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April 21, 1993

Improving Access to Primary Care

JAMA. 1993;269(15):1943. doi:10.1001/jama.1993.03500150051023

To the Editor.  —I agree with Dr Ginzberg's1 statements that the professional satisfaction of the individual physician—and especially the primary physician—is critically important to the outcome of health reform of whatever stripe, and that a system based on massively second-guessing the myriad decisions of the individual physician is unlikely to work.However, his solution consisted of three suggestions for manipulating graduate medical education programs and their funding as a way to reverse the inexorable weakening of the American primary care physician base. Thus, a long-term solution was proposed in place of more immediate measures to alleviate the present and near-term distress of the practicing internist and family practitioner. This "let the chips fall where they may" view of primary care is likely to undermine even well-conceived, longer-term plans.The current reality for all physicians is managed care and managed competition. The consequences to primary physicians remain unique, however. Only