RETRAINING THE SUBSPECIALIST FOR A PRIMARY-CARE CAREER - 4 POSSIBLE PATHWAYS

The degree to which a reformed U.S. health care system relies on an ad equate supply of primary care physicians will determine the urgency of change in the composition of the medical workforce. In many areas of the United States, the demand for primary care physicians, particularl y in managed care settings, far exceeds the supply. In contrast, repor ts of reduced practice opportunities for medical and surgical subspeci alists in the same settings are increasing. As opportunities for and i ncomes of primary care physicians are enhanced, some medical subspecia lists may seek retraining in primary care. This article provides a con text for understanding the development of physician retraining program s, examines precedents for retraining physicians, describes four possi ble pathways through which medical subspecialists might acquire primar y care training, and emphasizes the importance of defining the scope o f practice and necessary skills for providing primary care. Obstacles to retraining appear to be economic (Who will pay? Is the cost worth t he benefit?) and jurisdictional (Who will define core competencies? Wh o will credential programs and trainees?). The current absence of dema nd for such retraining programs suggests either that marketplace-induc ed changes will not take place or that the notion of a primary care pr ovider shortage and an oversupply of medical subspecialists is oversta ted. The inclusion of physician retraining programs in proposed health reform legislation suggests that policymakers are convinced that such programs offer one viable solution to the nation's medical workforce needs.