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Supplement: The Future of Generalism in Medicine |

Rekindling Student Interest in Generalist Careers

Mark D. Schwartz, MD; William T. Basco Jr, MD; Michael R. Grey, MD, MPH; Joann G. Elmore, MD, MPH; and Arthur Rubenstein, MBBCh
[+] Article and Author Information

From New York University School of Medicine, New York, New York; Medical University of South Carolina, Charleston, South Carolina; High Street Health Center, Springfield, Massachusetts; Harborview Medical Center; Robert Wood Johnson Clinical Scholars Program; University of Washington School of Medicine, Seattle, Washington; and University of Pennsylvania, Philadelphia, Pennsylvania.


Grant Support: By grant R01 HS11955-01 from the Department of Health and Human Services, Agency for Healthcare Research and Quality (Dr. Schwartz), and the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Mark D. Schwartz, MD, New York University School of Medicine, Division of General Internal Medicine, Veterans Affairs New York Harbor Healthcare System, Medical Service (111), 423 East 23rd Street, New York, NY 10010; e-mail, mark.schwartz@med.nyu.edu.

Current Author Addresses: Dr. Schwartz: Division of General Internal Medicine, New York University School of Medicine, Veterans Affairs New York Harbor Healthcare System, Medical Service (111), 423 East 23rd Street, New York, NY 10010.

Dr. Basco: Division of General Pediatrics, Medical University of South Carolina, 135 Rutledge Avenue, PO Box 250561, Charleston, SC 29425.

Dr. Grey: High Street Health Center, 140 High Street, Springfield, MA 01199

Dr. Elmore: University of Washington School of Medicine, 325 Ninth Avenue, Box 359780, Seattle, WA 98104-2499

Dr. Rubenstein: University of Pennsylvania, 3620 Hamilton Walk, Room 295, John Morgan Building, Philadelphia, PA 19104-6055.


Ann Intern Med. 2005;142(8):715-724. doi:10.7326/0003-4819-142-8-200504190-00040
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Rekindle: from Old Norse, kynda, to start (a fire) burning; to stir up, arouse, to cause to glow, or illuminate; and from Middle English, to bring forth young (1).

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Figures

Grahic Jump Location
Figure 1.
Number of U.S. medical school graduates who matched in primary care specialties, 1999 to 2004.
Grahic Jump Location
Grahic Jump Location
Figure 2.
Proportion of all graduating medical students in the United States who matched to generalist residency programs, 1991 to 2004.
Grahic Jump Location

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Employ the Invisible Hand
Posted on May 14, 2005
Stuart Oserman
Advocate Lutheran General Hospital
Conflict of Interest: None Declared

Schwartz et al offer many constructive suggestions to stimulate medical student interest in generalist careers. However, I offer an additional idea. Mobilize the invisible hand of Adam Smith toward elevating internal medicine, pediatrics, and family medicine on students' ranking lists for the matching program. Simply increase the salary for residents in these specialties. Free market economics uses price changes to signal variations in supply and demand. There is no real justification for the tradition of paying residents equally, regardless of specialty.

Loan forgiveness programs are also desirable, but the reward comes too far into the future. Also, the signaling effect of a significant variation in resident salaries among the specialties should not be underestimated.

Conflict of Interest:

None declared

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