• An orientation toward the longitudinal care of the patient.

• Responsibility for coordination of other health services that relate to the patient's care.

Physicians who provide primary medical care are trained as generalists. Their training, practice, and continuing education involve the following competencies:

• Health promotion and disease prevention.

• Assessment/evaluation of common symptoms and physical signs.

• Management of common acute and chronic medical conditions.

• Identification and appropriate referral for other needed health care services.

When the elements and competencies of primary care are defined clearly, the physician specialties that constitute the primary care specialties become evident—those trained, certified, and practicing in the specialties of family practice, general internal medicine, and general pediatrics. ³

As Dr. Boufford stated, the United States has a comparatively small proportion of physicians practicing in primary care specialties. Other industrialized countries have 50 to 75 percent of their physicians practicing in primary care, whereas in the United States the proportion of non-primary-care specialists is about 67 percent (Figure 1).

The United States has about 20 practicing physicians per 10,000 Americans (a ratio somewhere below the median for developed coun-

FIGURE 1 Decrease in primary-care M.D.s as compared with other specialties.