The doctor is in

The growing trend toward an overproduction of specialists and an underproduction of generalists (i.e., family physicians, general internists, and general pediatricians) in the United States has prompted many in medicine and academic medicine to endorse the goal that 50% of the United States's physician graduates should be generalists. The author discusses (1) the definition of the term generalist; (2) the number of generalists presently being produced (as estimated by three methods) and why the 50% goal is an informed and reasonable one; (3) changes needed in graduate medical education of the three main categories of generalist physicians; (4) changes needed in medical education; (5) changes needed in the practice environment; and (6) overall implementation strategies and the question of how much the federal government or some central authority should be involved. He concludes by reflecting that the 50% goal is worthwhile, although challenging, and that it is better to have a goal--even if it is not met--then to have no goal at all.