Economic 1 Jconomic and political forces are changing the practice of medicine more radically than medical discoveries. Only yesterday, third-party insurers were denying payment for outpatient care, insisting that patients be hospitalized to confirm that they were indeed ill. Physicians were not paid for preventive care or even corrective outpatient services. Such cost-inefficient policies reinforced the trend toward heavy subspecialization; consultants were handsomely rewarded with money and prestige and students discouraged from entering primary care disciplines.
Today, outpatient care is "in," expensive hospitalization is "out," and those of us in primary care stifle the temptation to say "I told you so." However, the family physicians needed for cost-effective primary care are not available, and funds for residency programs are being reduced rather than increased. The maldistribution of physician talent over the past 30 years has depleted the primary care ranks such that today the well-trained family physician is one of
Rakel RE. Family Practice. JAMA. 1985;254(16):2252–2254. doi:10.1001/jama.1985.03360160084015
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