Internal medicine is confronting a conflict between its generalist and specialty roles, coupled with a conflict between the needs of academic internal medicine in contrast to those of private practice. The historical origins of these conflicts are explored. To resolve these conflicts, internal medicine must rediscover the common ground shared by the general internist and specialist, academician and practitioner. This common ground is best found in the role of internist as physician-scientist. In the future, specialists and general internists will need to emphasize their roles as consultants. In the process, internal medicine will become smaller and more 'academic.' The benefits of this role for internal medicine should be rapidly demonstrated through outcomes based research in order to win over skeptical payors, peers, and the public at large.
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