Chair's Message: What it Means to be a Subspecialist in Internal Medicine

by Donald E. Wesson, MD
ABIM Chair, 2007-08

This issue of Perspectives notes how the internal medicine landscape is heavily influenced by the unique challenges and rewards within each of the subspecialties. Dr. Cassel’s article, in particular, illustrates how our overall program to certify general internists and subspecialists continues to expand, but – equally important – her message suggests how internal medicine and the subspecialties are closely interwoven with internists joining forces to deliver the best care possible.

My personal experience in internal medicine has taken me on a pathway that began with medical training at Washington University School of Medicine, my residency at Baylor College of Medicine and my fellowship in nephrology at the University of Illinois in Chicago. Over the years, I have focused on academic medicine and research, leading to my current work at Texas A&M College of Medicine and as Chief Academic Officer at Scott and White Hospital.

From my earliest training at Washington University and throughout my career as an internist, I was drawn to the subspecialty of nephrology and the study of kidney physiology because, for me, nephrology is the specialty that best allows for the direct application of physiologic and pathophysiologic understanding to the care of patients. Nephrology is the specialty whose routine clinical practice I think best incorporates the breadth of internal medicine with all of its component subspecialties.

However, my background as an internist continues to provide the foundation upon which my specialization in nephrology rests. I consider myself a physician who does research, rather than a researcher who sees patients. Specifically, I think of myself as an internist with a concentration toward patients with kidney disease and other metabolic problems. Patients with kidney disease commonly have problems that span the spectrum of internal medicine. Consequently, nephrologists must routinely practice good internal medicine even if they limit their practice exclusively to patients with kidney disease. In my role as an academician, I round on the General Internal Medicine service so that I must maintain my patient care skills in general internal medicine and am able to teach general internal medicine to our increasingly sophisticated internal medicine house staff.

Although my certification in both internal medicine and nephrology is time-unlimited, remaining current in both areas is important. In 2005, I voluntarily renewed my internal medicine certificate and plan to do the same in nephrology as well. Once I began the process of preparing to renew my internal medicine certificate, I came to appreciate that, along with taking and passing the secure exam, self-assessment of both my knowledge and performance in practice were important measures of my competence.

For those of you certified in more than one area, your individual circumstances may call for you to renew either certificate or both. Indeed, many of you are choosing the path to maintain your certification in all areas, even though this is not a requirement. We recognize your hard work and dedication and it reflects your commitment to your patients and our profession.