Letters

Preserving family medicine's integrity

To the Editor:

Robert L. Edsall's editorial ["The First Step Toward the Future of Family Medicine," November/December 2003, page 9] brought to mind a criticism I have always had of our Academy: We did nothing to protect the name of family medicine. Every inadequately trained storefront doctor who has no boards in anything calls himself or herself a "family physician."

It is no wonder that family medicine is maligned; even our fellow physicians can't make the distinction. I grimace whenever I am lumped together with these fake family physicians, and I resent the fact that in my hospital and many others, the family medicine departments have been the dumping ground for any physician who is not board certified in anything, thus even further blurring the distinction.

Kathryn J. Stewart, MD, MPH
Chicago

More tips for burnout prevention

To the Editor:

In this era of rampant cynicism within our profession, it is encouraging to see the energy and creativity of many of our younger colleagues. Dr. Gordon Moore's latest offering, "Creating a Vital, Burnout-Proof Practice" [September 2003, page 51], is another heartening example and provides a useful compass for those physicians trying to reinvent themselves and their practices. As a family physician who has been around for most of the modern history of family medicine, I applaud his fresh, optimistic perspectives. I particularly like his eschewing of the "hamster-wheel," production-based approach so characteristic of most salary formulas. As a veteran of several practices and business models, I offer the following comments on the piece:

1. "How much would you like to work?" I would add, "How much do I have to work to meet basic needs?" This amount is usually less than most overachievers think, but it is invariably more than it used to be as the costs of practicing have escalated (regardless of the practice model) and the reimbursement for professional services has failed to keep pace.

2. "What is your ideal scope of practice?" I've found it useful to evaluate the demographics, competition and particularly the needs of the practice population as well as personal preferences when determining scope of practice. Many physicians are disappointed to find that what they want to do is not needed. In short, find the place that fits your desired scope.

3. "Where would you like to work?" Besides distance from home and type of facility, consider your proximity to a hospital and ancillary services when choosing where to work. Also consider what type of community would best fit your family's lifestyle. Perhaps the most important location-related consideration should be the local professional and community cultures. Without any hard data, my gut tells me that cultural issues, both professional and personal, account for many cases of dissatisfaction and burnout for physicians and their families. I am fond of saying, "When you've seen one practice, you've seen one practice." Remember that there are many different environments.

4. "How would you like to work?" In addition to compensation, another fundamental issue is whether the practice views and rewards care-delivery as a team activity or merely as the work of the provider. I have a strong bias that today's fragmented system of care and reimbursement mandates a team approach.

Finally, I applaud Dr. Moore's commitment to same-day appointments and appropriate time management of patient visits. These precepts have been shown to increase patient satisfaction in numerous studies. However, after 35 years of practice (eight years solo, rural), I must differ with his conclusion about the importance of personal availability. I know of very few folks who can sustain this commitment in the long term. Most patients understand what is realistic for one physician to handle. If they understand the office operates as a team, with all members capable and willing to help, usually patients' needs can be met without risking burnout from well-intended overcommitment.

Frank M. Reed, MD
Corvallis, Mont.

Family medicine residencies

To the Editor:

Jennifer Bush's article "Family Medicine Takes Center Stage" [November/December 2003, page 43] addresses the challenge of making family medicine a more appealing career choice for students. We must remake the family medicine residency so that residents who choose to can subspecialize, as they can with internal medicine residency programs. Family medicine residency training makes a physician ideally suited for any subspecialty, whether medical or surgical. If such opportunities were available, family medicine residencies would be even more attractive to medical students than internal medicine. Once in the residency, students would see what a great field family medicine is and stay with it. Then we would gain many capable family physicians who would add to the prestige of our specialty. In its present state, family medicine is a choice with no outs and is scary to go into when you are a third-year student trying to decide which residency to pick.

Dennis Y. Fong, MD
Walnut Creek, Calif.

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