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November 18, 1998

Specialist Delivery of Primary Care—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(19):1659. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-19-jbk1118

In Reply.—The Letter by Dr Rosen and the Editorial by Dr Vanselow1 demonstrate that it is possible to draw quite different lessons from the same set of data. We conclude from our study of the generalist role of specialty physicians that most specialists do not function as primary care physicians; they rarely become a patient's principal care physician, provide little care outside their usual clinical domain, and do not take responsibility for routine immunizations. Vanselow focuses on the exceptions, the relatively small number of specialists from selected disciplines who incorporate elements of primary care into their relationships with patients.1