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Stephan D. Fihn, MD, MPH

JAMA. 1995;274(18):1473-1474.

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

Sixty-five years ago nearly 90% of the physicians in the United States were generalists.¹ Since then there has been a trend toward increasing specialization, particularly during the past two decades, with the result that two thirds of the practicing physicians in this country are now specialists. Coincidentally, medical expenditures grew uncontrollably, fueled by explosive growth in specialized and expensive technologies. Lately, various forms of managed care have emerged as a means to control costs, leading to controversy about the relative quality of care available from different systems.

Many managed care organizations restrict access to specialists because they tend to perform more tests and procedures than generalist physicians.^2,3 This declining use of speciality services has created a surfeit of specialists that many authorities believe will persist until well into the next century.⁴ Although anticipated for decades, this reduction in demand for specialty services in many communities has occurred . . . [Full Text PDF of this Article]

Author Affiliations
From the Department of Veterans Affairs Medical Center, Seattle, Wash.

Footnotes
Corresponding author: Stephan D. Fihn, MD, MPH, Department of Veterans Affairs Medical Center, 1660 S Columbian Way, Seattle, WA 98018.

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