Graduate Medical Education Confronted

To the Editor.  —Writing from the perspective of an advocate of family practice, I would like to question some points in the otherwise excellent commentary by Dr Perkoff,¹ beginning with his statement that "family practice provides less in-hospital training than needed either for the practice activities of most modern family practitioners or for the best care of seriously ill hospitalized patients."To support the first portion of this assertion, he cites an extensive mail survey of the work done by a sample of physicians in various specialties. Family physicians were reported to spend about one fourth of their working hours with hospital patients; present national standards require that family practice residents spend substantially more than half of their training time with inpatients. Some educators think this is insufficient, but supporting evidence is meager and subject to varying interpretations. Evaluation is further complicated by the fact that family physicians practice