Vermont Internal Medicine

What is internal medicine?

Internal Medicine is the branch of medicine that focuses on diagnosis and treatment of disease of most of the body's internal organ systems. Doctors like me who practice this type of medicine are called internists. Internists generally focus on adults ranging from age 17 to 100+.

Internal medicine training focuses on adults. In that regard we are different from family practitioners. We don't see children. We do see geriatric patients.

Internists also coordinate care among specialists, though one of the secrets of concierge medicine is that, given appropriate time with the patient, internists can handle much more in their offices than most administrators realize. This is one of the reasons I became a concierge doctor - I like dealing with "the whole you," the whole body. A holistic view on diagnosis, treatment, and prevention is both important for you, interesting for you and me, and it saves the health care system a massive amount of money. I do not view my role as just a "gatekeeper" to other doctors.

Why is important that you see a physician?

Seeing a board-certified physician is critical to your good health care. Internal medicine physicians are trained not just to do routine medical tasks and exams, but to look for unusual patterns in diseases that may be difficult to diagnose. If caught early and treated correctly, this can have a substantial effect on your well being.

Medicine has gotten incredibly complex in the past few decades. For example, the standard of care for simple diabetes, which outlines what a doctor needs to know, is 33 single spaced pages! (You can see it for yourself here.) And that is just one disease among thousands that internists study and follow.

While there are a lot of other methods of care being proposed to patients as substitutions for physicians, the reality is that only doctors have gone to medical school, gone through medical internships and residencies, taken the medical boards, and executed ongoing doctor-level training every year. There are no substitutes for this. From Christopher Flavelle at Bloomberg:

What's made U.S. outcomes so bad? Partly it's that Americans have built a system that makes them less likely on average to see doctors than their developed-world counterparts. In 2009, the latest year for which the OECD has published data, there were 4.1 doctor consultations for each American; only Sweden was lower, while the numbers in Germany, Spain and Canada were about twice as high. Fewer doctor's visits mean fewer chances to diagnose problems, manage treatments, or even take simple preventive measures -- such as talking about the importance of diet and exercise. See the data here.

The American Academy of Family Physicians has released a concise report on this issue. Read it here.

Finding a Vermont doctor.

It is getting much harder to find a good internist in the State of Vermont - the number of doctors practicing internal medicine here is collapsing. We have lost 24% of our internists in the four counties bordering Lake Champlain in just the last four years, from 2008-2012. The shortage is bad now but a cursory study of the statistics, including the average age of internists in Vermont, shows that the shortage is about to get much worse.

The simple reality is new medical students do not want to go into this field as it exists today, and existing internists are leaving. This is not because of the patients - it's because of how the health care system treats the profession. As a result, almost all internal medicine practices across the state of Vermont are closed to new patients.