Ginzberg E
Columbia University, New York, New York.
Acad Med. 1989 Sep;64(9):495-7. doi: 10.1097/00001888-198909000-00001.
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.
作者指出了自二战以来塑造美国医学以支持专科化的各种融合力量。他得出结论，在学术健康中心的结构与功能、医疗保健融资以及医疗服务提供方面没有先行和同步变革，且没有重大的、持久的变化的情况下，任何增加医学全科医生数量和比例的努力都是有问题的。只有在解决了这些更广泛的问题之后，才有可能预期以全科医生为导向的系统带来的益处。即便如此，预期从更多全科医生身上获得的收益可能也会被证明是虚幻的。
