AAFP: What does it mean to be a family physician?

Paul Simmons’s recent post highlights the challenges family physicians face, both in practicing the full scope of family medicine and how we communicate about our profession. I couldn’t agree more that we must raise awareness about what it means to be a family physician and fight to ensure we can practice to the fullest extent of our credentials. Family physicians care for both genders and all ages. Our comprehensive approach to care is necessary in our health care system. Now more than ever, we must walk our talk and do all that we have been trained to do! When we do so, we are the answer to the transformation of our health care system.

However, one of the strengths of our specialty is the ability to tailor our practices to meet our personal and professional needs. We also need to be open to our colleagues who choose to limit what they do. Even in limited practices, however, the many hours of education and training provide clinical understanding, insight and judgment that no other member of the health care team can claim. This makes our role unique and valuable, even if we choose not to do it all.

For this reason, I respectfully disagree with the notion that the American Academy of Family Physicians should not also protect our specialty by ensuring patients receive the best care possible by being part of a team-based setting led by a physician. Nurse practitioners are a critically important part of any medical team. However, we cannot forget that the two professions are different.

Family physicians receive extensive, diverse medical education and clinical experience. After graduating from college, every physician completes 21,000 hours of a standardized educational and training process, including passing exams that are overseen by one certification body. The rigors of medical school, residency and licensing requirements serve a purpose: ensuring that physicians have the experience and training necessary to diagnose and treat patients at all stages of life. Total hours of coursework and training for a nurse practitioner, by contrast, range from 3,500 to 6,600. License requirements vary from state to state, and accreditation can come from one of three groups, each with different criteria.

The primary care physician shortage is real and must be addressed. However, our country also faces an even greater nursing shortage. Most important, independent practice for nurse practitioners has not solved poor access to care, inadequate patient outcomes and high costs of care, which still exist in the states that allow independent practice for NPs.

The conversation I would love to have is about the model that best delivers efficient and high-quality medical care in the patient-centered medical home and other team-based approaches led by a physician. The more we communicate about the important role of the family physician in the health care system, the more we will make our case for a team-based care setting that is led by a physician, and spend our energies implementing this solution.

We can continue to have a dialogue. Thanks for starting the conversation.

Reid Blackwelder is president-elect, American Academy of Family Physicians.

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  • Adolfo E. Teran

    Dear Doctor Blackweider, I appreciated your post above. I am a family Doc in Central florida. I heard all the time the AAFP talk about patient center and team approach of care. I am not sure I am getting the AFFP and the Feds but the more bodies you have working in your office the higher the overhead. I contacted the AAFP about the patient center idea, when I tell them that I am a solo practitioner, they said that I am going in the right direction, bla, bla. I think the AAFP and the Feds forgot about the small solo guy. In my clinic the patient is the center of my works and efforts. I do not have to talk or have a meeting to make changes that benefit my patients. I do not have any “Suits” walking around trying to stab me in the back. I do not think having an office the size of baseball team would benefit anyone. It will send me in the red numbers.

    • buzzkillerjsmith

      Dr. B wants you in the pen with the rest of us sheep. Time to upgrade your typing skills.

    • Shawn Martin

      Dr. Teran-
      You can contact me directly and I will be happy to share with you the work AAFP is doing on behalf of and in support of solo practice physicians.

      • drgn

        how does the AAFP have time to find this post? You’re almost as quick as the AMA was in finding my post. Obviously money well spent.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Why not share with everybody right here? As you can see there are many that would love to learn more…

        • LeoHolmMD

          Dues first… then you will get the secrets.

          • Mengles

            More like dues first and then get stabbed in the back.

      • Adolfo E. Teran

        where is the Dr Blackweider?, he is the author or the post. I took time to read and answer his post.
        I am a family doc and take time to call my patients , I do not ask anyone else to call them.

        • Disqus_37216b4O

          These are the same people who babble on about “patient-centered” this and “patient-centered” that, while meaning nothing of the sort. I’m not surprised that a “team member”, rather than the person you actually wanted to converse with, has stepped in.

      • Mengles

        I think we’ve seen enough of how much the AAFP has “helped” solo-practice physicians. Things would be better if you guys STOPPED helping.

  • southerndoc1

    “one of the strengths of our specialty is the ability to tailor our practices to meet our personal and professional needs”
    If so, why is the AAFP:
    telling their members that the only acceptable practice style is the rigid, highly bureaucratic, highly expensive PCMH?
    working aggressively to kill off solo and small practices?
    aiming to reduce family physicians to the level of sub-standard case managers/social workers/data entry clerks?
    The hypocrisy is sickening.

    • Adolfo E. Teran

      I think you removed the sugar coating from my post below.

    • drgn

      I am well aware of the AMA and the RUC that is destructive to PCP’s. But I have to say I am confused as to why the AAFP and other primary care organizations are working against themselves. Or at least it would seem? What do they have to gain politically in destroying their own specialty?

  • openyourmind

    I’ll choose who I want for my healthcare. I sure as hell don’t want someone who has to tell me how good they are. If I want a PA or an NP or an herbalist, I’ll choose. You aren’t making the decision for me. Why do you feel you have to defend yourself against a lowly nurse? What an inferiority complex. Get out of my way and out of my healthcare business. Go take care of someone.

    • southerndoc1

      “What an inferiority complex”
      Exactly.

      • PoliticallyIncorrectMD

        I don’t think the guy and his supporters get your irony.

    • Mengles

      Sorry, with Obamacare you don’t get to choose who you want. The Primary Care Medical Home is an Obamacare construct. You DON’T get to “If you like your doctor you can keep your doctor”. Elections have consequences and it is patients that will suffer.

      • LIS92

        I believe the TransforMed project began in 2006. It’s hard to have a conversation when all you want to do is inject your partisan bias.

        • LeoHolmMD

          Medicare is causing me more headache than Obamacare…for now. But you are correct, this has little to do with party politics. The problems with Primary Care have been stewing for a long time.

    • ErnieG

      You probably won’t have much choice– I’m sure most docs would fire you as a patient.

    • Guest

      Troll

    • PoliticallyIncorrectMD

      How is doctor bashing working for you so far?

      • openyourmind

        If my sole intent were to doctor bash – I suppose it is working well. But as to my deeper objective: after two days, you are still obsessed with responding to my posts who no one is responding to. So babble on and say what you will. I made it through. I’m officially in your head. Thanks.

        • PoliticallyIncorrectMD

          Oh, no…thank you! I actually enjoy exposing ignoramuses like you, who troll forum sites commenting on things they don’t understand deliberately trying to piss people off just to attract attention to their miserable self.

        • buzzkillerjsmith

          Ah, so open your mind refers to you opening our minds, getting inside ,and then messin’ with stuff. Very slippery of you. I like it.

      • LIS92

        I thought the original post reiterated most of the other posts on the PCMH. I don’t want a team either…Does that mean I am doctor bashing? I thought the post was more medical team bashing. Does this mean you agree with the AAFP?

        • PoliticallyIncorrectMD

          I did not say YOU were doctor bashing. And I do not agree with AAFP.

          The person I was referring to is using this forum to lash out at physicians any time they can, commonly without even understanding the topic of discussion. Look up their other comments and hopefully you’ll see the pattern.

          • LIS92

            I have seen comments…sometimes I feel exactly the same. It seems to me lots of these posts are system bashing…not doctor bashing…like the one above.

            There are lots of doctors who vent and engage in patient bashing…why aren’t you hassling them.

  • buzzkillerjsmith

    This guy, our fearless leader, is giving us the usual pablum, exactly what we could have predicted he would write. Perhaps his career path will bring him to pinnacle of medical propaganda, the AMA. Good work if you can get it.

    Family medicine is in a downward spiral and probably will not pull out of it, at least not soon. Sure, there will a some hard-cores and dinosaurs, and it might even turn out that the numbers will stabilize at some level. But the idea that we’ll have enough family and general internal medicine docs to give people “access, quality, and affordability” doesn’t make a whole lot of sense to interested and analytical observers. And NPs and PAs know what time it is. and they’re heading for the exits. More than half of PAs now go into subspecialties as do close to half of NPs.

    If you are a medical student, you would be a damn fool to enter my specialty. Southerndoc details several of the reasons below. I’ll let the NPs and PAs speak for themselves.

    • Mengles

      The only ones who will “choose” Family Medicine, are those who have low board scores and couldn’t match into other specialties and now with a mountain of debt, have nowhere else to go. All bc the AAFP sold out to Obamacare.

      • southerndoc1

        Actually, the whoring-out started 25 years ago, and really hit the big time around 96-98. The details of the PCMH were finalized in cooperation with CMS during the early years of the Bush administration.
        We need to be factual as we express our contempt for the AAFP.

        • Mike S.

          Yes, I am certainly no great fan of Obama, but even so, there is no way I could see clear to pin this one on him. The AAFP was “acting stupidly”, to coin a phrase, long before Obama appeared on the national stage.

        • Mengles

          While details of it may have been finalized during the Bush Administration. I don’t think he would advocate the monstrosity that is Obamacare. Obamacare made the PCMH a reality.

          • LIS92

            The AAFP started implementing the TransforMed project in 2006…long before Obama took office.

          • southerndoc1

            “Obamacare made the PCMH a reality”
            Absolutely not true. The PCMH train had left the station long before Obama took office.

      • crnp2001

        Really? Are you kidding me? “Low board scores?” Do you work in Family Medicine and have any idea what kind of patients walk in every day? That person with dizziness may have an inner ear infection…or Menieres. The person with fatigue may have iron-deficiency anemia (from a whole host of causes, needing work-up), or cancer — multiple types….or thyroid problems…or electrolyte imbalances…maybe due to diuretics…or a pituitary tumor. Or maybe he/she is depressed because of situational issues…

        Or, perhaps, your patient with abdominal discomfort and a cough…who saw three other DOCTORS…and was treated (ineffectively) for bronchitis, actually was diagnosed (correctly, by yours-truly, the nurse practitioner), with elevated liver enzymes and ultimately, a stage 4 lung CA with liver, brain, and bone metastasis. Yeah, his “cough” was NOT bronchitis. And no one addressed his RUQ pain.

        So don’t spout that those who choose Family medicine can’t “cut it.” We are just as astute (or better) than any specialist, because we see all, do all, and can differentiate between a lot of “stuff” to get to the real diagnosis…not just “specialize.”

        Why am I so irritated? Said patient has gone through several rounds of chemo, radiation, more chemo, and now has more advanced mets to the liver/spine, etc. He will likely die in 3 months. Had his first docs LISTENED to him, maybe he’d have a longer course.

        • buzzkillerjsmith

          Actually, fam med board scores are among the lowest. A Google search will verify this.

          • Mengles

            Low USMLE scores from American graduates or IMGs.

          • IndigoBoy0

            Mengles you need to stop with these backhanded comments. I am choosing FM because I am in the National Health Service Corps who paid for all of my school thank you. I have pretty decent board scores and could probably do whatever specialty I wanted.

          • Mengles

            So you “chose” FM bc the NHSC forces people who do it, to do primary care.

          • IndigoBoy0

            No. I applied to the extremely highly competitive NHSC because I WANTED to do primary care and avoid 300+ debt. No its not a myth. My institution costs $78k a year. And if you knew anything about NHSC you would know that you are able to go into IM (higher board scores), FM, Med/Peds (highest board scores, 85% USG), Psych or Ob/Gyn. So yes, this is a choice. Why are you so bitter? Are you an FM that hates your job? Who do you want taking care of you. I had a career in public health before med school and I can tell you our country is falling apart and with no one to go into primary care there will be no one to take care of YOU when you get sick unless you want to go to a specialist,

        • Mengles

          Once again I’m referring to MEDICAL STUDENTS. Please learn to read properly. Sorry but board scores from specialists are MUCH higher. They CHOOSE to do specialties for a reason.

          • crnp2001

            I read just fine, thanks. Get over yourself. You do a disservice to many well-qualified family practice PHYSICIANS who were medical students as well.

            Here’s a suggestion…why don’t you plan to spend a week with me in practice…to see exactly what I do.

            “Actual patients will get hurt?” Really? Your superiority complex will get you nowhere…and patients will suffer. I’m finished with this so-called discussion, since you obviously have nothing of so-called “worth” to offer. Read the research, “friend,” which shows our worth.

            Better yet, why don’t you have a chat with my patients that I spoke with tonight…the husband who has Stage 4 metastatic lung CA to his liver, brain, spine, ribs, etc. Round 2 of chemo failed. Brain radiation worked for his brain mets…but now admitted with failure to thrive…slurred speech, inability to walk, etc. His ONCOLOGIST (physician) office told his wife that it wasn’t a “cancer problem” when she called them with the symptoms — “call your PCP.” HA! I admitted him.

            Now, upon admission…new liver and bone mets. Worsening spinal mets. He doesn’t trust his oncologist, who hasn’t come through on multiple occasions. After eight months, he was recommended for hospice care. His wife called my PERSONAL cell number tonight. Why? I gave it to them months ago.

            “We ONLY trust you…no one else.” Multiple other providers have let them down. They wanted MY advice about starting hospice, which was recommended while he was an inpatient.

            You better believe that I know what the heck I’m doing. So do THOUSANDS of other NP and PA providers.

            GET. OVER. IT. We are here to stay. And we know WHAT we know. And do a damn good job at it.

            Sorry for the rant. I hate cancer. I hate being perceived as second-best. ‘Cause I do a damn good job at what I do. And my patients know it. They recognize it. AND appreciate it.

            I work COLLABORATIVELY with a team, including physicians. Don’t sell me (or my patients’ thoughts/opinions) short.

            Rant over.

        • Margaret Houlehan

          Your post reminds me of just one of many instances in my 26+ year career as a PA. I was working in Indian Health in Oklahoma. A woman came in with onset of headache at 50+ years old. She saw her PCP and two ED MDs. All three told her she had migraine (mind you, she was over 50 with no hx) and sent her home with Demerol. She actually had double angle-closure glaucoma and thankfully did not lose here vision. Folks, it is not about the initials after one’s name. It is about listening to the patient, and from my experience as a patient, a lot od docs have forgotten this important lesson from their first year of med school.

      • LIS92

        I guess your low board scores explain why you have such a hard time understanding the the PCMH isn’t an Obamacare thing.

    • crnp2001

      I’ll speak for myself and my NP/PA colleagues. I don’t think we are “fools” to enter family practice/internal medicine. We do what we do quite well, thanks. Many, many studies prove this, and I won’t even go there to belabor the point. Check out http://www.aanp.org if you want to see the studies. We do 90% of what family practice docs do effectively and efficiently…equally or BETTER than our physician colleagues in outcomes.

      There is no research that states that it takes 21,000 hours of education/training to do what family practice physicians do. In fact, multiple medical schools are streamlining their educational didactic to three years.

      I daresay…give me a well-trained seasoned NP/PA who is working 3 years (mind you, we have MANY years of training PRIOR to our graduate degree)…and compare us to the residents coming out of their training…I bet you would find our practice is similar.

      My collaborating doc is fond of saying I’m “better” than a physician. I disagree. I think I work collaboratively. He has his strengths…I have mine. We work as a team. But I don’t see a bunch of docs jumping to family medicine/internal medicine…and we NP/PAs are doing just fine. Yes, we, too, specialize. We go where the jobs are. But the rank-and-file folks that protest that “we don’t know what we don’t know” protest in the name of their own preservation, IMHO.

      NOT based on research. NOT based on patient satisfaction. NOT based on outcomes. Simply…based on fear of losing their “piece of the pie” to us.

      Let’s call a spade a spade. I do a darn good job managing my patients…and yes, cleaning up messes by others, including physicians. We all have ENOUGH patients to go around. Time to start WORKING TOGETHER and NOT AGAINST each other.

      Rant over. (smile)

      • buzzkillerjsmith

        Thanks for input. Primary care is a bonehead move for med students financially and in terms of lifestyle. That calculus might be different for PAs and NPs. If so, great! Keep up the good work.

      • Mengles

        He was referring to MEDICAL STUDENTS who pay a ridiculous amount of tuition, not PAs or even worse, NPs who can take an online course to meet requirements.

        • crnp2001

          I did NOT take an online course. I took a course (part-time, as I had a full-time job and family commitments) in-person, over six years, thanks. This was 12 years ago, and yes, now there are online courses for the coursework in many programs. However, CLINICAL practice still needs to be done in a personal format. No exceptions. My graduate program was roughly $40,000, not including ANY books or ancillary costs. Sure…no comparison to med school. I get that. If I went back for the DNP (doctorate) courses, I would fork out anywhere from another $36,000 to $50,000 for an additional 2 – 4 years of study. No thanks. Not at this point in my career.

          • crnp2001

            Funny. One can see who responds positively…but the “negative” comments are blank. Chickens. ;)

        • LIS92

          Online courses are the future. Stanford School of Medicine offers a nice MOOC on antibiotics for physician’s continuing education. If a course is ridiculous for a NP, then it is ridiculous for a physician. But, of course, the point of your post is to let everyone know you are bitter and angry.

          I would suggest you open your solo cash only practice but my guess is you would alienate all the patients.

          • Mengles

            There’s a difference between MOOC and actual foundation of education. Try to learn the difference.

  • rtpinfla

    …”however, the many hours of education and training provide clinical understanding, insight and judgment that no other member of the health care team can claim. This makes our role unique and valuable, even if we choose not to do it all.”
    Yikes. That appears to be very faulty logic. If the breadth of training is what makes FP unique and valuable, then limiting your scope as an FP eliminates, or at the very least greatly diminishes, that value. Seems to me you can’t have your cake and eat it too.

  • LeoHolmMD

    Dr. Blackwelder, you are a good man. But the argument about training hours is one only FM docs understand…and we are not the ones we are trying to convince. Normal humans and administrators do not understand, and mostly don’t care. They need a warm body, of whatever qualification, to “cover” the clinic and make referrals. Whoever will listen to patients and get refills done on time: thats who counts. Reduce overhead through lower salaries: even better. Since groups like the AAFP have facilitated the demise of private practice through expanding regulatory demands and failing to correct the reimbursement issues (at the same time), there is little hope for a FM doc who does not want to work for CorpMed. Once CorpMed is involved, the whole issue turns supply side. In other words: no one cares about your board certification or how full your extent of credentials are. The PCMH raises bureaucracy, raises costs, empowers large hospital systems and still does not correct the reimbursement issue. Despite a “doctor shortage” my time is being wasted on Metrics, data entry, data mining, EMR troubleshooting and plenty of other stuff patients could care less about. The AAFP needs to take a hard look in the mirror…while they still have a “profession”.

  • drgn

    What is the political gain for the AAFP in being destructive to family practitioners? Inquiring minds want to know.

  • msfwally

    Being a family practitioner means one is coerced into forking over megabucks to participate in the worthless MOC program

  • nigeltown

    Wow. I’m so glad I don’t have to work alongside such burned-out, bitter know-it-alls. Come to New Mexico where people at the top of their medical school class choose Family Medicine, there’s enough work for everyone and we appreciate the different roles that people play to get things done. Live and let live. There’s so much work to be done, get over yourselves and stop whining. The patients are waiting.

    • southerndoc1

      Nah, not burned-out or bitter, but just very, very cynical.

      We’re the ones who haven’t sold out, who are still out there fighting the good fight against tremendous odds, and feel that it’s very important to the future of family medicine to point out the incompetence and maliciousness of the AAFP.

  • Dave Mittman, PA, DFAAPA

    The defensiveness in this essay is significant.

    As a PA for almost 40 years, I don’t know where to start the debate. Unfortunately, it usually winds up with “if you want to practice medicine, go to medicinal school” from some of my physician colleagues on the site.

    Let’s face facts. Many NPs and PAs are good. Spend time as a medic in Afghanistan/Iraq/Viet-Nam or where ever, or an RN for years or a paramedic.Have a BS degree already. Then finish all your pre-med subjects, go to a PA program for 27 full months, the last year an internship and then possibly (and that may change to being required) do a year or two post graduate residency. Then work alongside a family physician for years. Are you really unequipped to do much of what they do very competently? if so, why do 50% of Dr. Blackwelder’s colleagues have a PA or NP who many consider a partner? Because we are that incompetent>
    Why are family doctors the ONLY people who can learn primary care? It seems even defensive to think that of ones self.

    Hours
    If we want to look at hours, a cardiologist should be the only person treating hypertension, an ENT the only person treating otitis, as all others just have may less hours in training for those diseases. Or maybe there comes a point where you can treat things well with less hours? Yes, treat things well. Suture well, without being a surgeon. I know we PAs can do those things well. Our hours are enough, especially with residencies. So are family physician hours. Let’s look at competence as a barometer. Measure outcomes. Allow 100 PAs and 100 NPs in family practice with 5 years experience to take the FP Boards, not to become physicians but to see what we know and then let’s judge.
    Or have every PA or NP who wants to go into primary care have to practice with a family physician (if we could find them) for a period of three years. I think many of us would be open to that.
    The country will never have enough primary care clinicians. So you belittle us and say we can not do this or that, or do not have the hours to even provide a basic level of care to our population.
    Are we a team? Team members support each other. They pull FOR each other. They are open to educating each other. None of that is coming from the AAFP. All I get is “we are better than you and you are inadequate”. Wow.

    That my colleagues, will not support any positive change in the future.
    Dave

    • Mengles

      Complete the FP boards AND complete an FP residency.

      • Dave Mittman, PA, DFAAPA

        You really are clueless. Ok. If I get it. No peace. Your way or the highway it is. We will act accordingly. Physicians want to compromise. Are you even a physician?
        Dave

        • crnp2001

          If he/she is, it’s a thwarted view. And no hope for this person.

      • Suzi Q 38

        He doesn’t need to.
        He is practicing now without it.
        Reality.

        • Guest

          “I’m not a doctor, but I play one on TV!”

    • Suzi Q 38

      You make excellent points.

  • Nichole Satterwhite

    The problem, Dr. Blackweilder, is that you cannot fix what you do not acknowledge. You scream team at the people you want to be your teammate. You exclude them from the discussion from the very outset of the conversation. You denigrate them and then expect them to join your proposed team. Your methods are flawed. Your damage is done and you cannot recover a shred of trust among the very people you are now recognizing WILL be your teammates whether you begrudgingly like it or not. Physician Assistants and Nurse Practitioners are here to stay and the AMA and AAFP realize they must accept that reality.
    Now the race is on to see what political maneuvering those organizations will employ to continue to minimize and marginalize those respective professionals into submission. By that, I mean the barrage of media play about the statistics of PAs and NPs – only roughly half – that remain in primary care – TEN this week alone from mainstream media outlets. Where is that generated from? I believe from you, your organization and the AMA. The veiled attempt to minimize our prospects as being a viable part of the solution to the primary care shortange is obvious to me.
    You can’t have it both ways. Physicians can’t expect PAs and NPs seek jobs in primary care where our legally necessary physician counterparts don’t exist. I would be interested to know if the AAFP Graham Center sponsored researchers investigated the statistics of states where NPs are not legally dependent upon physicians and whether their propensity to remain in primary care was statistically different that other states that have BOM imposed physician oversight. Perhaps it is no different – I really don’t know. But I have my suspicions there are significant differences that the AAFP wouldn’t want to plaster all over mainstream media.
    The AAFP and AMA are amazingly transparent and predictable. Physicians and healthcare leaders that get my attention are those who drop the rhetoric and truly want to problem solve our critical healthcare issues with the existing resources we have as a nation. Guess what, 25,000 Primary Care Physicians aren’t going to miraculously show up to save the day while you argue over who should be a leader. Meanwhile patients are suffering. Problem solver, you are not.

  • southerndoc1

    Dr. Blackwelder has really argued himself into a corner here.

    He’s trying to make the case for something he calls a “team-based care setting led by a physician,” but I doubt if anyone here has ever heard a patient say that’s what they want. What he’s really talking about is the AAFP/PCMH/Transformed version of primary care in which “simple” patients are routed by the receptionist to random members of the team; the doctor is made as inaccessible as possible, allowing her to sit in her cubby-hole and concentrate on team huddles, pre-visit planning, and general data collection. This is the pure, unadulterated voice of CorpMed speaking.

    Why he considers this so superior to a continuous, one-on-one relationship between patient and provider, be they MD, NP, or PA, is incomprehensible.

    • Mengles

      If you look at how Dr. Blackwelder looks like with the long flowing beard – is there any more reason why no one would take family medicine seriously?

  • Stephen Sutherland

    Some thoughts from a 4th year med student.

    Family Medicine is training to provide comprehensive medical services. In locations where a Family Physician works >3 hours away from a sub-specialist, the broad skill-set is priceless and utilized. ie. deliver the baby, derm biopsies, gyn procedures & care, numerous in office diagnostic measures, minor surgical procedures etc.

    In dense populations where a specialist is very close by, there are various strong pressures to narrow the scope of a Family Physician’s Practice. In so doing the FP utilizes only a fraction of their 21000 hours of training and licensure requirement. This narrowed scope of practice emboldens the NP to say they can do whatever the Family Physician can do and do it better. ( Better meaning spending more time with the patient is easily accomplished when one does not have the financial time constraints of physicians malpractice , overhead etc ). I believe it is the narrowed scope of practice that engenders this kind of devaluing of the 21000 hours of training.

    The wisest move to restore the balance is for Family Physicians to continue serving patients to the full extent of their training and allow the NP/PA to operate the full extent of their training. Therefore we can all play together nicely. That’s my approach and that’s why I would be pleased to sign up for a Family Medicine Residency .

    • Suzi Q 38

      Spoken with confidence.

  • Suzi Q 38

    The PA’s and NP’s are here to stay because of a direct need to have them help us.
    If my PCP of 12+ years retires in the next 5 years, many of you say that there will be no PCP to replace him.

    Guess what? When I have a UTI or URI, or need my bp medication refilled, or a check up, I may go to a PA or an NP initially.

    I see them now at the dermatologist’s and gyn’s office.
    They are very competent, nice, and spend more time with me.

    When I am concerned, they assist me with getting an appointment with the doctor.
    They are professional and deliver a good and necessary service.

    I am understanding that with the “Chicken Little” doctors crying about the future shortage, the PA’s and NP’s will fill a void.
    I am appreciative of their education, dedication, and experience.

    I realize it is less than an MD, but what is the public to do, just do without medical care and ignore the fact that this group of providers and help us?

    I understand venting well, but you physicians are so wound up about this that many of you sound desperate and insecure.

  • southerndoc1

    “The conversation I would love to have is about the model that best delivers efficient and high-quality medical care in the patient-centered medical home and other team-based approaches led by a physician.
    We can continue to have a dialogue.”

    Sorry, Dr. Blackwelder, but dropping your turd in the punch bowl and then retreating into your hermetically-sealed bubble does not constitute a dialogue.

    In this thread, in your other postings on Kevin, and on the AAFP web site you conspicuously avoid addressing comments from practicing physicians. The AAFP has NEVER been interested in having an open discussion about the strengths and weaknesses of the PCMH model.

    Spare us your false pieties.

    • LeoHolmMD

      The AAFP just reigned in commentary again on their website. Apparently, their own dues paying members were leaving comments so hostile, it was making them look bad. So much for dialogue.

  • Ahmad AlSabban

    Thanks for the topic , but you tackled many different points and mixed them together ‘ e,g DNP and family medicine with sub-specialty , I lost the aim of your talk !

  • southerndoc1

    And the silence from Dr. Blackwelder continues.
    Really really lousy PR, AAFP.

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