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January 1977

The Flexible Medical Residency

Author Affiliations

From the Department of Medicine, Nassau County Medical Center and Health Science Center, State University of New York at Stony Brook.

Arch Intern Med. 1977;137(1):121-123. doi:10.1001/archinte.1977.03630130083019

Several years ago it appeared likely that health care provision in the United States would develop as Pellegrino1 suggested, with primary care being provided by the family practitioner (and his associates), and secondary and tertiary care by the general internist and the organsystem subspecialist, respectively. Consultative medicine appeared to become increasingly the domain of the organ-system subspecialist. This conceptual model for the role of the internist was reinforced on the undergraduate level by the process of tracking. On the postgraduate level, support for this model came from the abandonment of the internship, and the increase in subspecialty fellowship training at the expense of the time devoted to training in general internal medicine.

However, it now appears that the internist of the future will provide a considerable portion of primary care in America. What practicing internists knew all along has now become common knowledge in the academic community as a

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