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The Future of Generalism in Medicine

2005; American College of Physicians; Volume: 142; Issue: 8 Linguagem: Inglês

10.7326/0003-4819-142-8-200504190-00036

1539-3704

Eric B. Larson, Kevin Grumbach, Kenneth B. Roberts,

Healthcare cost, quality, practices

Supplement: The Future of Generalism in Medicine19 April 2005The Future of Generalism in MedicineEric B. Larson, MD, MPH, Kevin Grumbach, MD, and Kenneth B. Roberts, MDEric B. Larson, MD, MPHFrom Group Health Cooperative, Seattle, Washington; University of California, San Francisco, San Francisco, California; and University of North Carolina School of Medicine, Chapel Hill, North Carolina.Search for more papers by this author, Kevin Grumbach, MDFrom Group Health Cooperative, Seattle, Washington; University of California, San Francisco, San Francisco, California; and University of North Carolina School of Medicine, Chapel Hill, North Carolina.Search for more papers by this author, and Kenneth B. Roberts, MDFrom Group Health Cooperative, Seattle, Washington; University of California, San Francisco, San Francisco, California; and University of North Carolina School of Medicine, Chapel Hill, North Carolina.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-142-8-200504190-00036 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail What is the future of generalism in medicine? There was a time when financial analysts predicted that 90% of U.S. health care would be organized as managed care built on a primary care, generalist model (1). In the wake of these predictions, residency positions in family medicine and other generalist disciplines grew rapidly. Hospitals and health systems bought or built practices and added so-called primary care capacity to their operations (2).Today, however, the intellectual stratosphere and, more important, the medical marketplace resound with a very different language. Recent publications about generalism are resplendent with words like “crisis” (3), “distress” ...References1. Abramowitz KS. The Future of Health Care Delivery in America. New York: Bernstein Research, Sanford C. Bernstein; 1993. Google Scholar2. Larson EB. Medicine as a profession—back to basics: preserving the physician–patient relationship in a challenging medical marketplace. Am J Med. 2003;114:168-72. [PMID: 12586248] CrossrefMedlineGoogle Scholar3. Moore G, Showstack J. Primary care medicine in crisis: toward reconstruction and renewal. Ann Intern Med. 2003;138:244-7. [PMID: 12558374] LinkGoogle Scholar4. Martin JC, Avant RF, Bowman MA, Bucholtz JR, Dickinson JR, Evans KL, et al. The Future of Family Medicine: a collaborative project of the family medicine community. Ann Fam Med. 2004;2 Suppl 1 S3-32. [PMID: 15080220] CrossrefMedlineGoogle Scholar5. Sandy LG, Schroeder SA. Primary care in a new era: disillusion and dissolution? Ann Intern Med. 2003;138:262-7. [PMID: 12558377] LinkGoogle Scholar6. Schroeder SA. Primary care at a crossroads. Acad Med. 2002;77:767-73. [PMID: 12176687] CrossrefMedlineGoogle Scholar7. Larson EB. General internal medicine at the crossroads of prosperity and despair: caring for patients with chronic diseases in an aging society. Ann Intern Med. 2001;134:997-1000. [PMID: 11352700] LinkGoogle Scholar8. Showstack J, Lurie N, Larson EB, Rothman AA, Hassmiller S. Primary care: the next renaissance. Ann Intern Med. 2003;138:268-72. [PMID: 12558378] LinkGoogle Scholar9. Larson EB, Fihn SD, Kirk LM, Levinson W, Loge RV, Reynolds E, et al. The future of general internal medicine. Report and recommendations from the Society of General Internal Medicine (SGIM) Task Force on the Domain of General Internal Medicine. J Gen Intern Med. 2004;19:69-77. [PMID: 14748863] CrossrefMedlineGoogle Scholar10. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138:273-87. [PMID: 12585825] LinkGoogle Scholar11. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138:288-98. [PMID: 12585826] LinkGoogle Scholar12. Larson EB. Health care system chaos should spur innovation: summary of a report of the Society of General Internal Medicine Task Force on the Domain of General Internal Medicine. Ann Intern Med. 2004;140:639-43. [PMID: 15096335] LinkGoogle Scholar13. Anderson GF. Physician, public, and policymaker perspectives on chronic conditions. Arch Intern Med. 2003;163:437-42. [PMID: 12588202] CrossrefMedlineGoogle Scholar14. Whitcomb ME. Primary care medicine in the United States: where are we headed? [Editorial]. Acad Med. 2002;77:759-60. [PMID: 12176685] CrossrefMedlineGoogle Scholar15. Starfield B. Is primary care essential? Lancet. 1994;344:1129-33. [PMID: 7934497] CrossrefMedlineGoogle Scholar16. Grumbach K, Bodenheimer T. A primary care home for Americans: putting the house in order. JAMA. 2002;288:889-93. [PMID: 12186609] CrossrefMedlineGoogle Scholar17. Rothman AA, Wagner EH. Chronic illness management in primary care.. In: Showstack J, Rothman AA, Hussmiller SB, eds. The Future of Primary Care. San Francisco: Jossey-Bass; 2004:180-202. Google Scholar18. Colwill JM, Perkoff GT, Blake RL, Paden C, Beachler M. Modifying the culture of medical education: the first three years of the RWJ Generalist Physician Initiative. Acad Med. 1997;72:745-53. [PMID: 9311314] CrossrefMedlineGoogle Scholar19. Robert Wood Johnson Foundation: Generalist Physician Initiative National Program Report. Last updated July 2003. Accessed at www.rwjf.org/report/npreports/gpi.htm on 1 July 2004. Google Scholar20. Ferrer RL, Hambidge S, Maly R. The essential role of generalists in health care systems. Ann Intern Med. 2005;142:691-9. LinkGoogle Scholar21. Stille CJ, Jerant A, Bell D, Meltzer D, Elmore JG. Coordinating care across diseases, settings, and clinicians: a key role for the generalist in practice. Ann Intern Med. 2005;142:700-8. LinkGoogle Scholar22. Weiner SJ, Barnet B, Cheng TL, Daaleman TP. Processes for effective communication in primary care. Ann Intern Med. 2005;142:709-14. LinkGoogle Scholar23. Schwartz MD, Basco WT, Grey MR, Elmore JG, Rubenstein A. Rekindling student interest in generalist careers. Ann Intern Med. 2005;142:715-24. LinkGoogle Scholar24. Safran DG. Defining the future of primary care: what can we learn from patients? Ann Intern Med. 2003;138:248-55. [PMID: 12558375] LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Eric B. Larson, MD, MPH; Kevin Grumbach, MD; Kenneth B. Roberts, MDAffiliations: From Group Health Cooperative, Seattle, Washington; University of California, San Francisco, San Francisco, California; and University of North Carolina School of Medicine, Chapel Hill, North Carolina.Disclosures: None disclosed.Corresponding Author: Eric B. Larson, MD, MPH, Group Health Cooperative, Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448; e-mail, larson.e@ghc.org.Addresses: Dr. Larson: Group Health Cooperative, Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448.Dr. Grumbach: Department of Family and Community Medicine, Family and Community Medicine, San Francisco General Hospital, Ward 83, 1001 Potrero Avenue, San Francisco, CA 94110.Dr. Roberts: Pediatric Teaching Program, Moses Cone Health System, 1200 North Elm Street, Greensboro, NC 27401. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Essential Role of Generalists in Health Care Systems Robert L. Ferrer , Simon J. Hambidge , and Rose C. Maly Coordinating Care across Diseases, Settings, and Clinicians: A Key Role for the Generalist in Practice Christopher J. Stille , Anthony Jerant , Douglas Bell , David Meltzer , and Joann G. Elmore Processes for Effective Communication in Primary Care Saul J. Weiner , Beth Barnet , Tina L. Cheng , and Timothy P. Daaleman Rekindling Student Interest in Generalist Careers Mark D. Schwartz , William T. Basco Jr , Michael R. Grey , Joann G. Elmore , and Arthur Rubenstein Primary Care, Generalism, Public Good: Déjà vu? Again! Eric B. Larson , Kenneth B. Roberts , and Kevin Grumbach Metrics Cited byMedical generalism. Past, present and futureEl generalismo médico. Pasado, presente y futuroCharacterising generalism in clinical practice: a systematic mixed studies review protocolThe effect of electronic reminders on risk management among diabetic patients in low resourced settings“I AM a Doctor”Introduction: Chronic Medical Conditions and Depression—the View from Primary CareImproving Colorectal Cancer Screening Through Research in Primary Care SettingsHow Strategies for Managing Patient Visit Time Affect Physician Job Satisfaction: A Qualitative AnalysisPerspective: United We Stand, Divided We Fall: The Case for a Single Primary Care Specialty in the United StatesThe Status of Academic General Pediatrics: No Longer Endangered?Access to and utilization of healthcare: the provider’s roleHuisarts en Wetenschap, jaargang 2005, nummer 9 De toekomst van de eerstelijnszorg ligt in de VSPrimary Care, Generalism, Public Good: Déjà vu? Again!Eric B. Larson, MD, MPH, Kenneth B. Roberts, MD, and Kevin Grumbach, MD 19 April 2005Volume 142, Issue 8 Page: 689-690 Keywords Forecasting Health care Health economics Hospital medicine Motivation Patients Primary care Primary care physicians Public policy Residency ePublished: 19 April 2005 Issue Published: 19 April 2005 Copyright & PermissionsCopyright © 2005 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...