Issues for American internal medicine through the last century

The content, role, and purpose of internal medicine, organized as an American specialty 100 years ago, have been marked by ambivalence from the beginning. Nevertheless, molded to a large extent by external events, including the strategic and symbolic importance of surgery in American medicine, the rise of university medical schools, development of other specialties, and, more recently, the demand for primary care and the incentives built into reimbursement schemes and organized health care systems, internal medicine has become a powerful entity in American medicine. Its role in the future is likely to be more influential than in the past, both in policy and substantive areas. Continuing tensions in internal medicine include uncertainties about the relation between generalism and specialism, primary care and subspecialties, and internal medicine and general medicine.