The Future of Generalism
Authors: Jeremiah A. Barondess
Journal: Annals of Internal Medicine (1993)

Perspectives15 July 1993The Future of GeneralismJeremiah A. Barondess, MDJeremiah A. Barondess, MDFrom the New York Academy of Medicine, New York, New York.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-119-2-199307150-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Internal medicine has, in recent decades, altered radically its traditional generalist complexion in favor of redefinition along subspecialty lines; in recent years, 60% to 70% [1, 2] of physicians completing categorical internal medicine residency training have entered subspecialty fellowships. The United States has developed subspecialty medicine to a degree seen in no other Western country (Figure 1). As a consequence, general internal medicine has lost much of its identity as a specific area of expertise, as a critical element in educational and training programs, and as the most rational basis for the clinical care of most of the adult population.... References1. Andersen RM, Lyttle CS, Kohrman CH, Levey GS, Clements MM. National study of internal medicine manpower: XIX. Trends in internal medicine residency training programs. Ann Intern Med. 1992:117:243-50. Google Scholar2. Petersdorf RG. Graduate medical education: a lesson in non-governance. In: Taking Charge of Graduate Medical Education: To Meet the Needs of the 21st Century. New York: Josiah Macy, Jr. Foundation; 1993. Google Scholar3. Berenson RA. How the preponderance of subspecialists affects the cost, quality and accessibility of health care, In: The National Primary Care Conference, DHHS, PHS, HRSA. Washington, DC; 1992:216-7. Google Scholar4. Braunwald E. Subspecialists and internal medicine: a perspective. 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Taking Charge of Graduate Medical Education: To Meet the 21st Century. Josiah Macy, Jr. Foundation; 1993. Google Scholar36. Levinsky NG. Recruiting for primary care. N Engl J Med. 1993; 328: 656-60. Google Scholar Author, Article, and Disclosure InformationAuthors: Jeremiah A. Barondess, MDAffiliations: From the New York Academy of Medicine, New York, New York.Corresponding Author: Jeremiah A. Barondess, MD, 2 East 103rd Street, The New York Academy of Medicine, New York, NY 10029.Acknowledgments: The author thanks the staff of the Library of The New York Academy of Medicine, especially Jill Snyder for research assistance, and Carol Barrett-Gonzalez for secretarial assistance. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoGeneral Internists and Subspecialists Gerald E. Thomson Internal Medicine and the Journey to Medical Generalism Marc L. 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