Specialists or Generalists? The Medical Outcomes Study-Reply

Abstract

In Reply. —Although the recent intensity of attention to primary care medicine cited by Dr Balestra may be unusual, the problem of specialty maldistribution in the United States is not new. National health personnel policy has revolved around this issue for much of the last 20 years. 1 What is new is the realization that the growing disarray of our medical care system is in some measure a consequence of the decline of the role of the generalist in American medicine. Balestra certainly is correct in his observation that the solution to the problem is neither simple nor likely to be solved by any single intervention. Physician specialty choice is influenced by preferences of admission committees, the shape and emphasis of medical school curricula, the availability and attractiveness of residency slots, and the differential rewards that society confers on those who follow disparate paths. Only by addressing the problem at