Have you ever gone to see your primary care physician, called him or her a general practitioner, or a GP, and had them give you a funny smirk or perhaps even a role of the eyes? Ever been embarrassed to ask what’s the difference between a general practitioner and a family practitioner or a family doctor?
Having been an eye roller and smirker myself let me take the opportunity this quiet Sunday morning to go into the difference between general practice, family practice, and family medicine.
Once upon a time medical students graduated from medical school and would do a one year intership at a hospital doing apprentice like work that we so often see on TV. When this was done they became licensed with the state, hung out their shingle, and went into practice. This is the general practitioner, the GP, that was the bedrock of primary care and provided so much of health care to rural areas for much of the history of the US.
In 1969 the American Board of Family Practice was formed in response to an overall trend toward specialization in American medicine. The percentage of medical school graduates going into general practice had declined from 47% in 1900 to 19% in 1964. Family Practice, changed from general practice, deserved to be a specialty of its own and deserved to have full residency training programs. Upon completion of residency training a test, and if all goes well, they could advertise themselves as “board certified.”
(Of note, many countries still use the term general practitioner and you won’t get any eye rolls there as its still the appropriate title.)
As time went on, family practice found that having its own specialty still wasn’t enough to avoid having sand kicked in its face by the specialists on the beach and decided that re-certification should take place to demonstrate physician currency. On a sabbatical-like cycle, family practitioners would retake their certification exam in addition to the continuing medical education (CME are workshops and lectures that most other specialties required of its members).
Eventually many specialties would come to join in on the re-certification parade, but if you ask around many doc still proudly hold lifelong board certification based on a test they took twenty years ago.Back in 2005 the American Board of Family Practice decided it was time for some other major changes. Mid-levels had impeded on the primary care turf. Specialists salaries really started to take off compared to primary care. It decided to start with the name. I began my residency training in family practice, but I graduated in family medicine. Sounds less mid-level-ish and more like we know what we’re doing. The term family practitioner is also probably outdated. Family physician or family doctor are more appropriate.
The other major change is how doctors maintain certification. The board spaced out the certification test to every ten years, but no requires some type of self-assessment or practice assessment on an annual basis. I’ve done computer modules to test my knowledge on cardiac disease, well child exams, and depression. This year I’m doing a chart review for my patients to look at the way I deliver asthma care. Those CME requirements from before, those haven’t gone away as well.
Now I hear rumblings that the other specialties are going to be changing to a similar model and undoubtedly my board will have to think of something new.
Being board certified is not equivalent to delivering quality care. In fact no study, to my knowledge, has ever shown board certified docs deliver better care than non-board certified and the same is true of family physicians that have been part of this new maintenance of certification pathway. Having said that, as board certification becomes more and more the norm and the expectation I would want a pretty good reason for a family member to see a doctor of any specialty that wasn’t board certified.
So if you find yourself fumbling around trying to remember if it’s the GP or family practitioners I recommend just sticking with “the doctor.”
The Country Doc
From thecountrydocreport.com
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