July 2001 • Volume 7 • Number 7
'One person makes a difference'
Family medicine leader urges specialty to harness powerBY CINDY McCANSE
Family practice match numbers down again ... further reimbursement hassles ... yet more scope of practice battles ... Title VII funding threatened ...
Heck of a time to be a family physician, right?
As a matter of fact, it is, according to F. Marian Bishop, Ph.D., M.S.P.H., professor and chair emerita in the University of Utah School of Medicine Department of Family and Preventive Medicine in Salt Lake City. Bishop delivered the Nicholas J. Pisacano, M.D., Memorial Lecture at last month's Workshop for Directors of Family Practice Residencies in Kansas City.
"Family medicine, as an academic discipline and as a practice specialty, has been a major success story over these past three decades," she said. "And I am convinced that it will continue to be a success in the decades to come, regardless of what happens to the economy, future resident match days, health insurance coverage, HMOs, PPOs or any other alphabet soup which may come along."
The reason, as Bishop explained it, is simple enough.
The Power of Family Medicine
"Family medicine equals power," said Bishop. Although, she added, "There've been times when we have failed to recognize the unbelievable power that was available to the discipline, and consequently we failed to utilize that power to leverage improved quality care for our patients and to leverage a positive, influential position for our specialty."
Family medicine enjoys the power of numbers, Bishop noted. Consider the phenomenal growth of the specialty -- from three family practice residents in the pipeline as of 1969 to 56,910 living graduates of accredited family practice residencies three decades later.
But numbers do little in the absence of voice, said Bishop. "If you want to change the world, you have to be heard. Unless you open your mouth and sing in the choir, you're just taking up space," she said.
Witness the restructuring going on within the AMA, she added.
Despite a sharp drop in membership, the AMA remains the world's largest medical group, wielding a level of influence unmatched by any other such organization. By joining the AMA, Bishop said, FPs can help shape "the fabric of health care in the United States."
Another power family medicine holds is persistence, said Bishop. "Instant success," she jibed, "takes time. Instant success does not occur overnight."
Bishop said that since this year's family practice residency match, she's heard a lot of doom and gloom about the future of family medicine. "I even heard someone say that family medicine had hit its peak and is in a free fall, and it's unlikely to recover," she noted.
Bishop doesn't buy it.
"Balderdash," she said. "I disagree. There are always peaks and valleys; this is the cyclical nature of progress. What is discouraging in one area will be made up for in achievements in another. We have to persist and hang in. Most of the time, just hanging in helps; it works. It's called the 'pain in the ass strategy.'"
The last power Bishop discussed -- altruism -- is arguably the greatest, she noted. "Altruism is the basic fuel for power. Recognizing that you've helped someone provides the energy to persist, to voice convictions and to join with colleagues to choose the high road when choices can be made."
A Spirit of Caring and Compassion
Yet for all its power -- or, perhaps, because of it -- family medicine continues to embody a spirit of caring and compassion, as Bishop knows firsthand.
Diagnosed two years ago with recurring breast cancer, Bishop is currently under the care of a host of physicians and other health providers. Although an oncologist heads the team, she said, it is her family physician who is at the heart of it.
F. Marian Bishop, Ph.D.:
"If you want to change the world, you have to be heard. Unless you open your mouth and sing in the choir, you're just taking up space.""She's the one member of this team who routinely asks me how I feel about the setbacks that seem to come along every four months," Bishop explained. "She gives me permission to feel, to grieve, to sigh, to cry and to be frightened."
And it is her family physician, said Bishop, who has been able to give her a sense of peace about the final days of her illness simply by promising her, "I will be there" -- four words Bishop clings to.
"She's a hero, just as you are heroes. She has personal power with her patients, just as you have personal power with your patients," she said.
Ultimately, Bishop concluded, all power derives from the individual: "One person makes a difference, and everyone should try."
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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