General medicine is being challenged by increasing numbers of patients who are presenting with multiple comorbidities and a decline in numbers of suitably trained personnel to manage these patients. A resurgence in generalist care, with collaboration between generalists and specialists, is the key to successfully managing patients who present with acute medical conditions. Better funded collaborative training programs for general physicians, which promote a diversity of skills and address clinical demand in a proscriptive manner, are needed. Research aimed at designing acute services to match local clinical demand is also required.