Posted by: notdeaddinosaur | April 12, 2015

Drawing Lines

Who is a Family Physician?

Who is a PCP? (And does that second “P” stand for “physician” or “provider”?)

Who gets to say? Does it matter?

Perhaps we should start with some basic qualifications: the degree of MD or DO, the satisfactory completion of an accredited residency in Family Medicine, and successfully passing the written examination of the American Board of Family Medicine (ABFP, an organization distinct and independent of the AAFP). Hard to argue with those.

How about going by what we do: Primary Care medicine consists of caring for patients as their first contact with the health care system, regardless of age, gender, organ system, or disease process. Also pretty straightforward.

But what about hospitalists? Family physicians trained and board certified who choose to limit their practice to caring for patients in a hospital setting; are they still “real” family doctors? What about those who go into Occupational Health? Academic medicine? Exclusively caring for patients in nursing homes? Do you have to even see patients? What about administration?

Wanda Filer MD, president-elect of the American Academy of Family Physicians (AAFP) and my new BFF, has come out in favor of an inclusive definition, at least regarding AAFP membership. Her position, and it’s a valid one, is that Family Physicians are under attack by enough non-Family Physicians (both inside and outside Medicine) that we should stick together. Her big tent says that we shouldn’t be fighting among ourselves about defining Family Doctor-hood by whether or not we deliver babies, care for children, perform surgery, or do house calls. Meeting the criteria for AAFP membership (completion of accredited residency, state licensure, ongoing Continuing Medical Education, and of course up-to-date dues payments) is what makes us Family Physicians.

Sounds good. But what about Internists who advertise as Family Physicians because it’s “better marketing”? I’ve seen this, and it pisses me off. Do we have any recourse?

Is it self-defined? Can anyone who wants to call themselves a Family Physician? This of course gets into the whole debate over Primary Care. To most in Health Administration, “Family Physicians” and “PCPs” are synonymous. They’re not, of course. NPs who want to practice the full scope of primary care (few and far between, actually; they have the same payment and administrative hurdles as we do), chiropractors and naturopaths; all claim the title for themselves. This is scary. As soon as someone drops dead of hypertrophic cradiomyopathy undiagnosed by a chiropractor who doesn’t even own a stethoscope, watch the fur fly.

What about conventionally trained Family Physician who turn their backs on the scientific basis of medicine and become proponents of “alternative”, “complementary”, and “integrative” modalities? I believe they have effectively repudiated the right to call themselves Physicians at all. They disagree.

Who’s going to draw the lines that say no, you are not qualified, and you may not hold yourself out to the public as a Family Physician, practitioner of primary care? Ultimately I think it needs to be the general public; the patients we care for who use, and ultimately pay for our services. The charlatans (the alties, the chiropractors, the reality-challenged naturopaths) and the wannabes (the PAs and NPs) make their case with wishful thinking and self-serving data.

The bottom line, the one drawn in the sand, is that however difficult it may be to define who is a Family Physician, you know it when you see it.

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Responses

  1. I’m an internist. I would never call myself an FP, but I am a primary care physician. I probably have more in common with you than with my hospitalist or specialist colleagues. I wish there was an umbrella organization that represented the interests of PCPs (FP, IM, and peds).

  2. “Her position, and it’s a valid one, is that Family Physicians are under attack by enough non-Family Physicians (both inside and outside Medicine) that we should stick together.”

    Hmm. That would be nice.

    In case you haven’t noticed, the AAFP has let loose with a series of statements, policies, and lobbying campaigns that treat family physicians who don’t practice in NCQA-certified PCMHs as second class citizens. And since NCQA thinks it’s just great for a NP to head up a medical home, the AAFP has put itself in the strange position of, in essence, arguing that these NPs should be paid better and treated better than the vast majority of board-certified family physicians.

    That’s an interesting way of “sticking together.”

  3. The AAFP is way worse than useless as far as I’m concerned. It never ceases to amaze me how many people want my job until it gets tedious, unprofitable, or the stuff hits the fan.

  4. Dr. Dino:

    Your new BFF just finished helping Congress drive a stake through the heart of family physicians in private practice. She may be nice, but she’s not your friend.

  5. Great post


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