So while medical schools and the governmentshould work together to change the distribution ofdoctors, "they should use positive incentivesinstead of regulations," says Jonas.

He adds that "planning for a work force is verydifficult because there are changes in thepopulation. If there are new advances in medicineor if tomorrow we had a brand new epidemic likeAIDS, the medical scene would change completely."

Larry Ronan '78, a graduate of the MedicalSchool and director of the combined residencyprogram in medicine-pediatrics at MassachusettsGeneral Hospital, would like to see the MedicalSchool work toward the national goal.

"It's part of the national reform to entailmany more generalists," he says, "I want studentsto get a superb experience in family practice atthe clinical and academic levels."

One possible way the Medical School couldimplement the Clinton directive would be to admitmore students who display an interest in primarycare.

But the admissions office does not do this andhas no plans to change its policy in the future.

"Our policy is not to pick students on what wethink they are going to do," says Dr. GeraldFoster, associate dean of admissions and associateclinical professor of medicine. "We pick the beststudents we can that will be leaders in theirrespective fields."

Unlike Harvard, Boston University MedicalSchool has instituted a 50 percent goal forgeneralists. Dr. John F. McCahan, dean foracademic affairs, notes that at most 25 percent ofmedical students at Boston University will enterprimary care fields.

"We have an aim to make a half-and-half balancebetween primary care doctors and specialties,"McCahan says. "We will train students in primarycare centers. We will work on the admissions endand bring in students that will opt to go intoprimary care.

Despite not instituting a formal goal ofan even ratio between primary care givers andspecialists, Harvard Medical School doesaccommodate those who want to be generalists.

Perhaps the foremost initiative is the NewPathway program, created in 1986, which placesstudents in non-clinical settings to learn moreabout the patient-doctor relationship.

Federman, Walter professor of medicine andmedical education, says, "[The New Pathway] doesnot resemble a family practice course in any way,but it still instills the values and respect thata patient deserves." The program includes acase-based tutorial that encourages students totake a holistic look at diagnoses.

Students endorse the New Pathway. Richard S.Hamilton, a second-year medical student, says thatthe program "gave him an understanding of thehuman aspect of medicine."

Hamilton expressed interest in primary care andsays the psychosocial issues addressed in the NewPathway are more relevant to a primary carphysician who serves as the care-giver throughouta patient's lifetime.

Jonas also supports the New Pathway. He notesthat "Harvard is based around many high teachresearch hospitals. The Medical School needs tofind the right balance between specialized andgeneralized training."