The letters above were sent to Dr. Fred and Dr. Gonzalo, who respond in this manner:

We thank Dr. Volpintesta1  and Dr. Kraft2  for their comments about our editorial3  and welcome the opportunity to respond.

Volpintesta's suggestion for producing more primary care physicians—although sound in theory—would be almost impossible to implement anytime soon. It would force medical schools to make substantial changes in curricula already undergoing the far-reaching modifications described in our editorial. An even bigger barrier, perhaps, is the widespread belief among today's trainees that specialties other than primary care offer them more prestige, more income, and more satisfying work-life balance.

Kraft echoes sentiments expressed by some practitioners and some academicians,4  especially those who trained in the “high-touch” era (late 1940s to mid-1970s).5,6  The reframing movement embraces traditional clinical skills, views them as crucial to good patient care, and does not attempt to replace or abandon them. It emphasizes instead a shift in mindset for physicians and their need to acquire health systems science skills. Many medical schools have yet to adopt this 3rd-pillar model. We agree that a considerable number of current medical students, house officers, and recent graduates lack sufficient clinical skills.7  And we, along with others,8,9  have encountered serious problems with the electronic health record.

Revising any longstanding tradition typically raises controversy and often leaves some degree of sadness and regret. But all things change, and we change with them.

References

References
1.
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Letters to the Editor should be no longer than 2 double-spaced typewritten pages and should generally contain no more than 6 references. They should be signed, with the expectation that the letters will be published if appropriate. The right to edit all correspondence in accordance with Journal style is reserved by the editors.