Bet you didn't realize that these once plentiful and admired people are on the endangered list. In British Columbia, the community/rural internist is the person who takes on every problem that is slippery and hard to grasp. Problems that might fall to a sub specialist also are taken on, since sub specialists tend to confine their activities to larger centres. The internists get patients ready for surgery, run the intensive care units, organize chemotherapy and do a host of other things that other specialists rely on. No internists and you may not have a surgical program.
Across the province hospitals are struggling as internists are unable to provide year 'round call coverage. According to HealthMatchBC, there are 29 permanent positions going begging today in British Columbia alone. The kicker is that last year we only graduated 38 general internists in the entire country.
That kind of arithmetic isn't encouraging. Unless we some up with some solutions, and soon, we will face a crisis of care. Here are some thoughts, and I'd welcome yours as well.
- Increase the supply of younger internists by:
- Improving payment
- Lobbying the provincial government to increase residency positions for general internists
- Providing debt relief to general internists working in community hospitals
- Providing the same debt relief to sub specialist internists who agree to work on call as generalists
- Making subspecialty practice attractive to those who will work on call as generalists
- Recruiting foreign medical graduates
- Increasing the prestige of the discipline by providing leadership roles to general internists.
- Keep established internists practicing by:
- Providing clinic space in or near the hospital at reduced rates
- Providing enhance training opportunities to allow established internists to upgrade their skills
- Training hospitalists to do many of the tasks presently covered by general internists at night - for example, ventilator management or insertion of lines
- Enhanced use of telehealth technology which could provide centralized medical advice for remote intensive care units.
Keep in mind that new internists are going to take four years to train following medical school. We don't have time to procrastinate.
What are your thoughts?
