LETTER
Training General Internists and "STARS"
Charles Moser, MD, PhD
1 January 1995 | Volume 122 Issue 1 | Pages 72-73
TO THE EDITOR:
Fogelman's strategy [1] to make general internal medicine more appealing to young physicians is interesting and innovative. Unfortunately, he repeats the unsubstantiated claim that there is a shortage of primary care physicians in the United States. This claim is behind many proposed changes in the medical education system and deserves closer scrutiny.
Using a strict definition of primary care physicians (including only general internists, general pediatricians, family physicians, and general practitioners in office-based practice), there are 51 primary care physicians per 100 000 persons [2]. This excludes all the interns, residents, and teaching staff who provide much of the service today. It does not include those employed by local, state, and federal governments; the specialists who choose to provide primary care; or the increasing number of nurse practitioners and physician assistants who provide primary care services. Nevertheless, even by this strict definition, there are more than enough primary care physicians to meet the need projected by Kronick and colleagues [3], Fogelman's source. Similarly, other objective sources also find the current supply of primary care physicians more than adequate [4, 5].
Although the goal of bolstering the status and privileges of general internists is noble and needed, these efforts should not be based on false assumptions.
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Author and Article Information
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St. Mary's Medical Center; San Francisco, CA 94117
1. Fogelman AM. Strategies for training generalists and subspecialists. Ann Intern Med. 1994; 120:579-83.
2. American Medical Association. Physician characteristics and distribution in the United States; 1992.
3. Kronick R, Goodman DC, Wennberg J, Wagner E. The marketplace in health care reform. The demographic limitations of managed competition. N Engl J Med. 1993; 328:148-52.
4. Mulhausen R, McGee J. Physician need—An alternative projection from a study of large, prepaid group practices. JAMA. 1989;261:1930-4.
5. Steinwachs DM, Weiner JP, Shapiro S, Batalden P, Coltin K, Wasserman F. A comparison of the requirements for primary care physicians in HMOs with projections made by the GMENAC. N Engl J Med. 1986; 314:217-22.
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