Two of the principles underlying generalism,whether in the form of internal medicine, pediatrics,or family medicine, have been comprehensivenessand continuity.7,8 Ideally, the primary care physicianwould provide all aspects of care, ranging from pre-ventive care to the care of critically ill hospitalizedpatients. This approach, argued the purists, wouldresult in medical care that was more holistic, less frag-mented, and less expensive.9 To its proponents, thenotion was so attractive — the general internist ad-mits the patient to the hospital, directs the inpatientworkup, and arranges for a seamless transition backto the outpatient setting — that questioning it wouldhave seemed sacrilegious merely a few years ago