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October 17, 1986

Family Practice

JAMA. 1986;256(15):2056-2057. doi:10.1001/jama.1986.03380150066011

Some say we are in the midst of a revolution in health care; others say it is just beginning—that the missile is just lifting off the pad. Over 45% of the people in Minneapolis-St Paul are enrolled in health maintenance organizations, compared with only 8% nationally. Paul Ellwood1 predicts that in ten years the 300 000 firms now providing medical care in the United States will be reduced to approximately ten medical megacorporations. It is clear that the primary care physicians needed to run this system are in short supply, and it is in this specialty that medical centers continue to train the fewest numbers and perhaps inefficiently.2-5 The incomes of these gatekeepers will rise as those of the already abundant subspecialists decline. The predictions of the Graduate Medical Education National Advisory Committee appear to be right on target with less than a 1% error. One problem facing