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Article |

Family Practice

Robert E. Rakel, MD
JAMA. 1986;256(15):2056-2057. doi:10.1001/jama.1986.03380150066011.
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Some say we are in the midst of a revolution in health care; others say it is just beginning—that the missile is just lifting off the pad. Over 45% of the people in Minneapolis-St Paul are enrolled in health maintenance organizations, compared with only 8% nationally. Paul Ellwood1 predicts that in ten years the 300 000 firms now providing medical care in the United States will be reduced to approximately ten medical megacorporations. It is clear that the primary care physicians needed to run this system are in short supply, and it is in this specialty that medical centers continue to train the fewest numbers and perhaps inefficiently.2-5 The incomes of these gatekeepers will rise as those of the already abundant subspecialists decline. The predictions of the Graduate Medical Education National Advisory Committee appear to be right on target with less than a 1% error. One problem facing


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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