The full content of Annals is available to subscribers

Subscribe/Learn More  >
Editorials |

Primary Care, Generalism, Public Good: Déjà vu? Again!

Eric B. Larson, MD, MPH; Kenneth B. Roberts, MD; and Kevin Grumbach, MD
[+] Article, Author, and Disclosure Information

From Group Health Cooperative, Seattle, WA 98101-1448; University of North Carolina School of Medicine, Chapel Hill, NC 27401; and University of California, San Francisco, San Francisco, CA 94110.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Eric B. Larson, MD, MPH, Group Health Cooperative, Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448; e-mail, larson.e@ghc.org.

Current Author Addresses: Dr. Larson: Group Health Cooperative, Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448.

Dr. Roberts: Pediatric Teaching Program, Moses H. Cone Health System, 1200 North Elm Street, Greensboro, NC 27401.

Dr. Grumbach: Department of Family and Community Medicine, Family and Community Medicine, San Francisco General Hospital, Ward 83, 1001 Potrero Avenue, San Francisco, CA 94110.

Ann Intern Med. 2005;142(8):671-674. doi:10.7326/0003-4819-142-8-200504190-00018
Text Size: A A A

Developing the supplement on the future of generalism in medicine in this issue caused us to have a collective sense of déjà vu (15). Many of the ideas and arguments presented in this supplement echo the calls for revitalization in recent “special reports” by groups in family medicine (6), pediatrics (78), and internal medicine (910) and harken back to the 1970s (1113). During the reviewing and editing process, we felt like we have been through all this before. And, in fact, we have. Admittedly, there are important differences between the mid-1970s, when the primary care movement emerged (11), and today. Costs are far greater than anyone would have anticipated. Science and technology and the acceptance of evidence-based principles are much further developed. Medical care is even more complex and occurs in more sites, with more exchanges, than we would have imagined possible 30 years ago. And, of course, advances in information systems have transformed modern society and are transforming medicine in ever more powerful ways. Indeed, the very notion that resources for medical care are finite is being called into question. However, medicine in the United States has still not developed into anything resembling a system—much less a system based on the model that seemed so promising 30 years ago, a model organized around a generalist principle or primary care physician. For most Americans, this ideal of patients receiving most of their care based on a relationship with a personal physician or personal team of clinicians located in the patient's community remains just that—an ideal.

First Page Preview

View Large
First page PDF preview





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Posted on April 20, 2005
Robert A Scarr
No Affiliation
Conflict of Interest: None Declared

In your article, Primary Care, Generalism, Public Good: Deja vu? Again!, you stated, "Will the market simply drive out providers who are unprofitable? Will it leave just a few types of primary care physicians -- highly compensated "boutique" practitioners providing primary, ongoing care to those who can afford it; ....

A growing number of primary care physicians have created practices that provide this type of care, but are not highly compensated, and are relatively affordable. We charge approximately $75/month for all primary care physician services. (Not including lab and xray.) This is often a valuable option for people with no medical insurance or only catastrophic coverage. Office visits are usually less time-pressured and allow for more open-ended questions and patient education.

Conflict of Interest:

None declared

Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.