Another general internist leaves The Happy Hospitalist's area, and there is difficulty finding a replacement. It's not news that this scenario is mirrored throughout the country.

He goes on to say that half of the health care dollars is spent by 5 percent of the population.

Generalists are needed to coordinate care, which will help rein in costs from this demographic subset. Not just a few, but "hundreds of thousands of generalists able to understand the big picture."

Here's what needs to be done:

If you want internal medicine to be a center point of patient access, you will have to make it fun again. Nobody who spends their entire high school, college and medical school career working their ass off will become the lowest paid, under appreciated, but most cost effective physicians. The docs we need the most of are rewarded the least. The docs who have the single greatest ability to pull back the unrelenting reigns of health care spending are leaving in droves.

Spending money to prop up the generalist foundation is the only solution I can see. Hopefully those in charge will come to that realization soon.