Medical Group Urges Limits to Specialization

The number of medical school graduates should be reduced by 500 each year nationwide--or 3%--as part of a strategy to cut back on a growing trend of doctors becoming specialists and neglecting family practice, internal medicine and pediatrics, the American Academy of Family Physicians recommended Friday at its annual scientific assembly.

Too many graduates are becoming cardiologists, oncologists and anesthesiologists, said Dr. Douglas E. Henley, president elect of the academy, which represents more than 80,000 members.

“Managed-care organizations are demanding more and more primary-care physicians from an educational system that produces sub-specialists by the thousands while ignoring the need for family physicians and other primary-care specialists,” Henley said.

The academy made several recommendations on how to correct an “imbalance” between generalists and specialists.

The number of generalist physicians has declined to one-third the total number of physicians, and the academy’s position is that half of the physicians produced in the U.S. should be primary-care physicians. In 1961, half of U.S. physicians were generalists.

As a result, the report said, fewer physicians are available to provide preventive care or general medical care in rural areas and inner cities.

“If this trend continues, we can look forward to more expensive and more fragmented health care at a time when an evolving medical marketplace is emphasizing prevention, continuity and person-centered care at lower cost,” Henley said.

According to the academy, medical schools are producing too many graduates--16,000 annually--a majority of whom go into specialties.

“Thus, some medical schools will need to decrease their enrollments; some schools may have to close,” Henley said.

As specialist jobs dry up, some potential doctors will leave the field rather than pursue family practice, Henley said.

“I think a disillusioned anesthesiology graduate is not going to become a family physician, and is not even going to go back to retrain,” he said. “You’re talking about very bright people, very intelligent people. Someone like that is probably going to go out and get an MBA or something like that.”

The academy also recommended that an additional 900 family physicians graduate from residency training each year so that the total number of new doctors in family practice would total 3,870 annually.

The academy based its recommendations on recent projections of the nation’s future needs for physicians. The recommendations are designed to achieve a ratio of 66.6 generalist physicians--up from 61-- per 100,000 population by the year 2010.

In order to achieve the ratio, federal funding policies must give priority to programs that train generalist physicians and reduce funding for programs that do not, Henley said.

Also, the highest priority for funding residency programs must be given to those with the best record of producing generalist physicians, especially those who work in rural areas and those from under-represented minority groups, he said.

“We hope these funds can be redistributed and redirected to create the type of physician that the American public needs,” he said.