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Specialists or Generalists: Title and subTitle BreakOn Whom Should We Base the American Health Care System? FREE

Roger A. Rosenblatt, MD, MPH
[+] Author Affiliations

Reprint requests to Department of Family Medicine, Research Section HQ-30, University of Washington School of Medicine, Seattle, WA 98195 (Dr Rosenblatt).


JAMA. 1992;267(12):1665-1666. doi:10.1001/jama.1992.03480120103041
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One of the enduring debates in American medical policy is whether the United States should build its medical care system on a foundation of medical generalists or rely instead on more narrowly defined specialists.1,2 For the most part, we have taken the latter road.3 Despite 21 years of federal programs designed to increase the production of primary care physicians, most physicians select specialty careers, a trend that has accelerated with declining match rates in primary care fields in recent years.4

Although the debate has been both loud and long, the evidence available to resolve this issue rationally has been somewhat meager and frequently flawed. It is very difficult to determine exactly what physicians do, much less how much it costs or how profound its impact. Answering these questions is difficult, methodologically treacherous, and enormously expensive. Unlike a population of laboratory animals, physicians are reluctant and often fractious

REFERENCES

Barnett PG, Midtling JE.  Public policy and the supply of primary care physicians. JAMA . 1989;;262:2864-2868.
Rosenblatt RA, Lishner D.  Surplus or shortage? unravelling the physician supply conundrum. West J Med . 1991;;154:43-50.
Institute of Medicine. A Manpower Policy for Primary Care . Washington, DC: National Academy of Sciences; 1978;.
AAMC Data Book . Washington, DC: Association of American Medical Colleges; 1991;.
Tarlov AR, Ware JE, Greenfield S, Nelson EC, Perrin E, Zubkoff M.  The Medical Outcomes Study: an application of methods for monitoring the results of medical care. JAMA . 1989;;262:925-930.
Stewart AL, Greenfield S, Hays RD, et al.  Functional status and well-being of patients with chronic conditions: results from the Medical Outcomes Study. JAMA . 1989;;262:907-913.
Kravitz RL, Greenfield S, Rogers W, et al.  Differences in the mix of patients among medical specialties and systems of care: results from the Medical Outcomes Study. JAMA . 1992;;267:1617-1623.
Greenfield S, Nelson EC, Zubkoff M, et al.  Variations in resource utilization among medical specialties and systems of care: results from the Medical Outcomes Study. JAMA . 1992;;267:1624-1630.
Rosenblatt RA, Cherkin D, Schneeweiss R, Hart LG.  The content of ambulatory care in the United States: an interspecialty comparison. N Engl J Med . 1983;;309:892-897.
Luft H.  How do health-maintenance organizations achieve their 'savings'? N Engl J Med . 1978;;298:1336-1343.
Ginsburg PB, LeRoy LB, Hammons GT.  Medicare physician payment reform. Health Aff . 1990;;9:178-188.
Brook RH, Ware JF, Rogers WH, et al.  Does free care improve adults' health? N Engl J Med . 1983;;309:1426-1434.
Vall-Spinosa A.  Lessons from London: the British are reforming their National Health Service. Am J Public Health . 1991;;81:1566-1570.
Fuchs VR, Hahn AB.  How does Canada do it? N Engl J Med . 1990;;323:884-890.

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Barnett PG, Midtling JE.  Public policy and the supply of primary care physicians. JAMA . 1989;;262:2864-2868.
Rosenblatt RA, Lishner D.  Surplus or shortage? unravelling the physician supply conundrum. West J Med . 1991;;154:43-50.
Institute of Medicine. A Manpower Policy for Primary Care . Washington, DC: National Academy of Sciences; 1978;.
AAMC Data Book . Washington, DC: Association of American Medical Colleges; 1991;.
Tarlov AR, Ware JE, Greenfield S, Nelson EC, Perrin E, Zubkoff M.  The Medical Outcomes Study: an application of methods for monitoring the results of medical care. JAMA . 1989;;262:925-930.
Stewart AL, Greenfield S, Hays RD, et al.  Functional status and well-being of patients with chronic conditions: results from the Medical Outcomes Study. JAMA . 1989;;262:907-913.
Kravitz RL, Greenfield S, Rogers W, et al.  Differences in the mix of patients among medical specialties and systems of care: results from the Medical Outcomes Study. JAMA . 1992;;267:1617-1623.
Greenfield S, Nelson EC, Zubkoff M, et al.  Variations in resource utilization among medical specialties and systems of care: results from the Medical Outcomes Study. JAMA . 1992;;267:1624-1630.
Rosenblatt RA, Cherkin D, Schneeweiss R, Hart LG.  The content of ambulatory care in the United States: an interspecialty comparison. N Engl J Med . 1983;;309:892-897.
Luft H.  How do health-maintenance organizations achieve their 'savings'? N Engl J Med . 1978;;298:1336-1343.
Ginsburg PB, LeRoy LB, Hammons GT.  Medicare physician payment reform. Health Aff . 1990;;9:178-188.
Brook RH, Ware JF, Rogers WH, et al.  Does free care improve adults' health? N Engl J Med . 1983;;309:1426-1434.
Vall-Spinosa A.  Lessons from London: the British are reforming their National Health Service. Am J Public Health . 1991;;81:1566-1570.
Fuchs VR, Hahn AB.  How does Canada do it? N Engl J Med . 1990;;323:884-890.
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To understand the clinical management of acute heart failure syndromes.
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