Counting generalist physicians

THERE HAS recently been renewed interest in the specialty balance in the US physician workforce, with many groups calling for increased production of generalist physicians. A number of factors are responsible for this, including declining medical student interest in generalist careers,1continued shortages in rural and inner-city areas,2,3increased demand from managed care organizations, cross-national experience,4as well as some evidence of cost savings from higher proportions of generalists.5,6The Council on Graduate Medical Education7has called for a reduction in first-year graduate medical education positions to 110% of US medical graduates with a 50:50 generalist-to-specialist mix, and the Physician Payment Review Commission8has also considered such changes. Similar recommendations have been proposed in the Clinton Health Security Act as well as independently in Congress. Such changes are significant and could be approached from a variety of educational, financial, and regulatory perspectives. In order