Generalists and Specialists

Abstract

To the Editor.— The failure of internal medicine residency programs to produce substantial numbers of generalist v subspecialty internists has been the subject of much discussion, including the recent commentary inThe Journalby Dr Davidson. A factor that seems to me a major one in dissuading residents from the generalists track is that in such a career they would, from a resident's perspective, face a lifetime of diminishing competence. To illustrate that, I ask you to consider this question: If you were acutely ill with diabetic ketoacidosis, pneumonia, and a complicated myocardial infarction, were admitted to a University Medical Center, and could choose only one physician to provide your care, who would it be? For me the answer is simple. I would choose the chief medical resident. I would do so because in the world of the complex acutely ill patients of the teaching hospital medical wards, he or