Do we need more generalists?

The author identifies the confluent forces that have structured U.S. medicine in favor of specialism since World War II. He concludes that any effort to increase the number and proportion of generalists in medicine is problematic in the absence of antecedent and concurrent transformations in the structure and functioning of academic health centers and in the financing of medical care, and of major, long-lasting changes in the delivery of health care. Only after these larger considerations have been addressed can the benefits of a generalist-oriented system be anticipated. Even then, the gains expected to accrue from a greater number of generalists might prove illusory.