The Future of Generalism in Medicine

What is the future of generalism in medicine? Therewas 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 general-ism are resplendent with words like “crisis ” (3), “distress” (4), “dissolution, disillusion ” (5), “crossroads ” (6), “pros-perity and despair ” (7), and “reconstruction, renewal, and renaissance ” (8). The authors seem preoccupied with the