In this issue of the Archives, Hershey et al1 report a "pervasive feeling of frustration and demoralization among practicing internists" in New York. They queried academics, general internists, and subspecialists. Accurate as Hershey et al may be in general, there are dramatic differences of concern between these groups of physicians; I believe that Hershey et al may be homogenizing marked variations of opinion. This is what I found when sampling opinions about the future of medicine shared by some general internists practicing in Denver, Colo.
Denver differs significantly from New York State. We are suffering from a prolonged economic recession, have a very low Medicare payment rate, and have a higher penetration of health maintenance organizations in our medical market. Perhaps because of these factors, I find Denver internists even more pessimistic than those studied by Hershey et al. My colleagues are depressed about loss of income, prestige, autonomy,
PLATT FW. What Do Internists Think? Arch Intern Med. 1989;149(8):1723–1724. doi:10.1001/archinte.1989.00390080009001
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