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September 23, 1992

Specialists or Generalists? The Medical Outcomes Study

Author Affiliations

Dartmouth Medical School White River Junction, Vt

JAMA. 1992;268(12):1537. doi:10.1001/jama.1992.03490120051015

To the Editor.  — Primary care medicine has recently scored the academic equivalent of the "triple-double" in basketball or the "hat trick" in hockey. Articles and editorials in the Annals of Internal Medicine, New England Journal of Medicine, and JAMA have addressed either the manpower shortages in primary care or the putative economic consequences of the specialist/generalist distribution in the United States.1-6 As a general internist, geriatrician, and member of a medical school admissions committee, I wish to challenge some of the opinions offered in the editorials and express a few of my own.Intelligence, commitment to medicine, skill, and humanism are desirable attributes in all physicians, not only in primary care physicians. Patients and most of my specialist colleagues would agree.I am unwilling to concede that surgical or support specialities and subspecialities are "more glamorous." In reality, most primary care physicians value professional recognition, financial rewards, and professional