Infectious: An unnecessary specialty

I am 64 years old, I am an internist and a professor of Medicine, and I really enjoy my work. Honestly, what satisfies me the most about my profession is the relationship with the patient. That is why I am an internist, because of my commitment to solving the patient’s problem, regardless of the organ it affects, with the involvement of other professionals. In Internal Medicine there is no room for the phrase: “you are doing very well from mine”, because mine is “everything”. This is our added value, and what determines the professional adaptation capacity of the internist to the needs of the patient. We are the specialty that assists the most patients in hospitalization. However, the value of our specialty is unknown to most citizens. It is common for them to tell us: “You are an internist, and what do you do? What is the field of your specialty?” The best way to explain it to you is to be cared for as a patient by an internist. In addition, what they are also unaware of is that the Spanish Internal Medicine specialty has always remained a complete specialty, with 5 years of training. Instead, in most countries, it became an intermediate core training period of 2-3 years, necessary for the subsequent acquisition of a specific specialty. This is the main reason why specialties such as Infectious Diseases exist in other countries, while in Spain it is successfully assumed by Internal Medicine. Taking into account our holistic vision, the provision of internist services is very broad. But, without a doubt, infectious diseases stand out, which constitute the most common reason, as a sole or associated cause, for admission to Internal Medicine services. The vast majority of these infections are part of the basic skills that internists acquire during their training. It is true that there is a small group of patients with complex infectious diseases, such as those acquired in transplant or cancer patients, who are cared for by professionals, also mostly internists, who have a preferential dedication to these diseases. Part of these professionals claim the creation of the specialty of Infectious, based on the work they carry out in their daily practice. But does this dedication justify the creation of a specialty of Infectious Diseases, independent from that of Internal Medicine? Are there other options that recognize this dedication, without carrying the serious consequences of fragmenting patient care? The fundamental argument put forward by the defenders of a new specialty is based on the fact that it exists in most European countries, and its implementation would improve patient care. Who can deny the progress of health care? Nobody, but as I mentioned before, there is no specialty in infectious diseases in our country because the vast majority of its skills are acquired during the 5 years of training in Internal Medicine. If we analyze the health results in the area of ​​infections, the Spanish indicators are comparable to those of the European countries where the specialty exists. Suffice it as an example, the participation that Internal Medicine services have had in Spain during the Covid-19 pandemic, where they competently cared for more than 70% of the patients hospitalized for this unprecedented and terrible disease. Therefore, the Spanish population must be convinced that our current health system offers quality care in infectious diseases, at least as good as in the rest of Europe. What would be the criteria for a hospitalized patient to be cared for by the recently created Infectious Diseases service? Obviously not all those admitted for infectious diseases. There are experiences in a few hospitals, such as the Ramón y Cajal University Hospital, where I work as an internist, where there has been an independent Infectious Diseases service for many years, and income distribution criteria have not yet been established, which creates with frequently organizational dysfunctions. Another very important question is the cost that the creation of the specialty would entail. Would the staff of the hospitals be increased or would the existing staff be redistributed, to the detriment of some services, such as Internal Medicine? There is an alternative to the creation of the specialty, without the negative consequences of the previous one. This solution would be the creation of a Specific Training Area for Infectious Diseases, whose training would be accessed after obtaining a specialty degree. In this way, there is no risk of fragmenting specialties that perform inclusive care work, and the expertise of professionals with a preferential dedication to infectious diseases is recognized, officially ensuring their generational replacement. Undoubtedly, the best way to solve the disparity of opinions that this issue raises is through dialogue. For this reason, I appeal to Scientific Societies, Health Departments and the Ministry of Health to organize a forum for dialogue on this issue, with the central participation of the patient, which is our reason for being. I’m sure we’ll come to an agreement. ABOUT THE AUTHOR Luis Manzano Espinosa Head of the Internal Medicine Service of the Ramón y Cajal University Hospital