Evaluation of Existing Research Shows the Need for More Studies on the Generalist/Specialist Mix

Feasibility and utility of future research on the generalist/specialist mix

An investigator at the University of Washington School of Medicine, Roger A. Rosenblatt, MD, MPH, studied the feasibility and necessity of a new research project on the differences and similarities in the care provided by generalist and specialist physicians.

This project was part of the Robert Wood Johnson Foundation's (RWJF) national program Generalist Provider Research Initiative.

 

Key Findings

  • In a report published in 1994, the investigator noted the following:

    • Few studies have systematically explored differences in the cost, quality, or outcomes of care provided by specialists versus generalists.
    • The major flaw of these studies was that they did not ask the most fundamental question: How do specialists compare with generalists in their role as physicians who provide the majority of care for defined populations of patients?
  • He suggested that several methodological approaches could yield timely, policy-relevant data:

    • Single studies of provider performance in one setting for specific clinical conditions.
    • Comparisons of broad areas of practice by using retrospective chart abstraction and controlling for case mix.
    • Comparisons of generalist and specialist performance as principal or primary care physicians in existing settings.
    • Using Medicare data to explore this area.
    • Randomized, controlled trials.