By emphasizing the family physician's role as a caregiver for patients in underserved areas, we can strengthen our specialty.
Fam Pract Manag. 2005 May;12(5):14-16.
The Future of Family Medicine project recently published recommendations that address a range of challenges faced by the specialty.1 Unfortunately, many of these recommendations involve complex solutions that may take years to make a significant difference. We must address our problems now, and I believe a solution is near at hand: We can improve the standing of family medicine simply by cultivating our existing role as physicians who take care of underserved patients. This is undeniably our turf. We should lay claim to it and foster a new identity for our specialty that has this calling at its core.
What we do best
Having worked in a rural area for two years, and now with urban and suburban underserved patients at a community health center, I can say with confidence that no other specialist can take care of these patient populations – be they in rural or urban areas or in developing countries – better than a family physician. Taking care of patients in under-served areas demands a full spectrum of care that, by virtue of our training, family physicians are uniquely qualified to provide.
Of course the key to improving the standing of family medicine is changing the perception of our specialty among medical students (and attendings) so that we can draw greater numbers of them to our specialty. I believe that caring for the underserved garners more respect than practicing traditional family medicine; an identity of family medicine with this at its core would make the specialty a more compelling choice for medical students. It would also appeal to the altruistic motivations that guide many college students to medicine in the first place. The desire to “help people,” although a common cliché in admission essays and interviews, is a powerful motivator for the majority of applicants,2 but this altruism is untapped during the indoctrination that occurs in medical school.
Under the influence of attendings and residents, medical students come to regard lifestyle, compensation and prestige as their principal motivators. We can't compete with most specialties in these areas, and we also can't compete when it comes to high-tech appeal. We must compete on our own terms, showing students that family medicine offers them an opportunity to embrace their higher ideals. Pediatricians have done a wonderful job of maintaining a clear purpose for their specialty. They do not rely on lifestyle, compensation or even high-tech appeal to recruit their residents, just the noble cause of taking care of children, and their fill rates in the Match have remained relatively stable.3
Other physicians already know that one does not go into family medicine because of the money or the lifestyle. But what if we were to reinforce that family physicians become family physicians for the very reasons that we hope every medical student is drawn to medical school – to help the patients who need it the most? Wouldn't this improve our standing not only in academic centers but among patients as well?
What we already do
Of course this image of family medicine as the specialty dedicated to caring for the underserved does not encompass the entirety of our field. We should continue to serve the diverse needs of all of our patients. However, this image provides a more tangible and manageable representation of our field that emphasizes what we already do – and do better than any other specialty. Family medicine would be well served by cultivating this image.
WHAT DO YOU THINK?
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1. Future of Family Medicine Project Leadership Committee. The future of family medicine: a collaborative project of the family medicine community. Ann Fam Med. 2004;2Suppl 1:S3–S32.
2. Matriculating Student Questionnaire. Washington, DC: Association of American Medical Colleges; 2004. Available online at http://www.aamc.org/data/msq/allschoolsreports/msq2004.pdf. Accessed April 25, 2005.
3. National Resident Matching Program data. Available online at http://www.nrmp.org/2005advdata.pdf. Accessed April 25, 2005.
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