Quiet Revolution

The health care system in US has a quiet revolution going on in the past three decades. More and more medical students desire to enter into medical specialties. The standard medical schooling is considered just basic and specialty is in high demands. Among young doctors, there is a trend or possibly pressure to advance oneself among the peers for more prestigious and lucrative specialist training. A more realistic estimate would be 40% primary care, 30% specialty care and 30% for hospital care in the landscape of US care system. The house calls from family physicians will be a thing of the past. As the shrinking population of providers dedicated to general practice becomes medical reality, the system needs to face and adjust to this change.
Though many considered this is "wrong" and worrisome. Personally I think this might not be a bad thing since nature itself having the ability to modulate the supplies. In the 21st century, we have an educated population and many channels of health information. More people are becoming health literate and seek treatments in an informed manner. In the 19th century and even 20th century, we do not have the educated mass and limited channels of getting informed on health issues. People now turn on TV, search Internet and read pamphlets to obtain health information and most have the reading and critical thinking ability. In the informed society, the primary care physicians may not play such important roles as before. Though many studies have shown the cost benefits of primary care, I think we need to re-think the roles and functions of primary care physicians in the post modern era. In several industrialized Asian countries, patients are allowed to see specialists and costs are low compared to the United States. The question states that studies have shown the cost benefits of access to primary cares, but do these studies consider the overall pictures of health care? If we look only at the saturated emergency rooms in cosmopolitan areas in US cities, then primary care would proved to be more cost effective and beneficial. However, when we consider the entire landscape of US health care, we might draw different conclusions. Most patients visit emergency rooms for common medical problems are uninsured, underinsured or illegal immigrants. If we have the universal health care in place, this phenomenon will disappear gradually. And this is more of a social issue rather than medical issue. When it comes to the right mix of medical practice, we need to ask other questions ? What kind of diseases American people have in the 21st century? What type of training and technology we need in responding to these illness? In what way can we most effectively and economically respond to the challenges of these popular modern diseases? Possibly the specialized approach and alternative approach are more in demands and can offer more for the US patients. We will always need the primary care physicians but the roles would be changed given the shift of modern lifestyle. Our thinking and study designs need to address these issues from the context of a post modern era. P.S. the reason I raise the percentage of hospital care is because of
the lager aging population and longivity. As the life expectancy increases and baby boomers age with a large number, the hospital usage will increase according to the demographic changes.