Family practice, internal medicine, and pediatrics as partners in the education of generalists

The generalist of the future will play an integral role in the health care delivery system, yet the three recognized generalist specialties have developed and functioned along largely separate tracks. No matter what form of generalism evolves, family practice, internal medicine, and pediatrics must begin to cooperate and collaborate in developing new graduate medical education programs that are sufficiently flexible to meet whatever emerges in the future. They must devote their energies to working together, rather than competing; to emphasizing those parts of their programs that have similarities; and to sharing their knowledge, skills, attitudes, and perspectives about the care of patients. They must develop training experiences in which residents will obtain maximum contact with a wide variety of problems and patients in many different settings; a substantial portion of such training should be generic and virtually interchangeable among the three specialties. As the health care system evolves, so should these disciplines; they must begin to "train physicians to provide continuing, comprehensive and coordinated medical care to a population undifferentiated by gender, disease or organ system," as urged by the American Boards of Family Practice and Internal Medicine.