The definition of a “doctor” is shifting in a way that feels increasingly fragmented. Growing up with a father who practiced for decades as a primary care physician before pursuing a residency in pediatrics, my baseline understanding of medicine was rooted in the “whole doctor” model. In that world, a physician addressed the majority of a patient’s needs and sought specialized intervention only when a situation truly demanded it. Today, however, our system leans into specialization almost immediately, offloading nearly all primary care responsibilities to family physicians and internists while the rest of the medical community retreats into increasingly narrow silos.
There is a personal weight to this observation. Throughout my career, moving from radiation oncology to psychiatry, I have felt a lingering disappointment that by narrowing my focus, I was surrendering a core part of my identity. I missed being the clinician who could address basic medical needs without an automatic referral. When a physician does one thing and one thing only, they risk losing the holistic perspective required to treat a human being rather than a pathology. This stratification creates an artificial hierarchy that devalues the generalist approach and places an unsustainable burden on our primary care colleagues.
To alleviate these pressure points, we should consider a structural shift where every physician, regardless of specialty, dedicates 10 to 20 percent of their practice to primary care. Beyond the clinical benefits, this would foster a renewed sense of camaraderie across the profession. If we all maintained a baseline as generalists, our conferences and meetings would move past narrow technicalities toward a shared language of physicianhood. This would bridge the gap between “highly paid specialist” and “lower-paid generalist,” a distinction that is often artificial and unwarranted.
Furthermore, this approach would dramatically improve community resilience. In times of crisis, a city full of specialists who have maintained their general medical skills is far better equipped to handle public health needs than a system where clinical skills have been siloed away. If a psychiatrist or a surgeon remains comfortable managing hypertension or basic metabolic screenings, the entire system gains flexibility and strength.
Achieving this requires more than just a shift in mindset; it demands changes in our medico-legal landscape and continuing education to support broad competence. However, the reward would be a medical community that is more integrated, less stratified, and more connected to the foundational essence of the profession. It is time to move away from being masters of a single organ system and return to being physicians first.
Farid Sabet-Sharghi is a psychiatrist.
