I write in response to “Hospitalists work to find their way in the ICU” in the May 2018 ACP Hospitalist. As a program director for a small community-based hospital program in rural Kentucky, I remain confused and perplexed by the current “state of the state” in internal medicine training.
Before my career switch to program director, I was a frontline general internist for nearly 30 years and was trained at the University of Alabama Birmingham in the 1980s to handle ICU care. I have a difficult time understanding how three years of IM training today does not espouse ICU care and procedural capability as the critical part of our mission. In this era where many internists are becoming hospitalists, and most ICUs in the U.S. will never be fully covered by intensivists, how can this not be so?
We train our housestaff in an open ICU model. They routinely provide the bulk of the critical care in our 18-bed ICU, are facile in airway management and line placement, and are comfortable with ventilator management. They, on a regular basis, care for nearly every critical care circumstance, with specialist consultation as needed. They feel fully prepared to provide ICU care as board-certified internists who intend to practice hospital medicine as a career.
I feel it is incumbent on the Accreditation Council for Graduate Medical Education (ACGME) to recognize the “splitting” of the old IM mission into outpatient and inpatient care and, after PGY-1, to have our trainees commit to an inpatient or outpatient career. The rest of their training time should reflect that commitment. Only then will their future patients receive care from fully prepared generalists.
It is unacceptable to spend three years training and not become fully competent to independently practice.
Joseph G. Weigel, MD, MACP