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To the Editor: Both Dr Graham and colleagues¹ and Drs Grumbach and Bodenheimer² discuss the travail of generalists in the current health care system. They cite reimbursement inadequacy, overload of new work, and the lack of respect for generalists' expertise. Although Graham et al celebrate the current importance of family practice, the specialty appears to be in decline in both numbers and eminence, as are primary care careers in all of medicine.

These experts in generalist medicine are concerned that there is simply not enough time in the day to provide the necessary care. They offer multiple explanations: we know more about treating illness and preventing first or recurrent episodes, see far more patients with lingering and time-consuming chronic illness, and have many more benchmarks to meet or exceed than ever before. Long days, low pay, and lack of professional fulfillment blemish the attractiveness of a career in primary care. . . . [Full Text of this Article]

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