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Generalists and Specialists

Thomas J. Ruane, MD
JAMA. 1984;251(14):1834. doi:10.1001/jama.1984.03340380019010.
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To the Editor.—  The failure of internal medicine residency programs to produce substantial numbers of generalist v subspecialty internists has been the subject of much discussion, including the recent commentary in The Journal by Dr Davidson. A factor that seems to me a major one in dissuading residents from the generalists track is that in such a career they would, from a resident's perspective, face a lifetime of diminishing competence.To illustrate that, I ask you to consider this question: If you were acutely ill with diabetic ketoacidosis, pneumonia, and a complicated myocardial infarction, were admitted to a University Medical Center, and could choose only one physician to provide your care, who would it be? For me the answer is simple. I would choose the chief medical resident. I would do so because in the world of the complex acutely ill patients of the teaching hospital medical wards, he or


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