The internal medicine in crisis: the analysis of causes and proposed changes.

Abstract

1068 intensity and nature, depending on the country which it encompasses; however, most frequently, the attention is called to general specialties, such as pediatrics, general surgery, and in particular internal medicine. There are 5 criteria defining “medical specialty in crisis”. The lack of proper candidates interested in training related to a giv‐ en area of medicine, the difficulties in finding em‐ ployees, excessive workload due to the limited number of employees in a doctors’ team, the sal‐ ary considered by the doctors as too low and lim‐ ited possibilities for additional income, low qual‐ ity of professional life.1 The experiences of the countries that have sim‐ ilar health care structure as Poland indicate that the causes of the crisis of medical specialties, such as internal medicine, stem from 3 different areas. Within the first area, namely the health care sys‐ tem and its affiliations, the following problems can be noticed: insufficient funding for the med‐ ical procedures performed in internal diseases units, the payer not taking into account the com‐ plexity of the care provided in internal diseases units, and no continuation of specialist inter‐ nal medicine care in an outpatient department.2 Those issues are of particular importance if we consider the extended human longevity and mul‐ tiple morbidities that intensify at an older age. Other problems within the system include short‐ age of training spots, an issue which is not given enough attention, as well as training programs for specialists that were not particularly interesting. The second group of causes underlying the cri‐ sis are the issues related to hospital management with the preference being placed on the profit‐ able narrow specialty units and the elimination of the cost of intensive internal diseases units. Another problem in this area is the lack of proper task planning and a clear definition of responsi‐ bilities, which would make it possible for medical personnel to feel more comfortable at work and to properly address the patient’s needs. The fact that due to the economic reasons the hiring of Introduction For at least 20 years now, we have been observing a continued crisis of some of the medical specialties that are important for the society’s health. This problem is of varying FORUM FOR INTERNAL MEDICINE