"It's not what you look at that matters, it's what you see." - Henry D. Thoreau
The silent paradox
There is a large and silent paradox developing in internal medicine in America. At the same time we can do more than ever to cure people, traditional internal medicine doctors are so overwhelmed by the medical system that they don't have time to read about new developments, diseases, and medications.
The referral treadwheel
Medical training is not like wine, it doesn't get better with age (though conversely, experience does matter). With more time to educate myself and update my training, I don't have to refer patients to specialists as frequently, saving you time, hassle, potential confusion, and money. By stepping off the "referral treadmill" and thinking about things carefully, with new medical knowledge considered, I can increase greatly the quality of your health care. Referrals to specialists often have a built-in delay, and it is more convenient for you if I can handle the issue myself. I enjoy this form of internal medicine - I don't want to be a doctor running on the "referral treadmill."
Medical Complexity Explosion
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.
In short, not only is it critical that you see a board-certified internist, it's important that you see one that has time to re-train continuously.
I was deeply frustrated by this paradox when I worked in big-system health care. It's almost invisible to patients yet it may be the most important problem in internal medicine. Now, as a concierge doctor, with fewer than a quarter of the patients of traditional practices, I have time to read the updated literature, study online courses, and attend seminars.
"The purpose of education is to use facts to challenge beliefs." - Jon Stewart