How many internists are necessary for optimal health care in the United States, and how do these needs relate to the total medical manpower issues confronting the nation? What are the factors responsible for the current interest in general internal medicine in academic centers and in internal medicine societies? A perceptive analysis of recent developments and future trends is presented by Mark Siegler, MD, and Alvin Tarlov, MD. These coauthors are uniquely qualified to present an authoritative update on internal medicine today. Siegler, a member of the faculty of the University of Chicago Department of Medicine, was coeditor of a special issue of the Archives of Internal Medicine devoted to the subject of "The Role, Training and Responsibilities of the General Internist" (Arch Intern Med 137:1271-1334, 1977). He and his colleagues have published many reports in recent years on such subjects as "Development of an Academic Section of General Internal Medicine, " "The University Medical School Reaching to the Community Physician," and "A Right to Health Care: Ambiguity, Professional Responsibility and Patient Liberty." His interests in clinical ethics and in medical education have resulted in the formulation of creative approaches to the physician-patient relationship. Siegler contends that the patient should have a primary principal physician. This clinician should assume ultimate responsibility for the complex system of health care involved in diagnosis and therapy. In a sense this physician is an advocate of the patient in dealing with the hospital, the consultants, and the clinical laboratory.
Tarlov is chairman of the Department of Medicine of the University of Chicago. He is chairman of the Federated Council for Internal Medicine and president-elect of the Association of Professors of Medicine. His skills and authority in the realm of manpower needs in internal medicine are widely respected. These interests encompass health manpower planning for all disciplines in medicine, and this leadership role has recently been recognized by the secretary of Health, Education, and Welfare (DHEW). Secretary Califano named Tarlov as chairman of the Graduate Medical Education National Advisory Committee of DHEW. Responsibilities of this committee are to assess the number of physicians needed in the United States and to make recommendations on the distribution of professionals among the various medical specialties, how they should be deployed geographically, how graduate medical education should be financed, and what the role of the federal government should be in influencing all of these factors. Tarlov heads another national project to evaluate aspects of this problem; he is the chairman of the Association of Professors of Medicine Task Force on Manpower Needs in Internal Medicine.—A.S.