LETTER
Training More Generalists
Henry Greenberg, MD
1 January 1994 | Volume 120 Issue 1 | Pages 92-93
TO THE EDITOR:
A reduction in specialists and an increase in generalists is being proclaimed as a way to improve care and to reduce costs. Proposals to alter training content seem to focus on a refurbished, second-best category of physician. Reducing accredited specialty training slots, financially supporting residents who opt for primary practice, enlarging the educational base, and lengthening the training period will impose unwelcome constraints. They are unlikely to attract to primary care a cadre of highly competent, devoted, and committed physicians [1].
The prism through which I view all reform efforts is that of excellence. Will the proposed change permit the capacity for excellence? Dr. Barondess [2] has given us an imaginative, intellectually gratifying proposal, expanding on earlier models [3], which permits the generalist to be excellent and the true captain of the team caring for a broad range of complex patients. His master internist supplants many specialists while offering the excellent care our society demands. The reduced number of specialists will be needed for technologically complex problems, and they will be expected to perform at a high level of competence. Both the generalist and the specialist will need a training and support milieu that can produce excellence. Dr. Barondess' proposed reform is one of the few that can make that claim.
|
Author and Article Information
|
|---|
St. Luke's-Roosevelt Hospital Center; New York, NY 10019
1. Fallon HS. Residency reform: a perspective from the Association of Professors of Medicine. 1992; 116:S1042-S115.
2. Barondess JA. The future of generalism. Ann Intern Med. 1993; 119: 153-60.
3. Stein JH. Grand cru versus generic: different approaches to altering the ratio of general internists to subspecialists. Ann Intern Med. 1991; 114:79-82.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Top
Author & Article Info
References
Article
