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The Future of Generalism in Medicine
- Eric B. Larson, MD, MPH;
- Kevin Grumbach, MD; and
- Kenneth B. Roberts, MD
- From Group Health Cooperative, Seattle, Washington; University of California, San Francisco, San Francisco, California; and University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Eric B. Larson, MD, MPH; Kenneth B. Roberts, MD; Kevin Grumbach, MD, and Christine Laine, MD, MPH, Editors
What is the future of generalism in medicine? There was a time when financial analysts predicted that 90% of U.S. health care would be organized as managed care built on a primary care, generalist model (1). In the wake of these predictions, residency positions in family medicine and other generalist disciplines grew rapidly. Hospitals and health systems bought or built practices and added so-called primary care capacity to their operations (2).
Today, however, the intellectual stratosphere and, more important, the medical marketplace resound with a very different language. Recent publications about generalism are resplendent with words like “crisis” (3), “distress” (4), “dissolution, disillusion” (5), “crossroads” (6), “prosperity and despair” (7), and “reconstruction, renewal, and renaissance” (8). The authors seem preoccupied with the notion that the generalist fields, while offering great value, need to change or may not survive (3-6, 9).
The picture is also grim for many generalist physicians and patients in the world of medical practice. The cost of care and …
