Generalist Medicine and the U.S. Health System (review)

Abstract

Reviewed by: Review Telisha W. Miller MPH (bio) and Patricia Rodney PhD, MPH (bio) Generalist Medicine and the U.S. Health System. Stephen L. Isaacs(Editor), James R. Knickman (Editor). San Francisco: Jossey-Bass, April 2004. 704 pp. $52.00 paper. Introduction Generalist Medicine and the U.S. Health System is the first of a two-volume series focusing on Health Policy compiled by the Robert Wood Johnson Foundation (RWJF) as a mechanism to highlight accomplishments and provide a justification for the investments and contributions made to the fields of medicine and health policy. The book examines the U.S. health system from a primary care perspective and its relationship to the practice of general medicine. It was designed to reduce knowledge gaps separating practitioners, the public, RWJF, and other specific audiences. The book is a compilation of over three hundred articles, abstracts, reports, and annotated bibliographies and comprises the work of several authors highlighting articles and reviews written from RWJF-sponsored research. The editors are Stephen L. Isaacs, J.D. President of Health Policy Associates and former Professor of Public Health at Columbia University and James K. Knickman Ph.D. Vice President for Research and Evaluation at the RWJF. The team also edited the most recent RWJF Anthology. This review will evaluate the usefulness of the text by focusing on the following: (1) understanding the relationship between the shortage of general practitioners and the increase in health disparities; (2) examining the impact of the economy on the physicians workforce and the consumer/patient access to quality health care services; (3) evaluating the need to return to a more community based health education model. The book is organized into five sections, which provide a comprehensive overview of the past, present, and future directions of the education and practice of generalist medicine in the U.S. The five sections are summarized here. (1) "Primary Care and the Education of Generalist Physicians," consists of two original articles, the first providing a chronological overview of primary care and generalist physician's education and the second in which Dr. Jack Colwill reviews the history of general medicine from his own personal and professional perspective. (2) "Primary Care and the Role of Generalist Physicians," consists of previously published articles addressing the role of primary care and generalist physicians in ensuring the availability [End Page 958] and accuracy of data to justify the quality of medical care and advances in biomedical sciences. (3) "Supply and Distribution" continues the examination of the physician workforce, bringing together previously published articles establishing that the increase of physicians entering specialty practice has negatively affected access to medical care and the costs related to medical care services. (4) "Education and Training" contains articles focusing on education, training, and recruitment strategies for attracting and maintaining medical personnel to work in rural and inner city areas. Finally, (5) "Generalists and Specialists" is divided into two parts. Part A includes reprints of several articles examining the cost and quality of medical care service providers by comparing care provided by specialists versus generalists; Part B consists of articles comparing services provided by non-physician practitioners with those provided by physicians. The papers in this section also discuss the role of nurse practitioners and physician assistants and their contributions to primary care. Generally, the book provides a detailed overview of the relationships among general medicine, family medicine, and primary care. Its approach to strengthening the health system is vague, however, failing to outline clearly a health policy strategy for future directions. Although it is a retrospective analysis of the evolution of the physicians' workforce, the book provides limited population-based scenarios addressing the medical service crisis from a policy perspective. Despite the use of several models as a projection for physician services, there is no integration or analysis of the impact that these models have on health policy. While the book was successful in examining the growth and future directions of primary care and generalist medicine and is an excellent resource for policymakers and public health advocates, it is not as useful for researchers. Interestingly, despite the acknowledgement of psychosocial issues related to health and illness the book lacks any detailed discussion of the impact these...