BY TONI LAPP
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Family physicians overall are happy with their career choice. Despite the lack of respect for family practice in academia, practicing subspecialists respect FPs and recognize the specialty's importance to health care. But patients don't always understand what an FP is.
These findings are highlights from preliminary data released in March by the Future of Family Medicine project, launched in 2001 to take an objective, comprehensive look at the discipline and develop a strategy for its future. The AAFP and six other family medicine organizations are partners in the project.
The preliminary data, available at http://www.futurefamilymed.org/, come from research coordinated by the national consulting firm Siegelgale of New York. The FFM Project Leadership Committee engaged Siegelgale to do quantitative and qualitative research to answer the question, "What do people want and expect from their doctor, and what is the role that family physicians could or should play?"
The results give family practice leaders something to work with, said Project Leadership Committee Chair and AAFP President James Martin, M.D., of San Antonio.
"The study indicates that the American people still want a personal relationship with a listening, caring physician. The study also indicated that we are more highly regarded by our subspecialty colleagues than we may have supposed," said Martin.
Patients' lack of understanding about family physicians was an especially interesting finding, said Martin. In focus groups of patients, 38 percent of participants erroneously thought their primary care physicians were not FPs when in fact they were. Similarly, 33 percent were seeing internists but thought their physicians were FPs.
To be sure, there are challenges, said Martin. "The public still does not understand the role and value of a family physician. Some patients do not have an appreciation of continuity relationships, and many patients do not see the family physician as scientifically and technologically astute."
But as the project's data analysis unfolds and its five task forces examine the output, the project will begin to tap into ways to rejuvenate the specialty and, in turn, health care, he said.
Family practice is the only specialty formed from social need, said Norman Kahn, M.D., AAFP vice president for science and education and staff executive to the FFM project.
"Our core values are still valued, but slightly differently than they were 30 years ago," Kahn said. "But we will have to transform and renew ourselves to be more responsive."
Some values FPs think are important may not rate highly with patients. Research data showed the areas of practice family physicians tend to give up are those that are not valued as fundamentally important by patients. For instance, Siegelgale data showed that providing maternity care ranked least important on patients' list of attributes they desire in a physician; seeing hospitalized patients ranked 30th out of 39 on the list.
Indeed, patients are wary of too much emphasis on comprehensiveness. "It's dangerous for anyone to try to know all of this," one patient said in a focus group. Another said, "They could miss something because they think they know as much as specialists and won't refer."
"Science has gotten so complex that it's not reasonable to expect someone to have the depth of knowledge necessary," said a consumer advocate.
Patients are divided on one core value: the "family" in family practice.
Idealistically, treating the whole family promotes a better understanding of the individual patient. However, for a majority of an FP's patients, the patient being treated is the sole family member being seen by that physician.
"The notion of 'family' is not universally accepted as being the epicenter of the specialty," said the Siegelgale report.
Some patients prefer it this way. "I wouldn't want my wife and kids to go to my doctor," one patient said. "I like to believe that what I talk to my doctor about remains between us."
The FFM project is now past its midpoint. Its five task forces are in the process of meeting to discuss data relating to topics such as education, systems of care and communicating the FP's role. Task force members are writing recommendations based on the Siegelgale findings.
Kahn says that the introspection in and of itself has been valuable.
"The most important findings are not the answers but the questions," Kahn said. "The discipline had the courage to ask open-ended questions, with the awareness that it might not like the answers it received," he said.
Doctors in other countries are taking notice: In Great Britain, a similar project is planned. Its name? The Future of General Practice project.
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
FP Report is published by the
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Copyright © 2003 by
American Academy of Family Physicians.