CONTRIBUTION OF SPECIALISTS TO THE DELIVERY OF PRIMARY CARE - NEW PERSPECTIVE

Despite increased numbers of medical-school graduates and opportunities for “primary-care” specialty training since the mid-1960's, many believe that the shortage of physicians delivering generalist care will continue through the 1980's. Missing, however, is solid information on the role of physician specialists in providing such care. Two national studies have shown that one of every five Americans now receives continuing general medical care from a specialist physician. Our study suggests that, despite the current shortage of generalistphysician services, continuing specialist participation in primary care will lead to sufficient generalist medical services by the mid-1980's. Whether specialist participation is the most appropriate or cost-effective way to improve access to such care is unclear. However, until this question is resolved, more governmental regulation of graduate medical education may be unwise. Offering all physicians, regardless of specialty, more primary-care experience during residency training might better deal with this aspect of American medical practice. (N Engl J Med 300:1363–1370, 1979) AFTER the publication of the report of the Citizens Commission on Graduate Medical Education (the Millis Report) over a decade ago, considerable attention was focused on the numbers of generalist physicians emerging from the nation's residency training programs.1 In the ensuing years a consensus gradually emerged that the country was underproducing generalists, or, in the terms of the commission's report, “primary physicians,” who would “serve as the primary medical resource and counselor to an individual or family.” In subsequent years, the commission's concept of the “primary physician” was modified, expanded and eventually equated with what is now called the “primary-care. © 1979, Massachusetts Medical Society. All rights reserved.