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To the Editor: In his Editorial about the growth of specialization, Dr Barondess¹ stated that " . . . it is clear that subspecialist practice contributes to fragmentation of patient care" and ". . . subspecialist care is by and large more costly than generalist care. . . ." He then proposes that " . . . one possible answer to the continuing growth of subspecialism is a return to programs seeking to develop sophisticated generalists capable of not only primary care, but of secondary and . . . tertiary care as well."

However, Barondess does not consider the possibility that the increasing scientific complexity of medical knowledge may necessitate more specialization. For instance, MacLean and colleagues² reported that among adults with rheumatic disease, specialists provided better overall quality of care than generalists. Indeed, adding a generalist to the team of specialists failed to demonstrate any additional benefits. Although costs . . . [Full Text of this Article]

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RELATED ARTICLE

Specialization and the Physician Workforce: Drivers and Determinants
Jeremiah A. Barondess
JAMA. 2000;284(10):1299-1301.
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