Education of the Primary Physician: A Time for Reconsideration?

Two thought-provoking articles in this issue of JAMA suggest the time is ripe for rethinking the education of primary physicians. Geyman¹ suggests (and provides evidence to support his thesis) that we face a shortage of physicians specifically educated for primary care. He identifies alternative approaches for increasing the proportion of primary physicians and provides strong support for the development of a "generic" primary physician. Christiansen et al² argue for the development of combined residency programs in family practice and internal medicine as a means of better preparing a primary physician.

Specialization has been a dominant force in our health care system during the past four to five decades. Teaching hospitals have both contributed to the explosion of medical knowledge and educated highly specialized physicians to provide this care. Graduates have then replicated these patterns of advanced secondary and tertiary care throughout the community. As a result, we have