The Clinton administration, which has made health-care reform one of its highest priorities, believes that the U.S. is facing a crisis in primary care. The government says that the country is in dire need of primary care doctors, citing other countries which have a 50-50 ratio between generalists and specialists.

Though possessing the resources to encourage more students to go into primary care, Harvard Medical School is not taking as active a role in pushing students towards primary care as the government would like.

Currently, 30 percent of American physicians practice primary care. Only about 15 percent of Harvard medical students are entering the field, according to Dean for Medical Education Dr. Daniel D. Federman.

"The government has made a conscious decision that there should be more primary care doctors," he says. "But this is not the trend among medical students."

Despite Clinton's call to arms, Harvard has not created a policy mandating the even ratio.

"We have not adopted a school policy that 50 percent of our students will go into primary care," says Federman. "We are strengthening our primary care offerings and giving them a glimpse of general practice, but we will not push our students toward that field."

Eleanor A. Drey, a second-year medical student and head of the pri- mary care group run through the MedicalSchool's student council, agrees with Harvard'spolicy.

"I could see some way of mandating increases,but to set actual numbers would penalize schoolswhere primary care has traditionally not been thefocus," she says.

Drey believes, however, that Harvard should domore. "I think more students would considerprimary care if they could," she says. "If theMedical School, like the Law School, was willingto subsidize students to pay off debt, thenstudents would not be driven by fear."

The fear Drey speaks of is real. Traditionally,primary care physicians--or generalpractitioners--have been paid significantly lessthen doctors who specialize.

The American Medical Association (AMA) does notsupport Clinton's 50 percent policy. Dr. Harry S.Jonas, assistant vice president for medicaleducation at the AMA, says "I don't think the pushfor an equal ratio makes any sense."

Jonas says the Clinton administration has usedmisinformation about the number of primary carephyscians in other countries in determining itspolicy of an even ratio between generalists andspecialists.

"We should talk about physician to populationratios," Jonas says. "We already have moregeneralists per population than England."

"The AMA believes that we should do everythingpossible to encourage people to choose primarycare careers, because the trend has been going somuch the other way," he says. "For the governmentto try to legislate numbers goes against our grainbecause we believer that students have the freedomof choice."

Jonas cites examples from recent historyto show how the government has miscalculated thenumber of physicians needed nationally.

"In 1965, the government decided that there wasa shortage of 500,000 physicians. Now the samepeople that were saying we had a shortage say thatwe have 100,000 too many," he says. "If we were tohave total managed care, some of the HMOs say thatwe wouldn't need any more primary care doctors."