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Primary Care as Part of US Health Services Reform

Jay Siwek, MD
JAMA. 1993;270(20):2433-2434. doi:10.1001/jama.1993.03510200038018.
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To the Editor.  —Starfield and Simpson1 outline some important steps for bolstering the role of primary care physicians in health care reform. But one problem they don't address is that of medical bigotry. By this I mean the prejudice that exists at many of our medical institutions against the specialty of family practice. I single out family practice from the other primary care specialties of general internal medicine and pediatrics because by and large they don't face this problem. But ask just about any medical student interested in family practice, and I think the odds are that they've been subjected to pervasive negative propaganda from attending physicians in other specialties.I interview medical students from all over the country, and the tales they tell are all too familiar to me and my colleagues in family medicine. Here's a sample of what they hear:"Why would you want to go


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