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On Whom Should We Base the American Health Care System?

Roger A. Rosenblatt, MD, MPH

JAMA. 1992;267(12):1665-1666.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

One of the enduring debates in American medical policy is whether the United States should build its medical care system on a foundation of medical generalists or rely instead on more narrowly defined specialists.^1,2 For the most part, we have taken the latter road.³ Despite 21 years of federal programs designed to increase the production of primary care physicians, most physicians select specialty careers, a trend that has accelerated with declining match rates in primary care fields in recent years.⁴

Although the debate has been both loud and long, the evidence available to resolve this issue rationally has been somewhat meager and frequently flawed. It is very difficult to determine exactly what physicians do, much less how much it costs or how profound its impact. Answering these questions is difficult, methodologically treacherous, and enormously expensive. Unlike a population of laboratory animals, physicians are reluctant and often fractious . . . [Full Text PDF of this Article]

Author Affiliations
From the Department of Family Medicine, University of Washington School of Medicine, Seattle.

Footnotes
Reprint requests to Department of Family Medicine, Research Section HQ-30, University of Washington School of Medicine, Seattle, WA 98195 (Dr Rosenblatt).

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