Dr. Kerr White coined the term "primary care" a few decades ago to reflect the type of practice of most generalist physicians [1]. A recent American College of Physicians position paper [2] calls for a goal of at least 50% generalists from current internal medicine residency graduates. One reason for the current lack of generalists is the low prestige of the generalist. Why not change the name from "primary care physician" to "principal physician"?

"Primary" is defined as "first in order of time or development," for example, "primitive," as in stage of civilization. "Primary" colors are the basic but somewhat boring red, yellow, and blue. Thus, the word primary both denotes and connotes something basic and unsophisticated. Generalist physicians certainly deal with basic and mundane medical problems; general internists, however, also deal with complex, multifactorial medical problems, ethical issues. They also coordinate an increasingly complex medical environment. The generalist's professional life would be better described by the vivid colors of chartreuse, fuchsia, or cerulean blue.

The word primary also denotes "principal," as in first in rank and importance. A principal investigator is someone quite important and influential. The primary or principal physician is the most important physician in the health care system.

The term general internist is redundant. An internist by nature and training should be broad based in skills. Frequently, the qualifier "just" is applied as in "just a general internist". In actuality, it is many of the subspecialists who are limited in practice and scope of expertise. The term specialist is used to connote subspecialist, whereas the term generalist implies lack of specialty. Principal internists are specialists, not simply general practitioners; nor are they the same as another group of specialists, family medicine physicians [3].

Most aspiring young physicians in training desire to be "special" and, not surprisingly, want to be "specialists". Patients also want someone "special". Internists who limit their practice to a traditional subspecialty should be called subspecialists, with a narrower, albeit more detailed, expertise with certain medical problems and with high-tech procedures. We can promote and revitalize our great field by using more appropriate terms to describe our practice.