Specialists/primary care professionals: striking a balance

Even before the recent movement toward managed care, there was mounting evidence of excessive numbers of many medical and surgical specialists. Generalist physicians are now in short supply, as are nonphysician providers. The ideal correction for the current problems of specialty surplus and total physician excess would be based on economics or the marketplace. However, a rapid correction is unlikely in a voluntary system. A national commission has been suggested by several bodies. This commission could make recommendations for the total number of training positions and, subsequently, the subspecialty trainees needed. Implementation of the recommendations could be through large multistate regional consortia.