Good care models
DR. JOSEPH Martin ("Where have all the doctors gone?" Op-ed, May 27) is quite right in saying that the shortage of certain types of doctors, such as primary care practitioners and general surgeons, can only be solved by "new models of healthcare delivery . . . with a new focus on team work," but he doesn't suggest how this might be accomplished. The answer is at hand, and the models already exist. Multispecialty group practices that function as group-model HMOs can provide comprehensive care on a prepaid, per capita basis. They offer every member a choice of a primary care physician who works with a team of other primary care providers and consults specialists as needed. A few examples are Harvard Vanguard Medical Associates in the Boston area, the Geisinger Health System in Pennsylvania, and Kaiser Permanente on the West Coast. A national plan that encouraged, or mandated, smaller versions of these groups would go far to ensure what Dr. Martin and all of us want: "the best heathcare possible at an affordable cost."
Dr. ARNOLD S. RELMAN
Boston
The writer is former editor in chief of the New England Journal of Medicine. 