Generalist Medicine and the U.S. Health System
March 2004, Jossey-Bass
· Examines the current challenges of primary care and generalist medicine
· Offers a chronological history of the growth of generalist medicine since the 1950s
· Reviews the models of care on which generalist medicine is based
· Analyzes the growth of three disciplines¾general internists, family physicians, and pediatricians
· Looks at the supply and distribution of generalist physicians
· Discusses the education and training of generalist physicians
· Reports on the cost and quality of the care provided by generalist versus specialists
Section One: Primary Care and the Education of Generalist Physicians: Past, Present, and Future.
Primary Care Medicine and the Education of Generalist Physicians (Jack M. Colwill).
Reconstructing Primary Care for the 21st Century (Kevin Grumbach and Thomas Bodenheimer).
Section Two: Primary Care: The Need for and the Role of Generalist Physicians.
Institute of Medicine, Primary Care: America's Health in a New Era - Summary, 1996.
The Generalist Function in Medicine, Journal of the American Medical Association, 1966 (Edmund D. Pellegrino).
The Ecology of Medical Care, Journal of the American Medical Association, 1961 (Kerr L. White, et al.).
The Need for a New Medical Model: A Challenge for Biomedicine, Science, 1977 (George Engel).
A National Study of Internal Medicine and Its Specialties: Primary Care in Internal Medicine, Annals of Internal Medicine, 1979 (Robert C. Mendenhall, et al.).
General Internal Medicine at the Crossroads of Prosperity and Despair: Caring for Patients with Chronic Diseases in an Aging Society, Annals of Internal Medicine, 2001 (Eric Larson).
The Intellectual Basis of Family Practice, Journal of Family Practice, 1975 (G. Gayle Stephens).
What Does Family Practice Need to Do Next? Family Medicine, 2001 (John P. Geymann and Erika Bliss).
Should There Be a Merger to a Single Primary Care Specialty for the 21st Century? An Affirmative View, The Journal of Family Practice, 1989 (Gerald T. Perkoff).
The Generalist Role of Specialty Physicians: Is There a Hidden System of Primary Care? Journal of the American Medical Association, 1998 (Roger A. Rosenblatt, et al.).
The Emerging Role of "Hospitalists" in the American Health Care System, New England Journal of Medicine, 1996 (Robert M. Wachter and Lee Goldman).
Primary Care and Health: A Cross-National Comparison, Journal of the American Medical Association, 1991 (Barbara Starfield).
Primary Care in a New Era: Disillusion or Dissolution? Annals of Internal Medicine, 2002 (Lewis G. Sandy and Steven A. Schroeder).
Section Three: Supply and Distribution.
Third Report: Improving Access to Health Care Through Physician Workforce Reform - Findings, 1992 (Council on Graduate Medical Education (COGME)).
A Manpower Policy for Primary Health Care, 1978 (Institute of Medicine).
Where Have All the Primary Care Applicants Gone? New England Journal of Medicine, 1992 (Jack M. Colwill).
The Elusive Generalist Physician: Can We Reach a 50% Goal? Journal of the American Medical Association, 1993 (David A. Kindig, et al.).
Economic and Demographic Trends Signal an Impending Physician Shortage, Health Affairs, 2002 and commentary by Kevin Grumbach (Richard A. Cooper, et al.).
Influence of Income, Hours Worked, and Loan Repayment on Medical Students' Decision to Pursue a Primary Care Career, Journal of the American Medical Association, 1994 (Michael P. Rosenthal, et al.)
Domestic Production vs. International Immigration: Options for the U.S. Physician Workforce, Journal of the American Medical Association, 1996 (David A. Kindig and Donald L. Libby).
Physicians and Rural America, Western Journal of Medicine, 2000 (Roger A. Rosenblatt and Gary L. Hart).
Practice Sights: State Primary Care Development Strategies, To Improve Health and Health Care, volume VI, 2002 (Irene M. Wielawski).
Section Four: The Training and Education of Primary Care Physicians.
Report of the Citizens Commission on Graduate Medical Education, The Graduate Education of Physicians ("The Millis Report") - Chapter 5, Comprehensive Health Care.
The Education of Physicians for Primary Care - Chapters 1, 2, and 6, 1973 (Joel J. Alpert and Evan Charney).
Education and Roles of Personal Physicians in Medical Practice, Journal of the American Medical Association, 1964 (Lawrence E. Young).
Residency Training in Internal Medicine: Time for a Change? Annals of Internal Medicine, 1986 (Steven A. Schroeder, et al.).
The Education of Pediatricians for Primary Care: The Score After Two Score Years, Pediatrics, 1995 (Evan Charney).
Sustaining the Development of Primary Care in Academic Medicine, Academic Medicine, 1998 (Thomas Inui, et al.).
Influencing Academic Health Centers: The Robert Wood Johnson Foundation Experience, To Improve Health and Health Care, 1998-1999 (Lewis G. Sandy and Richard Reynolds).
Section Five: The Practice of Primary Care: Quality and Cost.
Part A: Generalists and Specialists.
Comparing Generalist and Specialty Care: Discrepancies, Deficiencies, and Excesses, Archives of Internal Medicine, 1998 (Martin T. Donohoe).
Approach to Diagnosis by Primary Care Clinicians and Specialists: Is There a Difference? The Journal of Family Practice, 1996 (Walter W. Rosser).
Part B: Nurse Practitioners and other Non-Physician Practitioners.
Nurse Practitioners, Physician Assistants, and Certified Nurse-Midwives: A Policy Analysis - Summary and Policy Conclusions, 1986 (U.S. Office of Technological Assessment).
Quality of Patient Care by Nurse Practitioners and Physician's Assistants: A Ten-Year Perspective, Annals of Internal Medicine, 1979 (Harold C. Sox, Jr.).
Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians, Journal of the American Medical Association, 2000 (Mary O. Mundinger, et al.).
Support of Nurse Practitioners and Physician Assistants, To Improve Health and Health Care, 1998-1999 (Terrance Keenan).
Education of Southern Policymakers about the Use of Nurse Practitioners, 1998.
Evaluation of a Nurse-Run Primary Care Practice, 2000.
Evaluation of a Primary Care Practice in Washington Heights, 2001.
Analysis of Nurse Practitioner Clinical Training Costs, 2002.
James R. Knickman is vice president for research and evaluation at The Robert Wood Johnson Foundation in Princeton, New Jersey. He formerly was a professor of nonprofit administration in the Wagner School of New York University.