Editors note:—The above letter was referred to the authors of the original article, and Dr. Burton and Dr. Solomon's reply follows. In reply:—We thank Drs. Robertson, Goldlist, and Beattie and Dr. Morley (see Special Article) for their comments on our editorial. It is true that the status of geriatric medicine is controversial and certainly varies by country, region, and type of healthcare facility. The concept of primary care in Canada is naturally quite different from that in the United States: the healthcare systems are fundamentally different in the two countries. Basically, the US needs more primary-care physicians, not more subspecialists. It is incumbent upon each discipline to meet that need in whatever way it can. Internal medicine must promote the training of generalists. This may not be what some academicians prefer to do, but it is what we all must do in response to the needs of our country. Geriatrics, as a generalist discipline, must join in this effort and organize its training so as to emphasize comprehensive and continuing care of elderly patients, particularly frail elderly. Quality primary care cannot be taught by subspecialists who generally, as Dr. Morley points out, do it poorly. It must be taught by excellent primary care providers. We believe most academic geriatricians are, and indeed are very proud to be, considered such. That is not to say that a geriatrician cannot serve as a consultant. Clearly he or she can serve in that role just as an internist can. It is a matter of emphasis. It is true that Dr. Morley's figures (Table 3) show that geriatrics has a higher percent of its billings as consultations than some other subspecialty groups, but in absolute terms it was only 16%, which is not far from our finding of 5% and, in any event, suggests that an overwhelming majority of geriatrics services, even in an academic medical center, are in the non-consultant mode. Many studies of comprehensive geriatric assessment (CGA) indicate that it is rather ineffective when provided only in a consultative fashion. Effective outcomes require control by the CGA team over the follow-up. This is not surprising. Our field is very different from infectious disease, for example, where the reason for the consultation is often to get a recommendation on whether to give an antibiotic and, if so, which one. The recipient of the consultation is very likely to accept the recommendation and implement it. Not so in geriatrics where the consultation, even if not so worded, is really asking, “How can I deal with the 10 different problems this patient presents? I'm out of my depth.” This calls for a physician who is not just a consultant but who can take charge of the immediate situation and the follow-up. We are not saying that the geriatrician does not need specialized knowledge, and we make no comment on Dr. Hazzard's proposal to reduce geriatrics training to 1 year. Dr. Morley implies that in our editorial, we support Dr. Hazzard's view, but that is not so. We seek geriatricians even more. We seek general internists and family physicians with superb in-depth training that will allow them to manage the most difficult challenges in caring for the elderly. Our only difference with Dr. Morley lies in how the services of geriatricians fit into the healthcare system, not in how expert they are.