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Editorials |

Internal Medicine: Whole or in Pieces?

Robert H. Fletcher, MD; and Suzanne W. Fletcher, MD
Ann Intern Med. 1991;115(12):978-979. doi:10.7326/0003-4819-115-12-978
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Internal medicine has many centrifugal forces. In the last three decades there has been an extraordinary expansion in the knowledge base of internal medicine and with it has come subspecialization (1). Now 43% of internists identify themselves as subspecialists (2), and 60% of internal medicine residents enter subspecialty fellowships directly from residency (3). The subspecialties have established their own certification, societies, journals, meetings, and, in some cases, economic independence. By the year 2000, nearly half of all internists will be subspecialists.

Because they have increasingly separate identities, the subspecialties have been drifting away from each other and from internal medicine


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