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The role of internists in delivering primary care.

I NTERNAL medicine is perhaps unique among the specialties in that its practitioners can play a variety of roles in delivering medical care. Some internists, for example, are still broad-based consultants for problem patients of other practitioners in the traditional diagnostician's role, although this model is becoming uncommon. Other internists are subspecialists in referral practices, serving as consultants in a narrow subdivision of internal medicine. Still others, a great many of them-or so we believe-deliver primary care, either by itself or along with a subspecialty interest. One can speculate as to how these internists got into the business of delivering primary care. Were they driven into it by patient demand, filling a vacuum created perhaps by the dwindling ranks of general practitioners? Or did they seek it out, attracted by the perceived human satisfactions of firstaccess, continuing, and personal care of people? We do not even know the magnitude-although we suspect it is great-of the provision of primary care by internists. I know that I have provided primary care in my practice for more than 20 years. I know that my partners who are internists in our small group practice also do this. I am reasonably sure that fellow internists on the staff of my community hospital do so. In my travels over the United States as a trustee and officer of the American Society of Internal Medicine (ASIM) many members of ASIM also have told me that they provide primary care. Clearly, my evidence that internists deliver primary care is largely fragmentary and anecdotal. Aside from a few limited survey questionnaires sent to specific populations of internists, there are no statistics to show how many