Letters

How different are internists and FPs?

To the Editor:

Not only do many patients misunderstand the difference between internists and family physicians, but as the years pass, so do I. I didn't find the answer in "Recommendations for the Future of Family Medicine" [April 2004, page 34]. Even internists should be following the recommendations set forth in the article.

Perhaps the only distinction between the two specialties is our ability to practice obstetrics and pediatrics. However, given current malpractice premiums, I doubt most family physicians deliver enough babies to make it worth their while to continue. And obstetricians are more likely to recommend a pediatrician to provide the immediate postpartum care. This is most likely because family physicians spend approximately one year of their residency practicing pediatrics (most of that in outpatient settings), whereas pediatric residents spend three to four years practicing nothing but pediatrics and spend a good deal of time in the delivery suite.

The differentiation between internists and family physicians becomes even more daunting when confronting reviewers from the Joint Commission on Accreditation of Healthcare Organizations. I would like to have some answers in the future when confronted with this question.

Charles G. Perl, MD
Weston, Fla.

Money and status

To the Editor:

"Recommendations for the Future of Family Medicine" appears to be right on the mark. Given the demonstrated relationship between the health of a country's primary care system and the health of its population, the project should be an issue of national attention that requires immediate intervention.

Some of the many problems facing family medicine today include the increasing number of nonphysician providers who are demanding more traditional primary medicine functions and who are, in some cases, even calling themselves physicians; the non-family-physicians who are advertising "complete family care"; and the lack of public education about the specialty. However, two major problems with our specialty override all other considerations: 1) the staggering disparity in incomes between family physicians and other specialists, and 2) our status in the public's mind and, of greater concern, our fellow physicians' minds.

The dwindling interest in family medicine can be attributed in part to both problems, but for current students, financial considerations are of primary concern. There is no escaping that today's investment-to-return ratio makes family medicine an increasingly rare choice. Unless this is fixed quickly, our numbers will continue to decline given the increasing practice operating costs, low reimbursements and rising medical school costs.

Charles Friend, DO
Indianapolis

Just what is a family physician, anyway?

To the Editor:

I agree with Dr. Sanford Brown's concerns that the name "family physician" does not accurately portray what we do [Practice Diary, April 2004, page 60]. Although it has been written that a rose by any other name would smell as sweet, it helps that everybody knows what a rose is. As evidenced by the findings of the Future of Family Medicine project, a large number of people are unaware of or confused about what family physicians do. This should not come as a surprise, for when I look back at my own experience, I recall that I had never even heard of family medicine until I went to medical school. Furthermore, after my three years of residency and two in practice, my parents (both with advanced degrees) are still somewhat unclear about what I do.

Family medicine is not easily categorized. It is not identical from physician to physician. Some of us include obstetrics in our practice, while others include general surgery or specialize in geriatrics or sports medicine. Some of us perform colposcopies, vasectomies or Botox injections, and others don't. When patients choose a family physician, they really don't know which basket of services will be included.

Family medicine is probably the only specialty formed from a perceived need, rather than from an actual need. I treat very few families in my practice, and I treat even fewer with respect to the intricacies of family dynamics and interactions. I am afraid some patients decide not to come to us because they need care only for themselves, not for their entire family.

It seems there are no easy answers. Perhaps a better name for family physicians would be "comprehensive lifespan physicians." However, the definition of comprehensive would vary from physician to physician. Perhaps we should consider the name "generalist physician." After all, though it lacks pizzazz, it is fairly descriptive and easily understood.

Kirsten Stoesser, MD
Salt Lake City