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In Reply: We agree with Dr Flint that maternity care plays an important role in the practice of many family physicians and the communities they serve. It was not our intent to comment on specific elements of the scope of family practice, but to provide a broader overview of the context of specialty medicine within which it must function in the future.

The comments of Dr Fried and Drs Mundinger and Kane provide useful observations, albeit from very different perspectives, about the challenges facing professionals in the arena of primary care. The fragmentation of medical practice that is being driven by the business arrangements for funding health insurance coverage is unacceptable. In the face of a growing recognition that a relationship of continuity between patients and a personal physician has positive impact on the health status of the patient, barriers to the establishment of such a relationship are a constant . . . [Full Text of this Article]

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