Do internists need a name change?
Some say the term "adult medicine" would lead to less confusion
By Deborah Gesensway
When the College gauged public awareness about the identity of internal medicine five years ago, the results were not good. Pollsters found that the public was confused about who internists are and what they do.
Since those polls were conducted, the College's public awareness campaign has helped improve the public's perception of internal medicine. Some internists, however, want a more dramatic solution to internists' identity problem. They want their specialty to change its name to better reflect what internists do.
Internists practicing in the community complain that the public still often doesn't understand what they do, and academic internists say that many first-year medical students are confused by the term internal medicine. Changing the name "internal medicine" to something like "doctors of adult medicine," they say, would help clear up confusion and give internists' image a boost.
Skeptics, however, say that a simple name change will only go so far in improving the specialty's image. While some physicians agree that internists need help in improving their recognition among the public, they say other strategies will help more than a name change.
For several years, College Regent Mahendr S. Kochar, FACP, has argued that the specialty is due for a name change. Dr. Kochar, senior associate dean for graduate medical education at the Medical College of Wisconsin in Milwaukee, said the reason is simple: Although physicians know what internal medicine is, the general public tends to be confused.
Advocates of a name change point to data that the College gathered to prepare for its "Doctors for Adults" public awareness campaign. When the College hired professional pollsters to survey Americans about the image of internal medicine, it learned to its dismay that more than half of the American public didn't know what an internist was. Even worse, a fair proportion who said they knew were wrong.
You've probably heard it all before: An internist is an intern (trainee), or a specialist who treats only "internal organs," or someone who works in the hospital, or a doctor who is the same as a family practitioner or something so completely different that she can't be called a primary care physician at all. (See "'Doctors for Adults' enters fifth year with a new approach," this page, for an update on the College's campaign.)
"If you ask members of the general public, they don't have a clue, unless they are already under the care of an internist," Dr. Kochar said. "Even incoming medical students are at a loss when you ask them what internal medicine is."
"Although physicians know what internal medicine is, the general public tends to be confused"—Mahendr S. Kochar, FACP
Douglas Laidlaw, ACPASIM Student Member and a member of the College's Medical Student Council, said he frequently encounters this kind of confusion with first-year medical students. "I remember when I began planning for a career in medicine and first met a doctor doing his residency in internal medicine," said the fourth-year student at Mount Sinai School of Medicine in New York. "I remember wondering what it was that he did ... since most, if not all, of medicine is 'internal.' The only thing the title told me was that he was not a dermatologist."
Many advocates of a name change favor including the term "adult medicine." Dr. Kochar, for example, said the term is the most inclusive and descriptive of the options he has heard so far, and he doesn't think it excludes internists who treat adolescents. "I don't think adolescents would mind seeing a doctor of adult medicine," he explained.
Bruce L. Thomas, FACP, Immediate Past Governor for Pennsylvania's Western Chapter and an advocate of a name change, said that the term "adult medicine" makes sense from a marketing perspective. "Some patients don't want to walk into an office with a lot of kids with runny noses and coughs. They want to go to someone who specializes in adult problems like heart disease, lung disease or ulcers," he said. "I think a lot of older people would be very swayed by that name."
Walter J. McDonald, FACP, the College's Executive Vice President, said that many internists favor a name that is both more illustrative of what they do and less intimidating for patients, who he said apparently perceive "internal medicine doctor" as some sort of super-specialist. But he also said that he thinks most internists like their specialty's current name.
Is a name change enough?
That may be why even some internists who acknowledge that internal medicine has an image problem are opposed to a name change. Mark Schor, FACP, for example, a general internist in Boynton Beach, Fla., admitted that he has had some difficulty marketing his solo practice because of consumer confusion about what he does. Nonetheless, he doesn't think a name change alone will offer much help.
"I can't think of any name that would be descriptive enough," he explained. " 'Doctors for adults' is not particularly descriptive, and it discourages people from bringing in their children. I see teenagers and even younger children sometimes."
Besides, Dr. Schor said, a simple name change isn't likely to counter the misperceptions that patients get from health plans. He explained that HMOs compound internal medicine's identity problem through their marketing language. He described a common scenario he encounters in his practice: Seniors who are used to seeing a cardiologist, an endocrinologist and a rheumatologist join a Medicare HMO. The HMO tells them that they can continue to see their same doctors, but they must first see an internist to get a referral.
"The patient comes to me," Dr. Schor said, "and I think I'm getting a new patient. But then she says, 'I'm not really here to see you. I'm only here because I have to see you in order to see the other doctors.' The HMOs don't tell patients that internists are not just gatekeepers, that internists can take care of all their problems, and that they'll see a specialist if we can't."
Dr. Schor's solution? Educate the public about the role of internists, much like the College's public awareness campaign. He gives lectures on "What is an internist?" to about two community groups a month, speaking at bookstores, at senior centers and in the community room of his new office in a shopping mall.
While Dr. Schor said the marketing lectures are time-consuming, patients who have heard his talk don't perceive him as only a gatekeeper. "It really does work. They don't come just to get a referral."
He said that he doesn't think changing the name of the specialty would have the same impact, which is why he urges the College to continue with its "Doctors for Adults" public education campaign and to encourage more doctors to get involved with the marketing lectures that he gives. *
Deborah Gesensway is a freelance writer in Glenside, Pa.
The ads in this year's campaign have appeared in Better Homes and Gardens, Family Circle, Ladies Home Journal, Newsweek, Readers Digest Family Plus and Time. They are designed to reinforce the College's focus on women's health issues, including osteoporosis, heart disease, stroke, hypertension and cancers beyond those of the reproductive organs. The College plans to release public relations material later this year to address antibiotic resistance, adult immunization and depression.
The campaign ads were changed largely in response to internists' reaction that the old ads were "a little bit too flip and not providing any degree of public health service," explained David L. Sgrignoli, the College's Senior Vice President for Marketing and Communications. "We are not only trying to create identity, but also to improve patient care."
One accomplishment of the campaign, Mr. Sgrignoli said, has been its ability to help internists as they struggle to explain to patients what they do. "We have increased consumer awareness of who internists are, but we have a long way to go with that," he said. "But we really did create an identity that internists could latch onto. It has helped create a greater sense of community among our members."
Surveys show that since its inception in 1996, the College's campaign has helped raise public awareness about internal medicine. In 1996, for example, only 14% of consumers surveyed knew that internists were specialists in internal medicine. By 1998, that number had jumped to 23%.
Reproductions of this year's ads, as well as new patient brochures on women's health, depression, antibiotic resistance and "What is a Doctor of Internal Medicine?" are available for College members who want copies for their offices. Members can also request free CD-ROMs to create practice-promotion brochures.
Whether the "Doctors for Adults" campaign will have a future after this year is up for debate, first by the College's new Marketing and Communications Committee and then by the Board of Regents.
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