Specialists or Generalists

Abstract

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.^1,2For the most part, we have taken the latter road.³Despite 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