The 2 position papers strongly affirm the importance of training good generalists. The underlying premise is that most internists should know how to provide front-line care for the major diseases in any specialty of internal medicine. The case for training good generalists is based on strong evidence. First, patients want good generalist physicians to take responsibility for their care (3). Second, many health care systems (for example, Kaiser Permanente, the Veterans Administration, Group Health Cooperative, the military health system, and the Palo Alto Medical Clinic) organize their practice around primary care physicians (4–5). Third, many internal medicine subspecialists also need to function as generalists. While the position papers make a strong case for substantially more ambulatory learning time, the current system gives first priority to the care of fragile hospital patients. Shifting the balance toward more ambulatory care during training would be expensive, as shown by efforts to provide additional inpatient coverage in response to limits on residents' duty hours.