Training More Generalists

Marc L. Rivo

doi:10.7326/0003-4819-120-1-199401010-00033

Letters |1 January 1994

Training More Generalists

Marc L. Rivo, MD, MPH

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IN RESPONSE:

I agree with Dr. Lowther that the foremost strategy to produce more generalist physicians is to narrow the generalist-to-specialist reimbursement gap and to reduce regulatory, administrative, and malpractice burdens. Dr. Robinson is correct; I do not believe that these changes in the health care marketplace will produce the appropriate supply and specialty mix of graduating residents in a timely and predictable fashion. A general consensus exists that disincentives in the medical education marketplace, particularly the Medicare financing policy for graduate medical education, will also require changes to produce more generalists and fewer specialists [1].

I respectfully disagree with Dr. Lowther's explanation of the reason that internists are unprepared for managed care practice and his characterization of managed care organizations. The phenomenal growth of health maintenance organizations (HMOs) is evidence of their efficacy and popularity among the public and policymakers. Young physicians are comfortable practicing in managed care settings, and HMOs value the role of the generalist in delivering high-quality and cost-effective primary care. Concern over the dearth of well-trained generalists and the oversupply of narrowly trained specialists has led the managed care industry to become a vocal advocate for physician workforce and medical education reform and uneasy partners with academic medical centers [2].

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Letters |1 January 1994

Training More Generalists

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Letters |1 January 1994

Training More Generalists

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