Scalpel, please.

• Author: Georges, Christopher
• Position: Salaries of medical specialists

"Everyone told me it was the wrong thing to do," recalls Dr. Jennifer Weyler, explaining her decision two years ago as a medical student to become a family doctor. "My teachers discouraged me; administrators discouraged me. They told me I was too smart to go into primary care or that the job wouldn't be enough of a challenge." And sure enough, Weyler, now a resident in family medicine at the University of Massachusetts School of Medicine, is frustrated - but not by her job, which she loves. "It frustrates me," she explains, "to have to continually explain to people what a primary care practitioner is."

It was only 50 years ago, after all, that no one had to be told what a family doctor was, mainly because that's about all there was. Eighty-seven percent of all doctors in the thirties were general practitioners - namely internists, pediatricians, and family doctors. Today that figure has dropped to 30 percent.

That might appear, at first glance, like good news: As researchers become more sophisticated about what causes diseases and how to treat them, we need physicians who can focus on complex subfields of medicine. As medical technology evolves from stethoscopes to x-rays to CAT scans, we need doctors who can make the most of high-tech advances.

But it's also true that, despite the media's obsession with heart-warming stories about ice-packed kidneys air-lifted across America, the vast majority of medical treatments require little more than a visit to a generalist, where a check up, a prescription, or some simple medical advice will do the trick. More than three-fourths of all symptoms for which people seek treatment, studies show, can be fully treated by primary care doctors.

Problem is, the vast majority of doctors, namely specialists, aren't trained - or willing - to provide this kind of all-important treatment. All of which means that as Americans line up outside the neurologist's or radiologist's office to get their specialized care, we are wasting, according to one recent study, hundreds of millions of dollars annually on unnecessary procedures and other services prescribed by test-happy specialists. At the same time, the quality of care is dropping as preventive care - which is underprescribed by many specialists - takes a back seat.

Specialized tastes

While these problems have dogged our medical system for years, the real trauma of the primary care shortage is yet to come. Unless we act immediately to double the percentage of family doctors in America, any of the vaunted attempts to repair our system is doomed to fail. That's because - as everyone from Hillary to the AARP has agreed - the keys to repairing health care are eliminating waste, creating better "management" of health care resources, and beefing up emphasis on preventive care through HMOs and cooperative systems. To do this, they say, the point people must be generalists who would handle most cases on their own and curb expensive treatments.

But as things now stand, we haven't nearly enough generalists to make such a system work. One recent study showed that universal coverage would increase primary care office visits by 64 million a year - requiring 9,000 additional primary care doctors. And if the current rate...