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Rehabilitating the Medical Specialist

George G. Spellman Jr, MD
JAMA. 1993;269(19):2505. doi:10.1001/jama.1993.03500190047023.
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To the Editor.  —There is an almost universal assumption that the percentage of specialists will have to be reduced to increase the availability of quality medical care and to control costs.1Why can't a specialist provide better, more cost-effective care? Has the specialist pathetically lost his or her clinical skills so that he or she can no longer diagnose without expensive technology (eg, can a gastroenterologist no longer diagnose an ulcer without an expensive endoscopic photo session)? Or has the specialist willingly been seduced by the profitable perplexity usually danced as the now familiar two-step: "I agree this case is very perplexing" followed by "We will have to study this patient" (eg, cardiac catheterization). Further, high-tech dependence has discredited the specialist's clinical skills so that many primary care physicians consider their skills to be equal to the specialists'. Although not an easy sell to the savvy patient or tort


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