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Thursday, February 22, 2007

Family Practice may be joining Internal Medicine in identity crisis

This recent commentary in a family practice journal speaks of a major attitudinal change in family practice . Recently trained Family doctors seem to abandoning their "roots".According to the author the rigors, and risks of doing ob is something that only a shrinking number of FP docs choose to do. Other recently minted FP docs seem to be opting to doing fellowships in such areas as geriatrics, sports medicine, OB, and hospital and critical care seemingly abandoning their traditions of generalism just as some one us believe that internists may be abandoning their tradition of the care of complex and critically ill patients for the regular hours of an office practice,doing mainly primary care and punting to the hospitalists (who ironically now may as likely as not be a family practice doc) when someone gets sick.

The forces of increased medical school debt and decreasing payments for physicians-particularly those in primary care- seem to be at work in fostering the turmoil in both FP physicians and IM physicians. As IM and FP docs seem to be spending much of their time doing the same things the other does-at least in an office setting-there seem to be the same trend for both FP and IM docs as they end their residency to further specialize gaining higher pay,shorter hours and probably more prestige.

The author, Dr. James Glazer, argues for the value of maintaining the core values of the FP generalism which he believes is the heritage of the Family Practitioner. We are seeing internists morphing into primary care docs and the classical primary care doc-the family practice physician-morphing into a "generalist specialist".

As best I can tell, neurosurgeons at least, still know who they are .

1 comment:

Richard A Schoor MD FACS said...

Nice post. 1 comment. Even in the specialties, like neurosurgery, market forces encourage docs to strike a balance between specialization and generalization. For example, should a hand trained orthopod do general ortho as well? Should a cardiologist do primary care? Should a urologist do hernias, if qualified? I'm a male fertility microsurgery specialist, yet market forces demand that I do some some general urology. Just food for thought.