The American population, its health expectations, medical science's capacity to make a difference in the course of disease, consumer purchasing power, and both poverty and middle-class demand for medical services all have substantially increased during a 40-year period when the number and percentage of physicians interested principally in providing primary care have substantially decreased. Where three of every four physicians used to be in general practice, only one of four is found there today.
The revolution of American medical education in the more than half century since the Flexner report is a success story. Medical faculties and teaching hospitals have moved the undergraduate and graduate training of students in the direction of science, scholarship, specialization, and predominantly toward the hospital care of patients. The price of this success has been a loss of interest in career commitments to primary care.
The public demand for easily accessible, readily available, first-contact medical