Internal medicine and hospital attachment?

[Guest ewon2003]

I know a variety of internal medicine subspecialties require hospital attachment for access to equipments and services, and in return the physician will take on hospital duties and calls.

 

For example, a GI guy probably needs hospital to do scopes, and cardio likewise needs hospital to do angiography.

 

Are there IM specialties that do not require such hospital requirements?

 

Or does it depend on scope of practice? For example, in this case can a cardiologist, for example, have echo and ECG machines at outpatient office setting and practice solely in office based outpatient setting?

[Guest Kirsteen]

Hi there,

 

The autonomy of an internal medic will probably depend, in part, on how much interventionalist medicine they practice. For example, an interventional cardiologist is most probably going to need the services and support of a cath lab, and step-down beds (in the event of an adverse outcome) which would be pretty expensive (and possibly inefficient) to fund and staff privately. I'd imagine the same might be true of any interventionalist where resources must be in place to care for the patient when that small minority of cases go a bit wrong.

 

On the flipside, however, when I worked in a diagnostic lab the building that housed the lab was a 7-storey medical building. Therein, although there were a few family doctor practicess, there were primarily the practices of internal medicine specialists. Many types of specialty were represented, e.g., nephrologists, neurologists, etc. What was effective was that the building also contained (in addition to a full-service diagnostic lab with EKG facilities) imaging facilities in the basement (for US, X-rays, etc., although no MRI/CT) and a pharmacy on the main level. It was quite a nice little set-up. Additionally, there was a good-sized hospital across the road so interventionalists, I'd assume, might have access to those facilities.

 

Anyway, back to the main point: the autonomy of the internal medicine practitioner hinges upon the type of practices used and the inherent risks to the patients. In the case of the internal medicine folks in my building, they certainly seemed to do quite nicely in private practice without seeming to rely too heavily on the hospital.

 

Cheers,

Kirsteen

[Guest aneliz]

There are many internal medicine subspecialties that can be done without being attached to a hospital. The downside of this is that it limits what procedures you can do, and, without hospital privileges, you can't admit any of your patients yourself and would need to pass them on to someone else to care for if they needed an inpatient bed.

 

Some examples that could easily be all out-patient:

 

Rheumatology

Allergy and Immunology

Geriatrics

 

Others that could be done that way but may limit your scope of practice:

 

Cardiology - if you don't want to manage in-patients or do any interventional work

 

Nephro - outpatient only +/- dialysis

 

Resp - no scopes

 

GI - no scopes