. The loss of general pediatricians and the reduction of general internists will place even greater pressure on family practice practitioners to fill that void. And, by the year 2020, primary care may well be synonymous with family practice."

What the hell? Is this true? No sources cited. Nothing found on Google. And general scan of SGIM, ACP, and AAP didn't say anything, at least not in their press release. Is this a Med-Peds thing? A DO thing? Or... I'm confused.

Anyone heard/read anything on this? Just curious.

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[Faebinder]

Not surprised... I think they want mid levels to start taking over primary care. Crazy if you ask me.... Too many hard to diagnose diseases will be missed.

 

[drpoundsign]

I have been practicing for about ten years (with LOTS of gaps!) US born IMG had to pass FMGEMS do fifth pathway then residency. lots of double standards for us there, too. then getting board eligible certified recently re-certified. I worked in a large group practice then a lot of VA locum one VA perm that didnt last and now...community health clinic. nice area but diabetes hypertension all day long and MANY drug-seekers!!

I may get career counseling if this doesnt last

 

[deleted87716]

I have been practicing for about ten years (with LOTS of gaps!) US born IMG had to pass FMGEMS do fifth pathway then residency. lots of double standards for us there, too. then getting board eligible certified recently re-certified. I worked in a large group practice then a lot of VA locum one VA perm that didnt last and now...community health clinic. nice area but diabetes hypertension all day long and MANY drug-seekers!!

I may get career counseling if this doesnt last

Well, if you don't try to find a job that you like, you'll only have yourself to blame.

 

[deleted87716]

I think they want mid levels to start taking over primary care.

Where did you get that? And who are "they?"

 

[deleted87716]

Thomas Told DO wrote:

"This year, two major primary care specialties, Pediatrics and Internal Medicine, announced they are phasing-out primary care in favor of producing subspecialists."

Not only has nothing like this been "announced," but without primary care, pediatrics would exist only in tertiary care centers. I'm calling bull**** on this one.

 

[Faebinder]

Where did you get that? And who are "they?"

Insurance companies...

I am not saying this is going to happen btw.... I would say this is bull as well.

 

[oldbearprofessor]

Not only has nothing like this been "announced," but without primary care, pediatrics would exist only in tertiary care centers. I'm calling bull**** on this one.

And neonatologists, many of whom practice in decidedly non-tertiary centers (including many of us academic types who work in community hospitals at times) are chicken soup?

Actually, this interested me so I looked it up and sure enough, the OP has correctly quoted Dr. Told, apparently a society president for the osteopathic family physician group, in a news journal called "Osteopathic Family Physician News."

Now, what interests me is what Dr. Told had in mind. Of course, the AAP has said nothing of the sort and never will in my view. (I can't speak for the Medicine folks).

The only thing I can think of are the two articles in the December "Pediatrics" describing the continuing shortage of pediatric specialists with a small and controversial excess of general pediatricians. The authors tend to support simplifying and shortening pediatric specialty training to deal with this issue. This is one of several such ideas that has been floated regarding this topic in the last few years. Some subspecialties in pedi, especially the less well reimbursed ones do have a real shortage (try finding a pediatric rheumatologist in many states), and simplifying the training (down to 2 yrs, less research requirement) might make some folks go for it as opposed to general pedi.

That's the closest I can figure out to what Dr. Told had in mind. I'm really quite curious what he meant. Society presidents, usually, in articles THEY wrote don't entirely make things up, so he must have had something he was referring to....but what??

 

[deleted87716]

And neonatologists, many of whom practice in decidedly non-tertiary centers (including many of us academic types who work in community hospitals at times) are chicken soup?

No disrespect intended, but I'm sure you get my point. What children need more than anything else is good primary care. There's a reason that we don't have an overabundance of pediatric subspecialists...and the reason is that most children are pretty healthy.

As for why more people don't go into pediatric subspecialty training, I somehow doubt that it's really the length of training that's the issue. I think it's probably the fact that specialization really doesn't pay all that well*, and job opportunities are relatively limited. Shortening the length of training seems somewhat misguided. Since that's not likely the problem, it's probably not the solution.

As for what Dr. Told was thinking, I can only guess. I imagine it has something to do with the DO emphasis on primary care.

*Edit: Compared to specialization in internal medicine, anyway.

 

[sophiejane]

What children need more than anything else is good primary care. There's a reason that we don't have an overabundance of pediatric subspecialists...and the reason is that most children are pretty healthy.

Right...they are healthy ***in this country*** because of immunizations and good preventive medicine, which is delivered by general pediatricians and family physicians.

If it's true that the AAP is going to start decreasing the number of spots for general peds, that logic is very bizarre.

The other question would be, how are they going to stop people from NOT specializing? Will there only be specialty residencies that have the first 3 years combined with a 2 or 3 year fellowship, and you are obligated to complete both?

This whole thing just sounds kind of nutty to me.

 

[RuralMedicine]

If it's true that the AAP is going to start decreasing the number of spots for general peds, that logic is very bizarre.

The other question would be, how are they going to stop people from NOT specializing? Will there only be specialty residencies that have the first 3 years combined with a 2 or 3 year fellowship, and you are obligated to complete both?

This whole thing just sounds kind of nutty to me.

AAP actually doesn't control pediatric residency spots, but there isn't an effort to reduce pediatric residency spots (except perhaps in the mind of the ACOFP president). What OBP was referring to was discussions regarding changing the scope/arrangement of pediatric subspecialty training. Currently most pediatric subspecialty training has more months devoted to research than clinical practice. (This is different than the approach for fellowship off of IM)

*As an aside I would more strongly consider pediatric subspecialty training if the focus was more clinical than research.

 

[oldbearprofessor]

AAP actually doesn't control pediatric residency spots, but there isn't an effort to reduce pediatric residency spots (except perhaps in the mind of the ACOFP president). What OBP was referring to was discussions regarding changing the scope/arrangement of pediatric subspecialty training. Currently most pediatric subspecialty training has more months devoted to research than clinical practice. (This is different than the approach for fellowship off of IM)

*As an aside I would more strongly consider pediatric subspecialty training if the focus was more clinical than research.

What about clinical research?

Your perspective is extremely common and I agree with you that it should be an option, but no one has given me any authority in this matter.

Takes some doing to find them, but I know some faculty who have their fellows do highly clinically relevant, entirely patient-centered research!

And with that, I suggest that further discussions of pediatric training be in the pedi forum, so I'll pass on further comments on that issue here. I'm still waiting for an explanation about Dr. Told's comments.

 

[iatrosB]

I'm still waiting for an explanation about Dr. Told's comments.

I think that could only come from Dr. Told, as many of us are left scratching our collective heads.

 

[Faebinder]

The reason pediatric subspecialties are not very abundant is the lack of fellowships.... which comes from the lack of funding for fellowships....


It's really easy... you want more ped subspecialties? Add more fellowships...

 

[MiesVanDerMom]

Right...they are healthy ***in this country*** because of immunizations and good preventive medicine, which is delivered by general pediatricians and family physicians.

If it's true that the AAP is going to start decreasing the number of spots for general peds, that logic is very bizarre.

The other question would be, how are they going to stop people from NOT specializing? Will there only be specialty residencies that have the first 3 years combined with a 2 or 3 year fellowship, and you are obligated to complete both?

This whole thing just sounds kind of nutty to me.

i think nutrition and public hygiene have done a lot more than vaccinations and doctors. My sons' PCP (and I've tried four of them, so it's not like I'm not trying here) is fairly irrelevent. My healthy son is healthy without the guy and my sick son gets much better care from his specialists. His original ped failed to catch his microcephaly and nystagmus, the specialists caught both. None of his PCPs have ever really bothered to understand his rare diseases. I don't really think the world would suffer if more kids saw NP/PA for primary care and more peds docs went into specialty care. Eh, that's my two cents...

 

[Faebinder]

i think nutrition and public hygiene have done a lot more than vaccinations and doctors. My sons' PCP (and I've tried four of them, so it's not like I'm not trying here) is fairly irrelevent. My healthy son is healthy without the guy and my sick son gets much better care from his specialists. His original ped failed to catch his microcephaly and nystagmus, the specialists caught both. None of his PCPs have ever really bothered to understand his rare diseases. I don't really think the world would suffer if more kids saw NP/PA for primary care and more peds docs went into specialty care. Eh, that's my two cents...

Huh?! Did you just claim we got the best nutrition?! and public hygiene? You know we are the fattest and not so clean? I must be living in a strange part of the US.

 

[deleted87716]

I don't really think the world would suffer if more kids saw NP/PA for primary care and more peds docs went into specialty care. Eh, that's my two cents...

Putting less-qualified people in charge of primary care...yeah, that'll definitely result in fewer missed diagnoses.

You can have your two cents back.

 

[FPforLife]

Well usually people get to specialists through generalists so I'm sure your PCP did the correct thing and sent him to a specialist who knew more about this 1 in a million pediatirc ds, yes I'm being sarcastic. I'll tell ya what if you can memorize every obscure disease and tell me all about them I'll give you your 2 cents.

The reasons PCP's miss a dx is 1) they are to busy due to lack of enough PCP's 2) They have never seen or will ever see this obscure condition- ie they correctly refer 3) they are to arrogant to say I don't know and go look up info or call a colleuge- this in my opinion is what seperates the men from the boys. The best docs I've worked with are the ones that said I don't know, lets do some tests and I'll do some research and see ya back in a week unless things get worse.

Sorry I diverted from the original topic. I am glad to say though that in most IM residencies 1/3 do primary care, 1/3 hospitalist. 1/3 specialize( from IM residents opinions- no hard facts here). True though specializing is becoming more common in IM unfortunately. As far as peds go most still do primary care. It is true that certain specialties in peds are needed llike rheumatology. I live in phoenix and we just got our first pediatric rheumatologist- BIG city and only 1.