Change from Specialist to Generalist

Douglas M. De Long

doi:10.7326/0003-4819-122-8-199504150-00030

TO THE EDITOR:

Christakis and colleagues [1] reported on the “specialist” to “generalist” transformation. Please forgive me for tilting at windmills, but my button has been pushed one too many times. Yes, a disclaimer (buried in the methods section) defines a generalist as “technically” a specialist, but in this time of introspection within internal medicine, this nomenclature fosters the inappropriate image of the rank-and-file internist as second class.

Particularly in rural internal medicine, where I believe the essence of our specialty still survives, being an internist is enough of a label. Rural internists provide consultative services to family practice and surgical peers in all of the traditional subspecialty internal medicine disciplines, do the full array of invasive procedures in the intensive care unit, handle minor and major illness or trauma in the emergency department, offer gynecologic and psychiatric primary care, and provide ongoing traditional health care maintenance. In addition, many of us also recognize the importance of training outside of the traditional academic centers; thus, we frequently serve as mentors to students. Until a “specialist” internist can provide this array of professional service, I refuse to be labeled as a generalist. By publishing this article, I believe the editors perpetuate the myth that “general” internists are not specialists, and this does much to retard the needed rejuvenation of our specialty.

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Letters |15 April 1995

Change from Specialist to Generalist

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Letters |15 April 1995

Change from Specialist to Generalist

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