Petersdorf R G, Goitein L
Association of American Medical Colleges, Washington, DC 20037.
Ann Intern Med. 1993 Dec 1;119(11):1130-7. doi: 10.7326/0003-4819-119-11-199312010-00011.
Internal medicine may be in its twilight because it has failed to address the shortage of primary care physicians by training more general internists. Data from several sources indicate that progressively fewer persons are entering general internal medicine as opposed to its subspecialties. The reasons for this decline include adverse experiences in medical school, an unfavorable patient mix, declining incomes, and increasing hassles in caring for patients. A series of reforms, such as improving the teaching in medical school, strengthening divisions of general medicine, and establishing financial incentives, are proposed to reverse this trend. Other actions that must be taken include stopping the proliferation of subspecialty certificates, designating and accrediting primary care tracks, and cutting subspecialty positions. Internal medicine's fate is in its own hands, and the discipline must reorient itself to conform to societal needs.
内科医学可能正处于衰落期，因为它未能通过培养更多的普通内科医生来解决初级保健医生短缺的问题。来自多个来源的数据表明，与内科医学的亚专科相比，进入普通内科的人数越来越少。这种下降的原因包括医学院的负面经历、不理想的患者组合、收入下降以及照顾患者时麻烦事增多。有人提出了一系列改革措施，如改善医学院的教学、加强普通医学科以及建立经济激励机制，以扭转这一趋势。必须采取的其他行动包括停止亚专科证书的泛滥、指定并认证初级保健方向以及削减亚专科职位。内科医学的命运掌握在自己手中，该学科必须重新调整方向以符合社会需求。
