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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