Primary Care/Family Practice
Public demand for a single, competent physician
for the entire family has grown as the
availability of such physicians continues to
diminish. To meet this need, the specialty of
family practice evolved. This specialty differs
from the others in that it is defined in
terms of functions performed rather than limited
by treatment of certain diseases or
parts of the body or on the basis of the
patient's chronological age.
The specialist in family practice must acquire a
basic core of knowledge in all areas
of medicine. Being the physician of first
contact, he or she is responsible for evaluating
the patient's total health needs over an
extended period of time. Family practice is thus a
specialty in breadth rather than a specialty in
depth.
The family practice specialty will become
especially important as the U.S. health care
system undergoes changes. A suitable balance
between specialists and generalists will be
one of the ultimate goals to ensure the success
of a new system. An overabundance of
specialists makes the health care system more
expensive, less accessible, and less focused
on prevention. The imbalance is a principal
cause of the high cost of health care.
Suggestions are being made for ways to shift
the trend away from specialization by
limiting funding for training in
subspecialalties and by creating incentives for entering
the
field of primary care. Among the attractive
features of a primary care practice is the oppor-
tunity to treat patients ranging in age from
children to the elderly. A primary care physician
also sees a great variety of cases, from
cardiology to rheumatology, and is responsible for
providing continual care, creating a special
bond between the patient and the physician.
Many physicians are becoming convinced of the
value of preventive primary care.
Health care reforms, emphasis on primary care,
and the demand by women for more
comprehensive health care have motivated
obstetricians/gynecologists to seek recogni-
tion as primary care providers. Some groups,
such as the American Academy of Family
Physicians, strongly oppose granting such
recognition, believing that it should be used
for specially trained practitioners. Women
frequently use ob/gyn specialists who some-
times also provide a general medical check-up.
The American College of Obstetricians
and Gynecologists has redefined its mission to
include health care of women throughout
their lifetime. They have even encouraged their
members to subscribe to a journal con-
taining generalist information.
Considerable efforts are being made to
encourage medical students to choose pri-
mary care as their specialty, but there is some
uncertainty about the most effective
means of achieving this goal. Some feel that
having generalists serve as student mentors
is the best approach but a medical school
survey found that faculty can do little to
influence student specialty choice. A different
study, however, demonstrated that,
where required family practice clerkships
exist, the number of students electing to
become primary care physicians has
significantly increased. This should be of interest
to those premedical students considering
primary care as their career choice.
Interest in family practice over the past few
years has risen significantly, with the
number of fourth year students matched with
this specialty at high levels, second only to
internal medicine. There has been a concerted
and successful effort by the American
Academy of Family Physicians to market this
specialty. They have targeted medical
schools to set up departments of family
practice, and most now have them. Students are
encouraged to take primary care clerkships
within family practice settings. Such expo-
sure, as noted above, can profoundly alter
one's career goals. When the number of
physicians entering family practice, internal
medicine, and pediatrics for residency
training--namely the primary care
specialties--combined, it makes up about half of all
physicians receiving postgraduate training. Of
these three groups, the overwhelming
majority of those entering family practice will
remain in primary care, while, of the
other two segments, a portion go into
subspecialty training.
While the federal government is interested in
reforming medical education as part of
altering the health care system, these efforts
are slowed down by political in-fighting. A
somewhat more meaningful effort in being made
by state legislatures. Their focus is to
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