The Future of Primary Care

To the Editor.—Dr Mullan's¹ new series, Profiles in Primary Care, is well timed. Serious discussion of generalism has been minimal, and its advocacy has been sporadic rather than sustained in our medical literature. I share the author's hopes that his work "will stimulate students of medicine and the makers of policy to reflect on medical generalism."

For the past several years, policymakers in medicine and government have declared that primary care has a central role in our health care system and more primary care physicians need to be trained.² However, medicine seems ambivalent about accepting generalism into a profession that for the past several decades has been dominated by specialism. Within the medical hierarchy, primary care physicians are still accorded second-class status in most communities, and the rebirth of primary care, which seemed imminent several years ago, now appears doubtful.