Disappearing Generalists

John Nelson writes…

Notice anything similar about these two articles?

Where have all the General Internists Gone?


The Impending Disappearance of the General Surgeon

Generalists, it seems, could be on the way out, or at least abandoning traditional practice.  This should come as no surprise to you.  There are a lot more data and opinions available in addition to these two articles, but these two sounded the alarm for me more effectively than most. They seem to support the idea that the more a group of physicians embraces generalism, the more likely they are to divide themselves into those who practice exclusively (or nearly so) in a hospital or the outpatient setting.

The more specialized a doctor, the more likely she will continue to see patients in and out of the hospital (assuming her field has any role in the hospital at all).  I don’t expect fertility specialists will adopt a hospitalist vs. outpatient model, but psychiatrists are doing that very thing.  A (relatively small) portion of gastroenterologists are adopting the hospitalist model, but plastic surgeons probably never will (those in huge hospitals could be an exception).

Hospitalist leaders are likely to be asked for observations and lessons learned about the hospitalist model by physician groups in other specialties, or by hospital administrators, to doctors in other specialties.  And they should be ready to work with doctors who may adopt the hospitalist model.  In most cases the hospitalists will probably be happy when other specialties adopt the hospitalist model, but that may not always be the case.

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