Do Other Countries Have a Better Mix of Generalists and Specialists?

Abstract

Abstract The conventional wisdom that the United States has an imbalance of specialty and generalist physicians is supported by data from the Organisation for Economic Co-operation and Development (OECD), which show that just 12 percent of physicians in the United States are generalists and 88 percent are specialists. While it is undisputed that US physicians can choose to train in a striking array of medical specialties and subspecialties not seen elsewhere, the perception that the United States has a specialty-dominated workforce is not accurate. The US definition of generalist does not fit the OECD definition because the OECD considers only family and general practitioners as generalists. OECD numbers reinforce a tendency to define primary care as family and general practitioners, without recognizing the diversity of generalist physicians providing care. In addition, while other countries may have had more generalists that fit the OECD definition, many countries have seen a relative decline in the share of generalists that is slowly reshaping the generalist-specialty balance elsewhere. These two factors, along with changing international benchmarks against which the United States is compared, support the reassessment of the conventional wisdom.