To the Editor.
—Several issues addressed by Dr Whitcomb1 require clarification and response. First, Whitcomb erred in stating that the Council on Graduate Medical Education (COGME) relied heavily on a single cross-national study in making its 1992 recommendation to move toward a system in which generalist physicians approach 50% of the physician workforce. COGME based its recommendation on a critical analysis of all relevant data available at the time, including health maintenance organization (HMO) staffing data, analysis of changes in the US health care delivery system, and data on costs generated by generalist and specialist physicians.2 For the past 2 years, COGME has relied exclusively on population-based studies and evidence regarding supply and requirements.3Second, Whitcomb's conclusion that the current US generalist supply is adequate is drawn from a single managed care study commissioned by COGME and performed by Dr Weiner.4 Using a similar methodology but
Kindig DA. Projections for the Generalist Physician Workforce. JAMA. 1995;274(23):1833. doi:10.1001/jama.1995.03530230019010