Article    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Published comments/rapid response letters    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Schwartz, M. D.    Rubenstein, A.    Related Articles in PubMed    PubMed Citation    PubMed

SUPPLEMENT: THE FUTURE OF GENERALISM IN MEDICINE

Eric B. Larson, MD, MPH; Kenneth B. Roberts, MD; Kevin Grumbach, MD, and Christine Laine, MD, MPH, Editors

Rekindling Student Interest in Generalist Careers

Mark D. Schwartz, MD; William T. Basco, Jr, MD; Michael R. Grey, MD, MPH; Joann G. Elmore, MD, MPH; and Arthur Rubenstein, MBBCh

19 April 2005 | Volume 142 Issue 8 | Pages 715-724

Despite changes in the structure of the U.S. health care system, patients continue to need and seek out generalist physicians. However, the proportion of U.S. graduates of medical schools who choose to enter generalist residency training decreased from 50% in 1998 to less than 40% in the 2004 match. Unless we act now to reverse this trend, we may face a shortage of primary care physicians to care for the complex medical needs of an aging population.

This article reviews the history of and trends in career choice and proposes 4 evidence-based recommendations to rekindle student interest in generalist careers: 1) We must improve satisfaction and enthusiasm among generalist physician role models. 2) Schools of medicine should redouble their efforts to produce primary care physicians. 3) We must facilitate the pathway from medical school to generalist residency. 4) The U.S. government should increase funding for primary care research and research training. In the absence of a major overhaul of economic incentives in favor of generalist careers, we will need to work at these multiple levels to restore balance to the generalist physician workforce and align with the desires and expectations of patients for continuing healing relationships with generalist physicians.

Author and Article Information

From New York University School of Medicine, New York, New York; Medical University of South Carolina, Charleston, South Carolina; High Street Health Center, Springfield, Massachusetts; Harborview Medical Center; Robert Wood Johnson Clinical Scholars Program; University of Washington School of Medicine, Seattle, Washington; and University of Pennsylvania, Philadelphia, Pennsylvania.

Grant Support: By grant R01 HS11955-01 from the Department of Health and Human Services, Agency for Healthcare Research and Quality (Dr. Schwartz), and the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Mark D. Schwartz, MD, New York University School of Medicine, Division of General Internal Medicine, Veterans Affairs New York Harbor Healthcare System, Medical Service (111), 423 East 23rd Street, New York, NY 10010; e-mail, mark.schwartz{at}med.nyu.edu.

Current Author Addresses: Dr. Schwartz: Division of General Internal Medicine, New York University School of Medicine, Veterans Affairs New York Harbor Healthcare System, Medical Service (111), 423 East 23rd Street, New York, NY 10010.

Dr. Basco: Division of General Pediatrics, Medical University of South Carolina, 135 Rutledge Avenue, PO Box 250561, Charleston, SC 29425.

Dr. Grey: High Street Health Center, 140 High Street, Springfield, MA 01199

Dr. Elmore: University of Washington School of Medicine, 325 Ninth Avenue, Box 359780, Seattle, WA 98104-2499

Dr. Rubenstein: University of Pennsylvania, 3620 Hamilton Walk, Room 295, John Morgan Building, Philadelphia, PA 19104-6055.

Related articles in Annals:

Editorials
Primary Care, Generalism, Public Good: Déjà vu? Again!
Eric B. Larson, Kenneth B. Roberts, AND Kevin Grumbach

Annals 2005 142: 671-674. [Full Text]  

Supplement: The Future of Generalism in Medicine
The Future of Generalism in Medicine
Eric B. Larson, Kevin Grumbach, AND Kenneth B. Roberts

Annals 2005 142: 689-690. [Full Text]  

Supplement: The Future of Generalism in Medicine
The Essential Role of Generalists in Health Care Systems
Robert L. Ferrer, Simon J. Hambidge, AND Rose C. Maly

Annals 2005 142: 691-699. [ABSTRACT][Full Text]  

Supplement: The Future of Generalism in Medicine
Coordinating Care across Diseases, Settings, and Clinicians: A Key Role for the Generalist in Practice
Christopher J. Stille, Anthony Jerant, Douglas Bell, David Meltzer, AND Joann G. Elmore

Annals 2005 142: 700-708. [ABSTRACT][Full Text]  

Supplement: The Future of Generalism in Medicine
Processes for Effective Communication in Primary Care
Saul J. Weiner, Beth Barnet, Tina L. Cheng, AND Timothy P. Daaleman

Annals 2005 142: 709-714. [ABSTRACT][Full Text]  

This article has been cited by other articles:

				J. F. Wilson Massachusetts Health Care Reform Is a Pioneer Effort, but Complications Remain Ann Intern Med, March 18, 2008; 148(6): 489 - 492. [Full Text] [PDF]

				D. E. Lilienfeld The General Epidemiologist: Is There a Place in Today's Epidemiology? Am. J. Epidemiol., July 1, 2007; 166(1): 1 - 4. [Abstract] [Full Text] [PDF]

				T. L. Cheng, D. Markakis, and T. G. DeWitt The Status of Academic General Pediatrics: No Longer Endangered? Pediatrics, January 1, 2007; 119(1): e46 - e52. [Abstract] [Full Text] [PDF]

				J. P. Fitzgibbons, D. R. Bordley, L. R. Berkowitz, B. W. Miller, and M. C. Henderson Redesigning residency education in internal medicine: a position paper from the association of program directors in internal medicine. Ann Intern Med, June 20, 2006; 144(12): 920 - 926. [Abstract] [Full Text] [PDF]

				S. E. Weinberger, L. G. Smith, V. U. Collier, and for the Education Committee of the American Colleg Redesigning Training for Internal Medicine Ann Intern Med, June 20, 2006; 144(12): 927 - 932. [Abstract] [Full Text] [PDF]

				R. L Phillips Primary care in the United States: problems and possibilities BMJ, December 10, 2005; 331(7529): 1400 - 1402. [Full Text] [PDF]

				E. B. Larson, K. B. Roberts, and K. Grumbach Primary Care, Generalism, Public Good: Deja vu? Again! Ann Intern Med, April 19, 2005; 142(8): 671 - 674. [Full Text] [PDF]

				E. B. Larson, K. Grumbach, and K. B. Roberts The Future of Generalism in Medicine Ann Intern Med, April 19, 2005; 142(8): 689 - 690. [Full Text] [PDF]

Rapid Responses: