Henry Greenberg, MD
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Greenberg H.; Training More Generalists. Ann Intern Med. 1994;120:92-93. doi: 10.7326/0003-4819-120-1-199401010-00031
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Published: Ann Intern Med. 1994;120(1):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 .
The prism through which I view all reform efforts is that of excellence. Will the proposed change permit the capacity for excellence? Dr. Barondess  has given us an imaginative, intellectually gratifying proposal, expanding on earlier models , 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.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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