There are surprising misconceptions about what family physicians actually do in practice.
Americans maintain a fond respect for the classic image of the family physician, making house calls with black handbag in tow. They admire the Marcus Welbys of the world. While this classic image is endearing, it should not be confused with the 21st century family doctor. The modern family physician is trained to engage in the adaptable world of health care and systems innovation. The face of family medicine is certainly changing as it responds to the needs of both patient and community. However, the tradition of compassion and personal relationship remains intact. So, while some may suggest that family physicians are a dying breed, we contend that family physicians are a flexible and essential component of the next generation of medicine.
To be upfront, we are all faced with a seriously challenged health care system – one that is outrageously expensive, poorly coordinated, and generally not accountable for outcomes. The problems are manifest in lack of transparency, inefficiency of communication and continuity, and absence of personalized care.
So, what then, does our health care system need more than anything else? Our answer is the ingredient that brings sanity, cost effectiveness, quality of care, and patient centeredness: the family physician.
An important agent of necessary practice evolution is the family medicine training program. These programs are purposefully and actively working to provide better tools for the new generation. For the Marcus Welbys 2.0. The new “tools” in the next generation black handbag for family doctors include population health management, flexible usage of technology, advocacy, teamwork and communication. Family medicine residency programs from around the country have already begun to develop teaching opportunities to address areas such as (1) population data management and community engagement; (2) adaptable integration of technology; (3) awareness and involvement in active patient advocacy; and (4) clinical team dynamics. This will allow future generations of family doctors to address patient, community, and system needs in a new and unique manner that can provide a better chance for success in our rapidly changing health care environment.
We are the Marcus Welbys of the new generation, uniquely trained and with versatile experience. Family medicine residents spend nearly 10,000 hours with patients before our first day of practice beyond residency. This training allows us, collectively, to fill essential niches in health care, such as sports medicine, geriatrics, women’s health, obstetrics, complementary and alternative medicine, occupational medicine, and global health. It is this versatility that comes from being the only field that is not limited by patient age, sex, or organ system. While our scope of practice and expertise may certainly change in the near future, none can argue that the paradigm of family medicine is unique and essential to patients and the communities in which they live.
One of the most important services we provide is the ability to assess a patient with a high level of integrative analysis – those 10,000 hours after medical school give us the experience and intuition to work through complex cases. Meanwhile, our focus remains on the whole patient, with the complete nature of all of their illness and wellness, as well as associated family, social, and community circumstances. This ability compensates, in many cases, for the siloed and uncoordinated management patients often receive in our current system, a system in which one in four Medicare beneficiaries sees 13 physicians each year, and fills 50 prescriptions in that time. A family doctor can juggle multiple chronic diseases in a single visit, can refer based on procedural need and therapy recommendation with the workup already in progress, can handle multiple intersecting decisions, and can recognize those rare case zebras. Family physicians are trained to handle complexity well, and to integrate assessment and planning.
Our diverse and comprehensive training means that we can practice in environments with a limited physician supply, and provide services that otherwise patients might need to travel hundreds of miles to receive. Because family physicians can serve many of the functions provided by multiple specialists, we are particularly well suited for underserved settings. Additionally, we are the only medical specialists that are distributed geographically in the same proportion as the general population. We are there for just about anybody and everybody.
We are also particularly dedicated to seeing the patient in the context of his or her family and community. Our broad knowledge base and big picture approach to care also means that a single family physician in an under-served setting can apply skills to most of the needs of that community and its members. What results are opportunities, even on a world stage, such as a family physician traveling to a remote province of Haiti to construct a health delivery system from scratch. And it is one reason why family physicians make good Surgeons General to serve the needs of the national community, at home in the U.S.
Looking to the future, today’s family physician trainees enter a world of teamwork and collaboration in health care delivery and continue to engage in systems development and quality improvement. Family medicine residencies continue to find ways to balance service with education and to streamline the training of successful and productive family physicians in modern health care. The kind of family doctor that is best for patients, community, and the profession.
So, what does an outrageously expensive, poorly coordinated, and largely unaccountable health care system need more than anything else? Family physicians who can provide versatile care in multiple areas of need, who often make the difference between quality care and no care, who can add higher level multifactorial assessment to undifferentiated and complex cases, who are cost-effective, and who are dedicated to service to their communities, often underserved. We of course cannot exist in a vacuum without colleagues in our collective national health care team, but training and experience allow us to do all of these things well in a system that needs more of exactly this kind of integrated and wide-ranging care.
One more thing. If you have the opportunity, please tell a family physician you appreciate this effort!
Aaron George is a family practice resident who blogs at Future of Family Medicine. Dennis Gingrich is a family physician.