The Reply

Abstract

It is clear that US medical students, with the exception of those electing family medicine, have minimal interest in practicing primary care. This is best illustrated by the fact that more than 90% of those completing a 3-year residency in internal medicine now go on to another 3 years of residency to become a medical subspecialist rather than a general internist. The same is true to a lesser extent in pediatrics. There will be fewer general internists and general pediatricians in the future primary care workforce. I thank Dr. Volpintesta for his interest in my comments1Dalen J.E. Concierge medicine is here and growing.Am J Med. 2017; 130: 880-881Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 2Dalen J.E. Ryan K.J. Alpert J.S. Where have the generalists gone? They became specialists, then generalists, then subspecialists.Am J Med. 2017; 130: 7666-7768Abstract Full Text Full Text PDF Scopus (44) Google Scholar; I agree with him that it is very unlikely that US medical schools will create a primary care track aimed at producing primary care physicians in a total 6 years of college and medical school rather than the current 11 years. Fortunately there are 2 other groups of medical professionals who are entering primary care practice after 6 years of training: nurse practitioners and physician assistants. The number of physician assistants and nurse practitioners is increasing, and their patients have been shown to have outcomes comparable to those of primary care physicians. The primary care task force of the future will consist of MD and DO family practitioners, nurse practitioners, and physician assistants. Primary Care Training Must ChangeThe American Journal of MedicineVol. 131Issue 3PreviewWith concierge practices increasing the shortage of primary care doctors1 and the number of nurse practitioners and physician assistants increasing,2 it should be clear to medical educators that there is a pressing need to change the way primary care doctors are trained. Full-Text PDF