Although I agree with the definition of the general internist in the recently published position paper [1], I was disappointed that the Task Force on Physician Supply rejects the option of a "subspecialist" fulfilling the role of a general internist. What disqualifies a board-certified internist who happens to have completed subspecialty training from practicing high-quality general internal medicine? The Task Force proposes a double standard: They encourage general internists without formal subspecialty training to become local experts in an organ-based area in their practice locale but do not allow the subspecialist to practice general internal medicine. The presumption is that traditional organ-based subspecialty training somehow revokes one's general internal medicine abilities. This is far from the truth.

Most subspecialists provide primary, comprehensive, continuing care, including preventive care, to a substantial segment of their patient population whose primary disease the subspecialist also cares for. Many times these patients have no other physician and can rely on their subspecialist for primary care. We all agree with the future need for more physicians practicing general internal medicine, but the large amount of high-quality general internal medicine practiced by subspecialists should not be excluded.