This paper is divided into 4 parts. The first deals with the definition of specialties and traces its roots from the early 20th century in the United States of America with the formation and growth of Specialty Boards. The second is a reflection on the scene in Singapore from the 1960s to the present, describing the change from public healthcare institutions run by the civil service to the autonomous restructured public service hospitals towards the end of the 20th century. The third section deals with what the 4ps have expressed about changes necessary to the Singapore system in the 21st century. The 4ps are the politicians, the payers, the patients and the public. It is about value for money, better coordination and better communication. Finally, just what is Internal Medicine – its competencies and its practice. A review of the systems in Australia, New Zealand, and the USA is presented. The idea of the “hospitalist” is discussed. Concluding remarks deal with the viability of Internal Medicine because of low reimbursement, administrative burdens and brief patient visits.
It humbles me to accept the invitation to give this lecture, the First College of Physicians Lecture, titled “The Role of Internal Medicine as a Specialty in the Era of Subspecialisation”. I believe I am given this honour as I am one of the few of a seemingly dying breed of physicians – the general physician – and because I have passed the age of 50 years, having practiced now for over 30 years in this field in the public health sector.
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