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Weary PE. Primary care delivered by specialists
THE BLUE JOURNAL 25 YEARS AGO Weary PE. Primary care delivered by specialists. J Am Acad Dermatol 1979;1:283.
Comment In the late 1970s and early 1980s, the health care revolution in America was beginning to shape up. The proliferation of HMOs and the introduction of the gatekeeper concept, as a way to slow down the increasing costs of medical care, highlighted these times. Politicians were busy deciding on the distribution of manpower (ie, ‘‘health care providers’’). It was stated that medical schools were graduating too many physicians and overemphasizing the training of specialists. Consequently, the suggestion was put forth that the health care needs of the country were not being met because of the decreasing numbers of primary care ‘‘providers’’ being trained. Even in our field, many predicted a surplus of dermatologists by the end of the century. Despite these concerns, what we have witnessed in the last 20 years is remarkable: health care costs continue to increase, and more than 40 million Americans remain uninsured. The HMO industry, however, has been molded and adapted to the needs of insured payers, and the physician gatekeeper is no longer a key player. Moreover, the output of generalists and specialists is not an item in the agenda of politicians. In dermatology, we are
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facing a supply crisis because the number of graduating dermatologists does not meet the demands of the American public. In his 1979 editorial, Peyton Weary wrote the following regarding these issues: Those who contend that specialist care should be only by referral should thus be prepared to demonstrate that the primary care physician is capable of dealing with both severe and complex problems on a relatively equal footing with the specialist and that delay in proper diagnosis and management, either through inexperience or inability to keep up with recent advances, will not serve to reduce the overall quality of care which the American public has come to expect. Luis A. Diaz, MD Assistant Editor North Carolina
doi:10.1016/j.jaad.2004.06.003
Comment In the late 1970s and early 1980s, the health care revolution in America was beginning to shape up. The proliferation of HMOs and the introduction of the gatekeeper concept, as a way to slow down the increasing costs of medical care, highlighted these times. Politicians were busy deciding on the distribution of manpower (ie, ‘‘health care providers’’). It was stated that medical schools were graduating too many physicians and overemphasizing the training of specialists. Consequently, the suggestion was put forth that the health care needs of the country were not being met because of the decreasing numbers of primary care ‘‘providers’’ being trained. Even in our field, many predicted a surplus of dermatologists by the end of the century. Despite these concerns, what we have witnessed in the last 20 years is remarkable: health care costs continue to increase, and more than 40 million Americans remain uninsured. The HMO industry, however, has been molded and adapted to the needs of insured payers, and the physician gatekeeper is no longer a key player. Moreover, the output of generalists and specialists is not an item in the agenda of politicians. In dermatology, we are
488
facing a supply crisis because the number of graduating dermatologists does not meet the demands of the American public. In his 1979 editorial, Peyton Weary wrote the following regarding these issues: Those who contend that specialist care should be only by referral should thus be prepared to demonstrate that the primary care physician is capable of dealing with both severe and complex problems on a relatively equal footing with the specialist and that delay in proper diagnosis and management, either through inexperience or inability to keep up with recent advances, will not serve to reduce the overall quality of care which the American public has come to expect. Luis A. Diaz, MD Assistant Editor North Carolina
doi:10.1016/j.jaad.2004.06.003