Thursday, July 23, 2009
Primary care internist objects to hospitalist's "provider"
I am ashamed to admit that I actually felt annoyed tonight over being referred to as a "primary care provider." It is hard to explain that after 21 years of education and another 23 years of practice as a specialist in Internal Medicine, I would be bothered by this.
One of my patients that I have cared for for 20 years was admitted to the hospital after going to the ER with abdominal pain. I was not informed of his admission and the hospitalist became the attending physician. The patient called me today from his hospital bed to inform me. He actually had a previously scheduled appointment with me in the office today and, good patient that he is, was calling to say he couldn't make it. He assumed I already knew he was admitted to the hospital. I asked him to have the attending doctor call me as soon as he/she made rounds.
I got the call from a young-sounding hospitalist who did not know my name and wondered if I was the "primary care provider." When I replied that I was his physician, she then said, "Oh, I don't usually call the primary care provider." That phrase just stopped me cold. It is so "insurance" sounding. So contrived and replaceable. Primary care provider ... delivery man ... vacuum cleaner salesman ... Roto-Rooter man. It's the doctor you can dismiss if you are a hospitalist, one or two years out of training.
"I don't usually call the primary care provider."
Guess I better get thicker skin. 
Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
posted by Ryan DuBosar at
9:35 AM
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Members of the American College of Physicians contribute posts from their own sites to ACP Internist and ACP Hospitalist. Contributors include:
Albert Fuchs, MD
Albert Fuchs, MD, FACP,
graduated from the University of California, Los Angeles School of
Medicine, where he also did his internal medicine training.
Certified by the American Board of Internal Medicine, Dr. Fuchs
spent three years as a full-time faculty member at UCLA School of
Medicine before opening his private practice in Beverly Hills in
2000.
David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned
authority on nutrition, weight management, and the prevention of
chronic disease, and an internationally recognized leader in
integrative medicine and patient-centered care.
DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about
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Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more
than a decade and is an Associate Professor of Medicine at an
academic medical center on the East Coast. His time is split
between teaching medical students and residents, and caring for
patients.
Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science,
medicine, health and healing in the 21st century.
FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the
Internal Medicine Residency and Assistant Dean of Scholarship &
Discovery at the Pritzker School of Medicine for the University of
Chicago. Her education and research focus is on resident duty
hours, patient handoffs, medical professionalism, and quality of
hospital care. She is also an academic hospitalist.
Glass
Hospital
John H. Schumann, MD, FACP, provides transparency on the workings
of medical practice and the complexities of hospital care,
illuminates the emotional and cognitive aspects of caregiving and
decision-making from the perspective of an active primary care
physician, and offers behind-the-scenes portraits of hospital
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Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the
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I'm dok
ACP Member Mike Aref, MD, PhD, ACP Member, is an academic
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Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites
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Michael Kirsch, MD, FACP, addresses the joys and challenges of
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he's not writing, he's performing colonoscopies.
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Lessons
Elaine Schattner, MD, ACP Member, shares her ideas on education,
ethics in medicine, health care news and culture. Her views on
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David M. Sack, MD, FACP, practices general gastroenterology at a
small community hospital in Connecticut. His blog is a series of
musings on medicine, medical care, the health care system and
medical ethics, in no particular order.
Reflections
of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being
a doctor in a community hospital in Atlanta.
Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in
education, social media and networking, practice management and
evidence-based medicine tools, personal information and knowledge
management.
White Coat Underground
Peter A. Lipson, MD, ACP Member, is a practicing internist and
teaching physician in Southeast Michigan. The blog, which has been
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ACP Internist and ACP Hospitalist also contribute to and draw upon content from Get Better Health, a network created by Val Jones, MD, to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the clinician's point of view on health care reform, science, research and patient care.
Other blogs of note:
American
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Also known as the Green Journal, the American Journal of Medicine
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community-based practice.
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Center's internal medicine residency program. Faculty, residents
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White Coat Rants
One of the most popular anonymous blogs written by an emergency
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1 Comments:
The day Internal Medicine lost its intellectual appeal the Internist beame a "ambulatorist" and the discipline lost its professional respect.
Is it surprising that the resident out of an Internal Medicine program gravitates to the hospital???
The ambulatorist even if trained as an Internist is not easily recognizable from the myriad "providers" who populate the ambulatory care arena.
It does not take many skills to perform immunizations and other healthcare interventions.
The result; lack of differentiation of the Internist from the other providers.
Unfortunately, it is the complex, ill patient who requires all the skills of the Internist to keep him/her away from the hospitalist. A lack of financial reward for the skills of an Internist in performing this task results in a declining population of Internists in an ambulatory setting.
The patient centered medical home is being developed to rectify this but unless there is a realization that Internists provide a better home than other "providers" and are appropriately compensated the homes will be tract housing with little value.
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