Subspecialties hold back generalists

Issue 26 / 21 July 2014 Subspecialties hold back generalists Authored by SARAH COLYER Issue 26 / 21 July 2014

DESPITE a boom in the number of general medicine trainees in the past 10 years, new recruits are missing out on hospital training positions because subspecialist trainees get priority, according to a leading medical specialist.

Associate Professor Ian Scott, a former president of the Internal Medicine Society of Australia and New Zealand, said the number of trainees doing general medicine advanced training had “exploded” from less than 50 in 2005 to around 500 this year — largely due to the Royal Australasian College of Physicians (RACP) promoting dual training, where trainee physicians learn general medicine in addition to another specialty.

However, Professor Scott told MJA InSight the trend of increasing subspecialisation meant hospitals were geared against providing training positions for generalists despite the increasing calls to boost the number of doctors with a broad skill set.

“The biggest challenge is there’s a limit on the number of advanced training positions we can offer people who want to do advanced training in general medicine”, said Professor Scott, who is director of the department of internal medicine and clinical epidemiology at Brisbane’s Princess Alexandra Hospital.

“If trainees want to rotate through other specialties as part of their general medicine training, that’s difficult because specialists quarantine those positions for their own trainees.”

He was commenting on a “Perspective” article published today in the MJA calling for governments to do more to usher young doctors into generalist specialties, including general medicine and psychiatry, as well as general practice. (1)

The authors wrote that the medical labour market in Australia was characterised by “20-year boom˗bust cycles”, which successive governments had failed to manage.

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Genevieve Freer says: July 22, 2014 at 11:04 pm As a rural GP, the problem that I see is the increasing number of patients with multisystem chronic diseases like diabetes who need a general physician to sort out complex problems, not a subspecialist who can only deal with the endocrine system , kidney, heart, or nervous system, etc. The aging population would benefit from a geriatrician.

Despite this obvious need for the generalist physician, who is far more cost-effective than the four subspecialist physicians each seeing one patient, there is a serious shortage of general physicians and geriatricians in rural areas , and difficulty accessing outpatient appointments, with the resulting burden on public hospital admissions .

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Perhaps there is a need for a cost-benefit analysis of management by patient of the common chronic disease patients by general physicians, and of diseases of aging by geriatricians, both in conjunction with the GP, compared with management of the one patient by several different subspecialists .

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GEORGE HAMOR says: July 28, 2014 at 10:52 am General Medicine died in big urban areas when subspecialisation started to become a force, and Geriatricians took their place. In response to Sue Ieraci’s first comment, her elderly relative would have been best served by being admitted under the aged care team.

http://www.doctorportal.com.au/mjainsight/2014/26/subspecialties-hold-back-generalists/