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A Hypothetical Model for Clinical Education Under Managed Care

David L. Nahrwold, MD
Arch Surg. 1995;130(9):927-928. doi:10.1001/archsurg.1995.01430090013003.
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MEDICAL SPECIALTIES have expanded and proliferated, in part because they are the career choice of a majority of medical students. Most experts acknowledge that specialists provide excellent medical care, but it is fragmented, expensive, and partially responsible for the high cost of health care in our country. Replacement of sporadic, expensive specialty care with a system of managed care is imperative. A managed care system cannot be implemented immediately because the present ratio of generalists to specialists is inadequate. Accordingly, academic medical centers face a challenge to produce more generalists and fewer specialists.

The generalist imperative is supported and promulgated by a spectrum of influential groups and organizations, including the Association of American Medical Colleges, the Council on Graduate Medical Education, prestigious foundations and organizations, and lawmakers at the state and federal levels.

The theme that academic medical centers must produce and deploy more generalists and fewer specialists was formalized


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