Health Policy

Journal of General Internal Medicine

, Volume 19, Issue 1, pp 69-77

First online:

The future of general internal medicine

Report and recommendations from the society of general internal medicine (SGIM) task force on the domain of general internal medicine
  • Eric B. LarsonAffiliated withGroup Health Cooperative’s Center for Health Studies Email author 
  • , Stephan D. FihnAffiliated withUniversity of Washington Harborview Medical Center
  • , Lynne M. KirkAffiliated withUniversity of Texas Southwestern
  • , Wendy LevinsonAffiliated withUniversity of Toronto
  • , Ronald V. LogeAffiliated withThe Southwestern Montana Clinic
  • , Eileen ReynoldsAffiliated withBeth Israel Deaconess Medical Center
  • , Lewis SandyAffiliated withUnited Health Care
  • , Steven SchroederAffiliated withUniversity of California
  • , Neil WengerAffiliated withUCLA Medical Center
    • , Mark WilliamsAffiliated withEmory University

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The Society of General Internal Medicine asked a task force to redefine the domain of general internal medicine. The task force believes that the chaos and dysfunction that characterize today’s medical care, and the challenges facing general internal medicine, should spur innovation. These are our recommendations: while remaining true to its core values and competencies, general internal medicine should stay both broad and deep—ranging from uncomplicated primary care to continuous care of patients with multiple, complex, chronic diseases. Postgraduate and continuing education should develop mastery. Wherever they practice, general internists should be able to lead teams and be responsible for the care their teams give, embrace changes in information systems, and aim to provide most of the care their patients require. Current financing of physician services, especially fee-for-service, must be changed to recognize the value of services performed outside the traditional face-to-face visit and give practitioners incentives to improve quality and efficiency, and provide comprehensive, ongoing care. General internal medicine residency training should be reformed to provide both broad and deep medical knowledge, as well as mastery of informatics, management, and team leadership. General internal medicine residents should have options to tailor their final 1 to 2 years to fit their practice goals, often earning a certificate of added qualification (CAQ) in special generalist fields. Research will expand to include practice and operations management, developing more effective shared decision making and transparent medical records, and promoting the close personal connection that both doctors and patients want. We believe these changes constitute a paradigm shift that can benefit patients and the public and reenergize general internal medicine.

Key words

primary care medical education physician payment hospitalist geriatrics