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Letters to the Editor

Additional Considerations for the Expert–Generalist Model

Volpintesta, Edward Joseph MD

Author Information
doi: 10.1097/ACM.0000000000001107
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To the Editor:

Although the idea of expanding primary care physicians’ (PCPs’) skills to include some specialty skills1 sounds good and may work well in some areas of rural Canada, it would be difficult and even dangerous for PCPs here in the United States. In fact, the results could be disastrous.

First, in primary care in the United States the burden of administrative demands is extraordinarily onerous, and it alone has already brought on burnout in many PCPs. These doctors’ energies and emotional reserves are already stretched to the maximum, and any further strain would be ill conceived and lead to disaster.

Second, the U.S. litigation system is extremely aggressive and adversarial. Using PCPs to provide services beyond their usual skill set greatly increases their vulnerability to malpractice suits.

If specialists are seeing problems that they feel should be seen by a PCP then they should charge fees similar to what a PCP would charge. That is a better way of controlling costs.

Edward Joseph Volpintesta, MD

President, Bethel Medical Group, Bethel, Connecticut; [email protected]


1. Fins JJ.. The expert–generalist: A contradiction whose time has come. Acad Med. 2015;90:1010–1014
© 2016 by the Association of American Medical Colleges