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July 1, 1992

Trend to Specialization Reversing?

JAMA. 1992;268(1):11. doi:10.1001/jama.1992.03490010013003

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THE AMERICAN health care system is top-heavy with specialists, critics say.

Efforts are getting under way to reverse the trend on grounds that a system dominated by specialties results in ever-increasing costs and lack of access to basic care. But it's uphill work.

That is the conclusion of experts attending a recent Washington, DC, conference on primary care sponsored by the Department of Health and Human Services. It was held at a time when some states even are considering reducing state university medical school funding if the institutions do not graduate more primary care physicians.

Stuart H. Altman, PhD, dean, Brandeis University, Waltham, Mass, notes that, in virtually all developed nations, primary care physicians predominate. "In Australia," he says, "73% of physicans are primary care providers, in Canada it's 52%, in West Germany 45%, in Great Britain 70%, but in the United States it's 33% and falling."

Steven A. Schroeder,