title: The case of the disappearing generalist: does it need to be solved?
abstract: The proportion of generalist physicians in the United States has declined steadily over 50 years, bringing it to the lowest percentage of trained primary care physicians of any developed country; the trend toward subspecialization is accelerating. Many analysts believe this imbalance between generalists and subspecialists to be a major cause of America's high health care costs, heavy dependence on biotechnology, and consumer dissatisfaction. Others argue that sub-specialists can provide excellent primary care services, and the decrease in the number of generalists is not a problem. Three contrasting views on the implications of this trend state that today's generalists are an important and scarce resource that must be bolstered; that subspecialists can replace generalists as providers of primary care; and that the free market will determine the best manpower mix. A final view, on the marketplace option, posits that generalism will not recover until it creates a vital, and unique, role in handling the primary care challenges of the twenty-first century. These competing viewpoints are used to clarify assumptions underlying our major policy options in the arena of health manpower.
authors.affiliation: Harvard Community Health Plan, Teaching Center, Boston, MA 02215.
authors.forename: G T
authors.initials: GT
authors.lastname: Moore
mesh_terms: D003258:Consumer Behavior; D003695:Delivery of Health Care; D006801:Humans; D010821:Physicians, Family / Q000600:supply & distribution*; D011320:Primary Health Care; D013038:Specialization; D014481:United States