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The Future of Generalism

Jeremiah A. Barondess, MD
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From the New York Academy of Medicine, New York, New York. Requests for Reprints: Jeremiah A. Barondess, MD, 2 East 103rd Street, The New York Academy of Medicine, New York, NY 10029. Acknowledgments: The author thanks the staff of the Library of The New York Academy of Medicine, especially Jill Snyder for research assistance, and Carol Barrett-Gonzalez for secretarial assistance.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(2):153-160. doi:10.7326/0003-4819-119-2-199307150-00010
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Internal medicine has, in recent decades, altered radically its traditional generalist complexion in favor of redefinition along subspecialty lines; in recent years, 60% to 70% [12] of physicians completing categorical internal medicine residency training have entered subspecialty fellowships. The United States has developed subspecialty medicine to a degree seen in no other Western country (Figure 1). As a consequence, general internal medicine has lost much of its identity as a specific area of expertise, as a critical element in educational and training programs, and as the most rational basis for the clinical care of most of the adult population.

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Grahic Jump Location
Figure 1.
Specialists as a percentage of physicians from selected nations.

(Source: Physician Payment Review Commission, Annual Report to Congress, 1992.).

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Figure 2.
Trends in the growth of selected specialists from 1965 to 1990.
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Figure 3.
Rate of visitation to internists by age and sex in the United States in 1989.

Source: National Center for Health Statistics Division of Health Care Statistics, National Ambulatory Medical Care Survey.

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