The health work force, generalism, and the social contract

Since 1990, society has been evolving through a period of significant transformation. In response to an increasingly information-rich and knowledge-based environment, the work force for most of society is becoming more specialized. Medicine is one of the few areas developing a work force which emphasizes generalism. For our current needs, the transitional work force has overproduced physicians. Because the overproduction has been uneven by specialty, it is deceptive to evaluate growth collectively rather than by individual subspecialty. Future shifts in age and types of illness combined with enhanced technology will transform the public's expectations of the American health care system. The type and number of physicians that will be needed in the future will be substantially different than in the past, so current patterns in physician education may not address the population's future demands.