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Roz Diane Lasker, MD; David W. Shapiro, MD, JD
Physician Payment Review Commission Washington, DC

JAMA. 1992;268(12):1537-1538.

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

To the Editor.

—In the Editorial by Rosenblatt¹ and in discussions at last month's National Primary Care Conference in Washington, DC, the two recent articles published in THE JOURNAL about the Medical Outcomes Study (MOS)^2,3 were cited as supporting the premise that substantial savings in US health care costs could be achieved—without compromising quality of care—by increasing the relative proportion of generalists vs specialists. While there are good reasons to change the mix of practicing physicians, relying on studies such as these to predict substantial cost savings may be overly optimistic.

In the MOS, endocrinologists and cardiologists were shown to use more resources than general internists and family physicians, even after applying certain adjustments for patient mix. But the adjustments used did not adequately account for differences in the mix of medical problems that physicians in each specialty managed. This is an important limitation because different medical problems . . . [Full Text PDF of this Article]

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