The first medical doctors were generalists who treated everyone in town – adults, children and seniors. They diagnosed and treated chicken pox in the kids, performed surgery on Dad, delivered Mom’s babies and eased the pain of the elderly who were dying. In fact, for thousands of years, these generalists provided all of the medical care available. Today, these all-purpose physicians hold family practice jobs.
Because technology and medical knowledge has expanded to the point where it has seemed impractical for all physicians to have the latest training in every medicial discipline, most physicians began choosing specific specialties to practice. After World War II, the number of specialists and sub-specialists increased at astounding rates. In two decades, the number of generalists declined dramatically resulting in a public outcry due to the shortage of physicians who could provide comprehensive continual care for every member of their family.
Because of the shortages and the public frustration, medicine reintroduced the family medicine field as medicine’s twentieth specialty.
Not unlike other specialties, family medicine incorporates skill, knowledge and finally process in their practices. Knowledge and skill are shared with all specialties, it is the “process” that sets family medicine apart from the rest. The patient-physician relationship in this process is unique in that the patient is viewed in the context of the family, not individual. Because this is unique to only a family practice job, it separates the specialty from all other physician jobs in medicine.
The family physician functions as the gatekeeper for the patient’s entry into the health care system. Because he or she functions as the healthcare system’s point of first contact, the family medicine physician is in a unique position to form a bond with the patient. The family physician’s job is both personal and comprehensive, and not limited by their patient’s age, sex, or type of problem – be it biological, behavioral or social.
This relationsip allows the family physician to base the patient’s care on knowledge of the family and the community while focusing on disease prevention and health promotion. Should the patient need to be referred the family physician refers their patient to a specialist or caregiver, but will remain the overall coordinator of the patient’s health care. This system prevents confusion and mistakes in both the outpatient and inpatient settings.
The family physician serves as the patient’s advocate in dealing with other medical professionals, third party payers, employers and the world at large. As such, the family medicine physician serves as a governor over rising healthcare costs.
Geographic areas and other socioeconomic factors can determine the knowledge and skills required for a family physician job beyond the basic knowledge. The knowledge and skills usefull to a family physician practicing in an inner city will vary from those needed by a family physician with a rural practice.
The patient-physician relationship is central to the family medicine job and distinguishes family practice from other specialties. To sum it up, the family practice job today is rooted in the historical traditions keeping the specialty patient-focused and unbound by age, sex or malady.