Internists, along with other primary care specialties, are in short supply these days. According to a 2008 study published in the Journal of the American Medical Association, only 2 percent of fourth-year medical students planned to make a career of general internal medicine. Doctors in training cited long hours, an adversarial legal system and administrative hassles as reasons for staying out of primary care. Ironically, research shows that access to primary care physicians results in fewer emergency room visits, lower overall costs and better outcomes for patients. That’s because good primary docs still practice medicine the old-fashioned way: by talking with their patients.
Dr. Michael Petruso, the top vote-getter in the internist category of the Las Vegas Top Doctors survey, graduated from the University of Nevada Medical School in 1988 and has spent his entire professional career in Las Vegas. He was a late starter in the medical field, attending medical school in his 30s after a career as a professional guitarist working shows on the Strip. He talked to Vegas Seven about the challenges of his specialty and why he stays with it.
On being an internist: I think it is the ultimate diagnostic specialty. And now more than ever, I believe what the country needs is a cadre of very well trained, very disciplined and very rigorous internists to provide needs for the most people. I will never forget my first professor of medicine’s advice. He said I was responsible for knowing everything there was to know about the patient. Those were his exact words.
On actually listening to patients: Eighty-five percent of diagnosis comes from history, from simply talking to a patient. It doesn’t mean order a stress test, order an angiogram, order an MRI. It means talking. … Interestingly, only about 10 percent of diagnosis comes from physical exam. That leaves a very small amount for testing. But because of the way the system is funded, it is more cost-effective for internists to ask a couple of questions, get a rough idea of what is going on and then order a battery of tests.
On how many patients he sees per day: Too many. A new patient takes more time than an established patient. I can’t believe this number I am looking at, but it is probably in the ballpark of 25 to 28. I consistently run two hours late. That gets to be a long day. I don’t think most people on the street would sign up for a job that ties them up 10, 12, 14 hours a day, year after year.
On access to health care: Everybody in the country can get health care if they don’t have insurance; they go to a county clinic and go to an emergency room, and we pay for that through our taxes. In Las Vegas, [University Medical Center] is the place, and they do a terrific job of taking care of people who couldn’t get health care in any other place. I think it is quite miraculous what gets done there. It would be more efficient if we had a system whereby people could get health care earlier on in their disease course.
On his prior gig as a professional guitarist working on the Strip: It was a good job. It was a good business. I actually believe I made more per hour, adjusted for inflation, than I do now. I didn’t work that many hours per day, either. I make more now because I work more hours.