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• W1997168514 abstract "Perspectives15 July 1993The Future of GeneralismJeremiah A. Barondess, MDJeremiah A. Barondess, MDFrom the New York Academy of Medicine, New York, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-119-2-199307150-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Internal medicine has, in recent decades, altered radically its traditional generalist complexion in favor of redefinition along subspecialty lines; in recent years, 60% to 70% [1, 2] of physicians completing categorical internal medicine residency training have entered subspecialty fellowships. The United States has developed subspecialty medicine to a degree seen in no other Western country (Figure 1). As a consequence, general internal medicine has lost much of its identity as a specific area of expertise, as a critical element in educational and training programs, and as the most rational basis for the clinical care of most of the adult population.... References1. Andersen RM, Lyttle CS, Kohrman CH, Levey GS, Clements MM. National study of internal medicine manpower: XIX. Trends in internal medicine residency training programs. Ann Intern Med. 1992:117:243-50. Google Scholar2. Petersdorf RG. Graduate medical education: a lesson in non-governance. In: Taking Charge of Graduate Medical Education: To Meet the Needs of the 21st Century. New York: Josiah Macy, Jr. Foundation; 1993. Google Scholar3. Berenson RA. How the preponderance of subspecialists affects the cost, quality and accessibility of health care, In: The National Primary Care Conference, DHHS, PHS, HRSA. Washington, DC; 1992:216-7. Google Scholar4. Braunwald E. Subspecialists and internal medicine: a perspective. Ann Intern Med. 1991:114:76-8. Google Scholar5. Nolan JP, Inui TS. Tinkering or real reform? The choice is ours. Ann Intern Med. 1992:116:S1042-45. Google Scholar6. Institute of Medicine: A Manpower Policy for Primary Health Care. Washington, DC:National Academy of Sciences Press; 1978. Google Scholar7. Karpf M, Levey GS. Training primary care physicians. (Editorial) Ann Intern Med. 1992:116:514-5. Google Scholar8. Politzer RM, Harris DL, Gaston MH, Mullan F. Primary care physician supply and the medically underserved. A status report and recommendations. JAMA. 1991; 266:104-9. Google Scholar9. Rosenblatt RA. Specialists or generalists. On whom should we base the American health care system? (Editorial) JAMA. 1992; 267: 1665-6. Google Scholar10. Schroeder SA. The generalist shortage: where do we go from here? In: The National Primary Care Conference, DHHS, PHS, HRSA. Washington, DC; 1992:172-86. Google Scholar11. Physician Payment Review Commission. Annual Report to Congress. 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Google Scholar18. Kletke PR, Schleiter MK, Tarlov AR. Changes in the supply of internists: the internal medicine population from 1978 to 1998. Ann Intern Med. 1987; 107:93-100. Google Scholar19. White KL, Williams TF, Greenberg BG. The ecology of medical care. N Engl J Med. 1961; 265:885-93. Google Scholar20. Starfield B. How can research improve our understanding of the content and organization of primary care? In: The National Primary Care Conference, DHHS, PHS, HRSA. Washington, DC; 1992: 224-6. Google Scholar21. Greenlick MR: Educating physicians for population-based clinical practice. JAMA. 1992; 267:1645-8. Google Scholar22. Woodwell DA. Office visits to internists, 1989. Advance Data 1992: 209:1-10. National Center for Health Statistics, CDC, PHS, US Department of Health and Human Services. Google Scholar23. Barondess JA. Content and process in ambulatory care. Notes from an internist's practice. Am J Med. 1982; 73:735-9. Google Scholar24. Greenfield S, Nelson EC, Zubkoff M, Manning W, Rogers W, Kravitz RL, et al. Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study. JAMA. 1992; 267:1624-30. Google Scholar25. Stein JH. Grand Cru versus generic: different approaches to altering the ratio of general internists to subspecialists. Ann Intern Med. 1991; 114:79-82. Google Scholar26. Waring JP, Disario JA, Sanowski RA. Gastroenterology consultations from the internal medicine physician's perspective. J Gen Intern Med. 1991; 6:436-8. Google Scholar27. Levey GS. Changing the curriculum for internal medicine residency training. Ann Intern Med. 1992; 116:S1046-50. Google Scholar28. Nuckolls JG. Internal medicine practice in transition. Implications for curriculum changes. Ann Intern Med. 1992; 116:S1051-4. Google Scholar29. AAMC, Council of Teaching Hospitals. Survey of House Staff Stipends, Benefits and Funding, 1991. Washington, DC, AAMC; 1991: 67. Google Scholar30. Ebert RH, Ginzberg E. The future of GME: fine tuning is not enough. In: Taking Charge of Graduate Medical Education: To Meet the 21st Century. New York: Josiah Macy, Jr. Foundation; 1993. Google Scholar31. Vanselow NA. Graduate Medical Education: time for a change. In: Taking Charge of Graduate Medical Education: To Meet the 21st Century. New York: Josiah Macy, Jr. Foundation; 1993. Google Scholar32. Scherr L, Benson JA, Walt AJ, Clank LL. Graduate Medical Education: a national resource in need of renewal. In: Taking Charge of Graduate Medical Education: To Meet the 21st Century. New York: Josiah Macy, Jr. Foundation; 1993. Google Scholar33. Glickman R, Bennett JC, Nolan J, Stobo J, Rubenstein A, Terwilliger J. Activism in academic internal medicine (Editorial). Ann Intern Med. 1992; 117:259-60. Google Scholar34. Boyer E. Scholarship Reconsidered: Priorities of the Professoriate. Princeton, New Jersey: Princeton University Press; 1990. Google Scholar35. Taking Charge of Graduate Medical Education: To Meet the 21st Century. Josiah Macy, Jr. Foundation; 1993. Google Scholar36. Levinsky NG. Recruiting for primary care. N Engl J Med. 1993; 328: 656-60. Google Scholar Author, Article, and Disclosure InformationAffiliations: From the New York Academy of Medicine, New York, New York.Corresponding Author: Jeremiah A. Barondess, MD, 2 East 103rd Street, The New York Academy of Medicine, New York, NY 10029.Acknowledgments: The author thanks the staff of the Library of The New York Academy of Medicine, especially Jill Snyder for research assistance, and Carol Barrett-Gonzalez for secretarial assistance. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoGeneral Internists and Subspecialists Gerald E. Thomson Internal Medicine and the Journey to Medical Generalism Marc L. Rivo Metrics Cited byEl internista como consultor de ética clínica: un antídoto contra «la barbarie del especialismo» en la práctica hospitalariaThe internist as clinical ethics consultant: An antidote to “the barbarism of specialisation” in hospital practiceChiropractic Identity: A Neurological, Professional, and Political AssessmentAdults and Children with Low Back Pain in Primary Care Setting: Evidence-Based NeuroimagingPrimary and Secondary Hypertension20 Imaging of Adults with Low Back Pain in the Primary Care SettingLa dialéctica entre la medicina interna y las otras especialidades médicas desde la perspectiva profesionalInternal medicine: yesterday, today, and tomorrowImaging of adults with low back pain in the primary care settingDiagnostic Evaluation of Low Back Pain with Emphasis on ImagingJeffrey G. Jarvik, MD, MPH and Richard A. Deyo, MD, MPHThe effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the kneeIMAGING OF LUMBAR INTERVERTEBRAL DISK DEGENERATION AND AGING, EXCLUDING DISK HERNIATIONSDeveloping strategic plans for academic general internal medicineThe clinician-educator—Present and future rolesThe Opinion of Current and Recent Internal Medicine Residents Regarding a Fourth Year of Training and the Future of General Internal MedicinePulmonary Section Development Influences General Medical House Officer Interests and ABIM Certifying Examination PerformanceBalancing service and education: improving internal medicine residencies in the managed care eraForum Three: Changes in the U.S. Health Care System That Would Facilitate Improved Care for Non-Insulin-dependent Diabetes MellitusRoland G. Hiss, MD and Sheldon Greenfield, MDWomen’s health and enhancing generalism in internal medicineSubspecialization in Internal Medicine: A historical review, an analysis, and proposals for changeThe jaundiced eye: Generalism in generalThe promotion of generalism in medicineThree Threats to the Capacity for Excellence in MedicineDepartments of Medical Specialties: A Solution for the Divergent Missions of Internal Medicine?The generalist health care workforcePreparing generalist physiciansCounseling youths about firearmsImaging of Adults with Low Back Pain in the Primary Care Setting 15 July 1993Volume 119, Issue 2Page: 153-160KeywordsCardiovascular diseasesFellowshipsGraduate medical educationHealth careHospital medicineMedicarePatientsPrimary careResidencySub-specialty care Issue Published: 15 July 1993 Copyright & PermissionsCopyright © 1993 by American College of Physicians. All Rights Reserved.PDF downloadLoading ..." @default.
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