Abstract
The specialization of medical discipline has been established and qualification of specialty is almost necessary to practice in the U.S. The physicians who mainly practice in primary care field are general internists, pediatricians and family practitioners. Family Practice was approved as the 20th specialty of medicine by the Accreditation Council for Graduate Medical Education in 1969. American Academy of Family Practitioners is the second largest academic society next to American College of Physicians and had 50,969 members as of January 1992. The curriculum for residency training in family practice is for 3 year duration and contains behavior science as well as internal medicine, pediatrics, and emergency medicine as a chief component of the curriculum. The curriculum for residency training in family practice in the U.S. almost covers that of Japanese psychosomatic medicine. The term "primary care" is not uniformly recognized by physicians in Japan. The survey to interns of 8 major teaching hospitals in Japan showed that about 40 percent of the trainees regarded "primary care" as emergency care and/or resuscitation. In the U.S., pre-graduate medical school education includes behavior science, and psychosomatic medicine is thought to be a major component of primary care, but not an independent specialty. For the purpose of improving the status of Japanese psychosomatic medicine, the following suggestions would be made through a review of development and educational system of primary care in the U.S. : 1) education of psychosomatic medicine and behavior science would be offered to medical students, 2) requirements for training of psychosomatic medicine specialists should contain basic medical specialist training in order to obtain broad based medical knowledge and skills, 3) outpatient oriented postgraduate medical education should be emphasized to meet the needs of primary care.
