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Debra Glasser MD

It’s been a while since we last spoke. I remember one discussion at the time was about the trend in Internal Medicine training for a young physician to become a hospitalist rather than a primary care physician. I sensed at the time that primary care Internal Medicine would be shaken to the core and would in all likelihood not survive as we knew it. Much of this move by young physicians was financially motivated. Working for and being paid by a hospital system allowed Internists to continue the tradition of excellent hospital care yet having no long-term attachment to a patient. A hospitalist also has a guaranteed significantly greater income without the hassle of running their own office (hiring personnel, maintaining an office site and information systems crucial to reimbursement).

Despite my concerns I continued to practice the old Internal Medicine tradition of both outpatient and inpatient care. I saw how many hospitalists soon became pawns of the hospital system often following “check boxes” to document quality care which often did not exist. Doctors changed almost daily. Patients were losing their priority as guaranteeing hospital reimbursement became a new focus of the hospital system. I was proud to be among the last Primary Care Internists to admit and take care of his own patients. I could expedite their admissions, discharges and office follow-up.

Isn’t it ironic that the pillar of academic medicine which gave rise to all the subspecialties should meet such a fate. Also ironically, as I contemplated retirement, almost every medical subspecialist complained of the loss of primary care Internal Medicine as they viewed patients referred from primary care Internal Medicine as having excellent evaluations while those from other primary care sources not uncommonly were referred with little to no evaluation.

G.Fay MD