The leadership crisis in internal medicine: what can be done?

During the 1990s, internal medicine will change. Whether that change will be in directions desired by internists will depend on whether effective leadership of the discipline is accepted by the academic department chairs. Individually, and as a group, they are the only ones with sufficient authority to take control and initiate and sustain needed change. The time frame for action is short and diminishing. Opportunities still exist for effective leadership to present the discipline as more attractive to students by demonstrating that they can play an important role in helping to solve problems in health care. Unmet societal needs underlie much of the public's disaffection with the profession, and the chairpersons must begin to solve those needs. Today's practice environment is ever less appealing with increasing regulation and intrusive third-party actions. These stresses will increase until internists understand from research the value of what they do in practice and learn to choose what is effective in outcome and cost. Practice models integrating the skills and talents of internists, as these are focused on the needs of patients, are experiments that can be started in academic departments. Initiatives for such changes depend on active leadership--now sorely lacking in internal medicine.