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July 21, 1993

Solving Our Primary Care Crisis by Retraining Specialists to Gain Specific Primary Care Competencies

JAMA. 1993;270(3):380-381. doi:10.1001/jama.1993.03510030104045

That this country now has a full-blown crisis in its primary care physician work force is hardly disputed.1-3 Simply stated, other developed industrial countries for many years have practiced medicine with roughly 50% of physicians in primary care and 50% in specialties and subspecialties.4 In the United States, however, we train and employ about 32% primary care physicians (general practitioners, family physicians, general internists, general pediatricians, and some obstetrician-gynecologists and emergency medicine physicians) and about 68% specialists and subspecialists.4 Health indicators show that comparison countries do as well as or better than the United States at providing care at much lower cost, whether cost is measured as the amount spent per capita per year or as a percentage of the gross national product. If that news isn't bad enough, the situation in the United States is rapidly getting worse. The percentage of physicians graduating from US medical