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

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

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Addition
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

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