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To the Editor: In their study of factors associated with medical students' career choices regarding internal medicine, Dr Hauer and colleagues¹ noted that only 2% of a sample of fourth-year medical students planned careers in general internal medicine. An accompanying Editorial by Dr Goodman² recommended workforce planning to address this problem. There appeared to be an underlying belief that attracting more physicians to primary care and general internal medicine was necessary. It is not clear that this belief is justified. Another possibility is that medical students are recognizing a change in health care delivery and adapting to that change.

Nurse practitioners and physician assistants can and do provide many of the services expected of a primary care physician. Advocates for this evolution of the US health care system point to studies such as the one by Mundinger et al,³ in which patients were randomized to independent nurse practitioners or primary . . . [Full Text of this Article]

Frederick M. Perkins, MD
fred.perkins@va.gov
Veterans Administration Medical Center
White River Junction, Vermont

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