Family physicians are sub-specializing to fight declining reimbursements:

Many family physicians embark on careers in sports medicine, academic medicine or geriatrics in which they take no overnight call and have no responsibility for caring for hospitalized patients. As “subspecialists,” they typically command higher rates of reimbursement for clinical work – particularly those with certificates of added qualification. In a time when family physicians feel increasing pressure to work longer hours in order to offset flat or declining reimbursements, these financial and lifestyle benefits of fellowship training provide a compelling incentive for today’s graduates to abandon traditional generalist medicine.