A career in ambulatory medicine

To meet the need and resolve long standing conflicts in the delivery of primary care in an age of specialization, I propose an experiment with a different type of primary medical education based on the separation of careers into community-oriented primary and continuing care of ambulatory patients and hospital-based intensive care of acutely ill bed patients. High-school graduates selected for interest, aptitude, and personality would follow a six-year pathway through college and medical school. A singular feature of the proposal would be the replacement of bedside training with an undergraduate traineeship of two to 2 1/2 years in the hospital ambulatory specialty clinics, emergency clinic, and a primary-care model practice unit, followed by a one-year externship in this primary-care center. The graduate would be oriented toward group and team practice and would work in a system integrating primary, secondary, and tertiary care.