The Generalists' General

At 8:30 sharp each morning in a white clapboard house in Milan, Mich., a slim, bald man bounces out of bed, pads into the bathroom, takes up an electric razor in each hand and mows off the night's growth of beard. To Generalist John Sherrod DeTar (rhymes with guitar), 54, new president of the A.A.G.P., this ambidextrous start of the day is just commonsense efficiency. "I have a lot of things to do and I want to save time to do them."

John DeTar's two-fisted approach has helped make him the family doctor's leading booster and a national figure in U.S. medicine. When he arrived in Milan (pop. 3,900) just out of internship at Detroit's Henry Ford Hospital, he planned to return soon to the city and specialize in the growing field of pediatrics. But DeTar and his family (two sons, two daughters) found Milan pleasant and friendly, decided to stay on.

Homework Upstairs. Today, after 25 years in Milan, Family Doctor DeTar runs a one-man show at a pace that would weaken many a younger physician. After wolfing his breakfast, he slips by nine into his elaborate ground-floor office (laboratory, three examination rooms, four secretaries) to welcome the first of the day's 35-odd office patients. After four or five house calls in his 1950 Oldsmobile sedan, DeTar often skips lunch (to his wife's despair), sees more office callers until 7:30. After a quiet, 45-minute dinner with his wife, he climbs the stairs to his small study to catch up on his homework for the A.A.G.P. and A.M.A., gets to bed at midnight. Every Thursday afternoon he drives 18 miles to the University of Michigan Medical Center for postgraduate training, last year got credit for 100 hours' work, mostly in internal medicine.

Like any G.P., DeTar has his share of emergency calls. But night calls have dropped off ever since he was felled by virus pneumonia ten years ago. Although he performs minor surgery, e.g., cyst removals, suturing cuts, in his office and performs tonsilectomies in a nearby hospital, he refuses to perform bigger operations. "A doctor should not do major surgery if he's not trained in it. I'm not," he explains. After home-delivering some 300 babies, DeTar gave up obstetrics in 1952 to devote more time to A.A.G.P. duties, but he still handles pre-and postdelivery care for 100 babies a year. DeTar charges $3 for an office call, $5 for a house call, $6-$10 for a night call.

Dr. DeTar calls in nearby hospital specialists for 10 to 15% of his cases, but he relies most of all on the G.P.'s traditional helper, a detailed medical history of each patient. Says he: "I know if the person ever had a reaction to penicillin. I know when John Jones had a kidney stone. It's a tremendous advantage over the doctor who sees his patient for the first time in a hospital bed."

Captain of the Team. John DeTar readily admits that he has some special advantages: no cutthroat competition (all three Milan G.P.s have more than enough cases), nearby medical centers open for study and assistance, a prosperous, dependable clientele (an average of only 2 1/2% cannot pay their bills).

Other general practitioners are often less fortunate. Ninety percent of a young G.P.'s new patients in Philadelphia's white-collar Roxborough district are "floaters" with imagined ailments, who drift from one doctor to the next, demand "miracle" drugs and time-consuming examinations. Moreover, a city generalist competes with company and union-sponsored health centers as well as other G.P.s, and must augment his income from private practice by working for the city and a downtown insurance company.

Rural doctors are in many ways better off. Dr. David Hoehn and his wife are the only physicians in Holdingford, Minn, (pop. 500), thus "do everything" from obstetrics to gall bladder operations and would welcome more G.P.s. Dr. Charles Savarese is up against harsh hospital restrictions in Washington, D.C., but at Bethesda's Suburban Hospital he can, deliver babies and perform minor surgery. For all the restrictions, says Savarese, "we generalists do pretty well in Washington. This is a specialists' town, and competition among them is terrific."

Different as their problems are, most G.P.s would agree with Booster DeTar's, analysis of their task: "The family doctor is the captain of the medical team. He should make the diagnosis and care for the patient to the limit of his ability. He should bring in a specialist when needed. Then, with the help of the specialist, he should manage the overall care."

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