Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The creative destruction of the American family physician

Mitchell Brooks, MD
Physician
February 11, 2013
236 Shares
Share
Tweet
Share

shutterstock_85837342

Medical knowledge, technology and rapid clinical advances in related scientific fields are expanding in an almost exponential manner. It is thus impossible for any individual or any medical specialty to absorb and implement these strides.  Consequentially we physicians and other caregivers not only tend to specialize in medicine today, we are essentially ordained to subspecialize as a result of this knowledge explosion.

The current medical care environment then, requires revisiting traditional delivery models and such a re-assessment must begin at the foundation: family practice. With increasing demand, access to quality care and the need to make every penny count, the first question we must ask is, “What is the role and necessity of the family doctor in the age of 21st medical challenges?”

Understand that I ask this question as a former family practitioner in Canada. Unlike the United States, where family practitioners have experienced the continuous erosion of their patient care activities, in Canada they deliver babies, treat non-displaced fractures, set some displaced fractures, deliver well-baby care, well-women’s care, provide on-going treatment for chronic disease and many other things that here in the United States are, for myriad reasons, referred to a specialist.

While physicians have earned and enjoyed elevated status, our societal needs have encouraged enhanced training and certification in other non-physician provider disciplines such that an equivalency of sorts has been developed. A well-trained nurse practitioner or certified physician assistant working under the supervision of board certified internist can and does provide this type of equivalency.

In the current practice environment both see the same patients and perform similar clinical services. Yet, the cost of labor for the nurse practitioner is less than the family doctor and the time and price to train the former is less, therefore permitting more to enter the system at lower expenditures in less time.

Additionally, the current and future fiscal constraints placed on medical practice as a result of the Affordable Care Act, or ACA, and the increasing cost of providing care, as well as the flood of people coming into the healthcare system, will require the training of many more providers and physicians. Where will we spend our money how will we distribute our resources?

Training a nurse practitioner for four years costs $49,000/year following a BSN. The cost to train a family practice physician, requiring a three-year residency after an undergraduate degree and medical school averaged $96,000 per year for three years in 1999. This is not to suggest that the knowledge base or requirements of each discipline are the same, but the practical reality is the tasks required of each are very similar.

Thus, if we can train more nurse practitioners in less time and cost to perform similar services and tasks as today’s family practitioner and we re-allocate family practice training funds to train more internists, whose knowledge base replaces and exceeds that of the family practitioner, what then is left for the American family practitioner to treat that a well-trained nurse practitioner or a physician assistant can’t, or at least refer to a supervising internist? As the New York Times recently suggested in a lead editorial, much of the time and for many things, a doctor is not required.

Churchill said, “To improve is to change; to be perfect is to change often; in other words, we must continuously change to improve.” These changes in medical knowledge, healthcare delivery and technology have brought about the creative destruction of American family practice and times and circumstances dictate it will go the way of performing an appendectomy on the kitchen table, house calls and the hometown doctor of a Norman Rockwell illustration.

Mitchell Brooks is an orthopedic surgeon and the host of Health of the Nation on Talk Radio 570 KLIF in Dallas, Texas.  He blogs at Health of the Nation.

Image credit: Shutterstock.com

Prev

OpenNotes in geriatics: 6 awkward concerns

February 11, 2013 Kevin 5
…
Next

Diagnosed with brain cancer: An insurer adds to the nightmare

February 11, 2013 Kevin 15
…

Tagged as: Primary Care, Public Health & Policy

Post navigation

< Previous Post
OpenNotes in geriatics: 6 awkward concerns
Next Post >
Diagnosed with brain cancer: An insurer adds to the nightmare

More by Mitchell Brooks, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Healthcare consolidation may bend the cost curve the wrong way

    Mitchell Brooks, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Tort reform and integrated systems in health reform

    Mitchell Brooks, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Large American pharmaceutical companies cannot have it both ways

    Mitchell Brooks, MD

More in Physician

  • The heart of a Desi doctor: Balancing emotions and resources in oncology

    Dr. Damane Zehra
  • The Iranian diaspora’s fight for liberty: Overcoming challenges in the largest women’s rights movement of our century

    Montreh Tavakkoli, MD
  • The harmful effects of shaming patients for self-education

    Maryanna Barrett, MD
  • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

    Wendy Schofer, MD
  • Skydiving and surgery: How one doctor translates high-stress training to saving lives

    Alexandra Kharazi, MD
  • Don’t be caught off guard: Read your malpractice policy today

    Aaron Morgenstein, MD & Laura Fortner, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming Parkinson’s: a journey of laughter and resilience

      Cynthia Poire Mathews, FNP | Conditions
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Maximize sleep efficiency with stimulus control

      Pedram Navab, DO | Conditions
    • The Iranian diaspora’s fight for liberty: Overcoming challenges in the largest women’s rights movement of our century

      Montreh Tavakkoli, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 132 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • How This Doctor Found Purpose After a Devastating Injury
  • House Lawmakers Squabble Over HHS Budget
  • Infant Formula Crisis Exposed FDA and Industry Failings, Lawmakers Say
  • Building Vaccine Trust Among the General Public
  • Is It Business as Usual for the Drug Industry?

Meeting Coverage

  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Less Abuse With Extended-Release Oxycodone, Poison Center Data Suggest
  • Novel Strategies Show Winning Potential in Ovarian Cancer
  • Children Do Well With Fewer Opiates After Surgery
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming Parkinson’s: a journey of laughter and resilience

      Cynthia Poire Mathews, FNP | Conditions
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Maximize sleep efficiency with stimulus control

      Pedram Navab, DO | Conditions
    • The Iranian diaspora’s fight for liberty: Overcoming challenges in the largest women’s rights movement of our century

      Montreh Tavakkoli, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The creative destruction of the American family physician
132 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...