The Making of a Medical Generalist

Abstract

Prologue: Regardless of what one thinks about the absolute number of physicians needed in the future, there is a clear consensus among experts that something should be done to increase the proportion of primary care physicians in relationship to the number of specialty physicians. In this essay, Steven Schroeder, a professor of medicine and chief of the Division of General Internal Medicine at the University of California, San Francisco, makes the case for increasing the number of generalist physicians. Schroeder says there are four basic reasons why decreasing the relative supply of specialists makes sense: to increase the quality of care; to decrease the cost of care; to increase patient satisfaction; and to increase physician satisfaction. He brings to the subject of health manpower impeccable credentials as the driving force behind a highly successful department of general internal medicine that operates in an environment that places a premium on specialty care. Schroeder, educated at Stanford and Harvard Universities, also has earned a national reputation as a health policy analyst and active participant in a wide variety of issues. Indeed, over the years, Schroeder has demonstrated an uncanny ability to spot emerging issues, including the use of medical technology, physician payment, and high-cost illness, examine them and then write essays which are used as primers by private and public sector participants alike in the ensuing debates. Schroeder is a member of the Prospective Payment Assessment Commission and of the Institute of Medicine. He also was recently elected president of the Society for Research and Education in Primary Care Internal Medicine.