Family Doctor Comes Back

After years of giving ground to the growing army of specialists, the all-round family doctor is beginning a comeback.

This was the news applauded by 5,000 members of the American Academy of General Practice last week when they gathered in Washington for their annual convention. From President Eisenhower, a man who has had his days with specialists, they got formal greetings and an unexpected pat on the back, relayed through Vice President Nixon: "Give them my regards, Dick. They're the backbone of the profession." From a succession of cardiologists, psychiatrists, gynecologists, urologists and other specialists, they got briefings on the latest in discoveries and techniques. From their newly installed president. Dr. John S. DeTar of Milan, Mich, (see below), they got a heartening report on their efforts to regain some of the prestige and responsibility pared away from the nation's 80,000 G.P.s--or "generalists" as they want to be called--by the tendency to medical specialization. "The renaissance of the generalists is imminent," said Dr. DeTar.

As a result of pressures applied in recent months by the A.A.G.P. and through the American Medical Association, hospitals report a 50% increase in operating G.P. departments since 1952; a dozen of the 81 medical schools in the country have set up special G.P. programs. The "preceptor" system, whereby an intern divides his time between a central hospital and on-the-job training with a G.P., has spread from 9 schools in 1950 to 22, now equips some 1,000 each year to be family doctors if they choose to be.

Against the small gains, however, are many big problems still facing the generalists. Some of them:

P:Although 85% of all ailments can be treated by a G.P., many hospitals regard the generalist as a sorting clerk whose chief function is to refer patients to staff specialists. Restrictions on qualified generalists are strictest in large Eastern cities and include a complete shut-out in most teaching hospitals, limitation in others to minor surgery, nonoperative obstetrics, routine medical care. In Baltimore hospitals G.P.s are forbidden even to stitch a small cut or open an abscess in the emergency room. One hospital in Pittsburgh requires that the chief of obstetrics grant a G.P. official permission to use outlet forceps in a delivery. Twenty-three New York State hospital staffs are off limits to generalists.

P:The tendency in medical schools, mostly specialist-staffed, is still to discourage M.D.s from entering general practice. Of some 20,000 hospital-training residencies for young M.D.s, only 500 are for generalists; 198 of these are going begging. Last year only 35% of the nation's M.D.s were in general practice, v. 40% in 1940. Some 30 million Americans have no regular family doctor, although the overall U.S. doctor-patient ratio (one to 760) has changed little in the last 50 years.

P:The armed forces also discriminate in favor of specialists, giving them more deferments for advanced training than their G.P. contemporaries.

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