A recent National Public Radio story interviewed patients in Mexico City who custom-order restaurant meals in rooms outfitted with hot tubs. The operating rooms and ICUs are fully equipped. In contrast, at the hospital civil, the orthopedist brought in all his own instruments for each case. At the other hospital, the sole pulmonary physician had contributed the one intensive care monitor, and took pieces of it home with him at night so that they would not be stolen. I could see that it would be difficult, as a rural generalist, to stay current with medical practices.
Medical journals are prohibitively expensive.
U.S. Paying for medical journals for a private practice must be nearly impossible. The class I attended was probably a good example of courses open to generalists. It was taught from overhead projectors. While there was a syllabus, the hospital could not afford to make photocopies of it. The students didn't expect them, either.