The steady decline in primary physicians in the United States is documented. The increasingly severe maldistribution of physicians is examined in relation to the effect this has on primary care. The effect on the poor, rural people, and minority group people is particularly serious. Four approaches to the solution of this problem are identified and discussed in some detail: an increase in the output of physicians, an increase in the supply and use of ancillary support personnel, reform in the organization of medical care, and the creation of a new specialty of family practice. Special attention is devoted to the likely contribution of the Neighborhood Health Center and Health Maintenance Organization movements to solution of current problems in primary medical care.
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References
1.
WhiteK. L.General practice in the United States. J. Med. Educ. 39: 333–345, 1964.
2.
HaugJ. N.RobackG. A., and MartinB. C.Distribution of Physicians in the United States, 1970.Center for Health Services Research and Development, American Medical Association, Chicago, 1971.
3.
Final Report: Medical Care for the American People. The Committee on the Costs of Medical Care. University of Chicago Press, Chicago, 1932.
4.
Volume of Physician Visits, United States, July 1966–June 1967. Vital and Health Statistics, Series 10, Number 49, National Center for Health Statistics. U.S. Government Printing Office, Washington, D. C., 1968.
5.
HuntleyR. R., and MartinD. A.Family Practice in North Carolina. Mimeographed, 1964. Copies available from senior author.
6.
Report of the Mayor's Task Force on Public Health Goals. Office of Human Resources Programs, District of Columbia Government, Washington, D.C., 1970.
7.
NormanJ. C.Medicine in the ghetto. N. Engl. J. Med.281: 1271–1275, 1969.
8.
Executive Director's Page. Bulletin of the American College of Physicians7: 177–178, 1966.
9.
MillisJ. S., Chairman. The Graduate Education of Physicians. Report of the Citizens Commission of Graduate Medical Education. American Medical Association, Chicago, 1966.
10.
Health Manpower Action To Meet Community Needs. Report of the National Commission on Community Health Services. Public Affairs Press, Washington, D.C., 1967.
11.
U.S. Department of Health, Education, and Welfare.Report to the President on Medical Care Prices. U.S. Government Printing Office, Washington, D. C., 1967.
12.
BaneF.Physicians for a Growing America. Report of the Surgeon General's Consultant Group on Medical Education, U. S. Public Health Service Publication Number 709. U. S. Government Printing Office, Washington, D. C., 1959.
13.
Higher Education and the Nation's Health: Policies for Medical and Dental Education. A Special Report and Recommendations by the Carnegie Commission on Higher Education. McGraw–Hill Book Company, New York, 1970.
14.
PL 92–157 and PL 92–158. Ninety–second Congress, 1970.
15.
StettenD.Projected Changes in Medical School Curriculum. Science174: 1303–1306, 1971.
16.
HaggertyR. J.Preparing personnel to meet the demand. J. Med. Educ. 46: 3–10, 1971.
17.
Nurse Clinician and Physician's Assistant: Relationship between Two Emerging Practitioner Concepts. The National Commission for the Study of Nursing and Nursing Education, Rochester, New York, 1971.
18.
The Physician's Assistant: A Synopsis, p. 14. Duke University Medical Center, 1968.
19.
Survey of Operational Physician's Assistant Programs. American Medical Association, Chicago, 1971.
20.
BatesB.Doctor and nurse: Changing roles and relations. N. Engl. J. Med.283: 129–134, 1970.
21.
SilverH. K.FordL. C., and DayL. R.The pediatric nurse practitioner program: Expanding the role of the nurse to provide increased health care for children. J.A.M.A.204: 298–302, 1968.
22.
CharneyE., and KitzmanH.The child health nurse (pediatric nurse practitioner) in private practice, a controlled trial. N. Engl. J. Med.285: 1353–1358, 1971.
23.
KnowlesJ. H.The quantity and quality of medical manpower: A review of medicine's current efforts. J. Med. Educ. 44: 81–118, 1969.
24.
BellinS. S.GeigerH. J., and GibsonC. D.Impact of ambulatory health care services on the demand for hospital beds. N. Engl. J. Med.280: 808–812, 1969.
25.
FrankA.Office of Comprehensive Health Services, Office of Economic Opportunity, personal communication, 1971.
26.
TorrensP. R.Administrative problems of neighborhood health centers. Med. Care9: 487–497, 1971.
27.
LloydW. B., and WiseH. B.The Montefiore experience. Bull. N. Y. Acad. Med.44: 1353–1362, 1968.
28.
SomersA. R.Health Care in Transition: Directions for the Future. Hospital Research and Educational Trust, Chicago, 1971.
29.
WilliamsG.Kaiser–Permanente Health Plan: Why It Works. The Henry J. Kaiser Foundation, Oakland, California, 1971.
30.
RoyW. R.The Health Maintenance Organization Act of 1971. Congressional Record, Ninety–Second Congress, First Session, November 11, 1971.
31.
PisacanoN.J., Chairman, American Board of Family Practice, Lexington, Kentucky, personal communication, 1971.
32.
Medical School Family Practice Programs, AAGP Reprint No. 164, American Academy of Family Physicians, Kansas City, Missouri, 1971.
