ABSTRACT
Trends in medical specialization will depend increasingly on deliberate actions taken from outside rather than inside the medical profession. The professional trends are toward the further decline of generalism, and continuing maldistributions among other specialties. If goals of reasonable access to health services are to be achieved in the United States, expressed through appropriate legislation, the trends of specialization within the medical profession will be changed. The importance of primary medical care in a specialist system has been emphasized again and again. If redistributions of specialists—specialist manpower planning—are to be seriously contemplated, other routes will prove more realistic. Authority to choose a specialty has been decentralized to individuals, delineation of specialty training to relatively autonomous specialist associations. If specialist educational policies are developed independently of hospital service expectations, hospitals will be forced to explore alternative means of staffing for the substantial services that are given by interns and residents.
