The U.S. model of internal medicine in and outside the hospital

The most striking change of the U.S. model of internal medicine has been expansion beyond a hospital-based, disease-focused, diagnostic and therapeutic discipline to one that includes ambulatory care for the well and the sick, and the management of disease, resources and information. In 1987 the American Board of Internal Medicine's Task Force on the Future of Internal Medicine proposed that general internal medicine should evolve to the new manager of care. Moreover, it recommended that general internal medicine and its subspecialties should remain united as a single integrated discipline. The 1997 training requirements added the study on practice of health promotion and disease prevention. Over 60% of U.S. internists practice a subspecialty, many as consultants both in and outside the hospital. Patients encounter a variety of doctors' offices: one-third are the decreasing number of general practice offices, one-third are the growing number of family practice offices; and one-third are general internal medicine offices; all of them are primary care specialists. In 1999 the general internist is a "doctor for adults"; he or she retains the original role diagnostician for patients with difficult or undifferentiated problems and for patients who will ultimately receive care from a subspecialist. The new age internist is the manager. He or she manages sick patients with complex problems.