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The generalist health care workforce

Issues and goals

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Abstract

The generalist health care workforce in the United States is best characterized as those practitioners who deliver primary care services. These include most family physicians, general internists, general pediatricians, nurse practitioners, osteopathic family physicians, and physician assistants. Based on a variety of factors, including health care needs, managed care/HMO hiring practices, international comparisons, and health care costs, the case for increasing the amount and proportion of generalist providers is compelling. Projections strongly suggest a worsening shortfall of generalists if no change is made. Changing the career choices of medical students to promote generalism, even significantly, will take 20 years or more to have a meaningful impact. Therefore, retraining specialist physicians in oversupply to practice as generalists is an important option to consider. To best meet the nation’s health care needs, three issues need to be addressed in the context of health care reform: the creation of a “system” of generalist care that integrates into a coherent and collaborative framework the scopes of practice of the various generalist disciplines; the pursuit of a workable short-term model to convert specialist physicians into generalist physicians, led jointly by family medicine, general internal medicine, and general pediatrics; and a significant change in the medical education process to produce an ample supply of well-trained generalists.

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Authors and Affiliations

  1. the Department of Internal Medicine, Mount Sinai Medical Center of Greater Miami and the University of Miami, Miami, Florida

    Steven A. Wartman MD, PhD

  2. the Department of Pediatrics, The Johns Hopkins School of Medicine, Baltimore, Maryland

    Modena Wilson MD

  3. the Division of Education, American Academy of Family Physicians, Kansas City, MO

    Norman Kahn MD

Authors
  1. Steven A. Wartman MD, PhD
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  2. Modena Wilson MD
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  3. Norman Kahn MD
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Wartman, S.A., Wilson, M. & Kahn, N. The generalist health care workforce. J Gen Intern Med 9 (Suppl 1), S7–S13 (1994). https://doi.org/10.1007/BF02598113

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