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Primary Care in Transition-Reply

Philip R. Alper, MD
JAMA. 1995;274(9):683. doi:10.1001/jama.1995.03530090012007.
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In Reply.  —Dr Harer's letter, sent on behalf of the American College of Obstetricians and Gynecologists, is a disappointment to those who are seriously interested in the future of nonprocedural primary care. Little has changed since Pearson1 first put forth the OBG agenda two decades ago. The contemporaneous response seems just as tangential now.2The reason for proposing separate budgets and a separate fee schedule for primary care and for limiting the definition of the primary care specialties to internal medicine, pediatrics, and family practice lies precisely in the posture of transitional specialists who seem to favor considering themselves as primary care physicians in the sense of being first-contact professionals, but who eschew any significant involvement in the details of managing the care of many of the diseases that characterize the everyday practice of most primary care physicians.For example, when have gynecologists evaluated chest pain? How many


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