Practice Options in Family Medicine

Education
Some family physicians find their calling in the educational field. By joining the medical school faculty as a professor, clerkship director or even dean, family physicians can incorporate teaching and working with medical students into their career. The options of serving as a community preceptor, an attending for a clinical rotation or joining a residency program as a faculty member also appeal to family physicians who want to incorporate clinical care with teaching.

The Society of Teachers of Family Medicine(www.stfm.org) (STFM) has an entire journal(www.stfm.org) dedicated to addressing the needs of all family medicine educators.

Emergency Medicine and Urgent Care
Family physicians who have hospital privileges sometimes choose to work exclusively in emergency departments or urgent care centers. Family physicians often provide the majority of emergency care in rural areas that do not have a designated emergency care doctor. It is beneficial to have physicians who are able to treat men and women, children and adults, and understand the whole person in the context of their environment. A potential drawback of this career option is that urgent care and emergency departments offer limited scope of practice and do not often allow for continuity of care.

Read the Robert Graham Center's one-pager on this issue: "Family Physicians help meet the emergency care needs of rural America."

Hospitalist
Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Family physicians possess unique attitudes, skills and knowledge which qualify them to provide continuing and comprehensive medical care to each patient regardless of sex, age or type of problem. They regularly act as the hub of medical care in the hospital, coordinating care and advice between other specialists. According to a study by the Society of Hospital Medicine(www.the-hospitalist.org), "family-medicine-trained hospitalists are a growing phenomenon in the specialty," with the proportion of family physicians versus other primary care specialists as hospitalists nearly doubling between 2007 and 2010.

Inpatient Medicine
Family physicians can choose to be dedicated inpatient physicians, or hospitalists, on a full-time or rotating basis, depending on the demand and level of inpatient care needed. Hospitalists’ primary focus is the general medical care of hospitalized patients, and they may serve as the referring or receiving physician in that setting. While not focused on full-time hospital practice, most family physicians provide care in the hospital setting.

Privileging: More than 66% of family physicians choose to have hospital privileges. By having hospital privileges, they can offer continuous care to their patients during hospital stays. Forty percent treat patients who have been admitted to a critical care unit (CCU) and nearly 50% treat those in an intensive care unit (ICU).

International and Wilderness Medicine
Family medicine’s broad scope of training prepares physicians to practice medicine abroad, in areas of our country that have scarce resources, and in extreme situations (like the Haiti earthquake). Because family physicians care for all people – regardless of sex, age or disease state – they are uniquely prepared to address a myriad of health problems under a broad range of circumstances.  Family medicine’s emphasis on community and public health also enables family physicians to do a community assessment in addressing needs.

For more information, visit STFM's October 2007 issue(www.stfm.org) on global health and how family medicine uniquely prepares its physicians for service abroad, or view the global health video in the Web-based Educational Forum.

Maternity Care
While many family physicians do not choose to provide maternity care, others offer a full scope of services, encompassing pre-and post-natal care and deliveries (including Cesarean sections). For those family physicians practicing in underserved and isolated areas, the provision of maternity care may be essential.

Read more in the Graham Center's one-pager: "Family Physicians Make a Substantial Contribution to Maternity Care: The Case of the State of Maine," or a group of family physicians' discussions about providing maternity care in their "Diary from a Week in Practice."

Multispecialty Group Practice
More than 20% of family physicians are part of a multispecialty group practice, meaning they are part of a practice comprised of physicians from different specialties. One of the advantages of working in a multispecialty group practice is that multiple patient services are provided at one location. Often times, this is easier for patients, as the referral process can be expedited. Practices may include specialists from family medicine, orthopaedics and cardiology in one building to enhance patient access.

Part-time vs. Full-Time Practice
Family physicians may choose to practice medicine part-time in order to take care of their families, pursue other interests or prepare for retirement. Part-time practice is economically viable for many family physicians, but can be financially challenging for others. Another alternative to full-time practice is job sharing, one full-time equivalent (FTE) position shared by two physicians who each work part-time. This option is advantageous because it frequently cuts down on paperwork and administrative duties.

Practice Ownership vs. Partnership vs. Employee Status
Some physicians choose to establish their practice as the sole owner, others prefer partnership in a practice. In both cases, these physicians are in the best position to define their practices and the style of practice management. Other physicians elect to be employees of a hospital, community health center or multispecialty group practice. Not having to pay overhead costs, or deal with staffing and administrative issues is appealing to many. It is important to talk with physicians in each setting to better understand the pros and cons of these practice arrangements.

Procedures
Family physicians in traditional practice settings enjoy being able to perform a number of office procedures. In addition to maternity-related procedures (caesarian section, ultrasound imaging), family physicians perform colonoscopies, endoscopies, IUD placement, colposcopies, skin biopsies, suturing lacerations, vasectomies and more.

For more information on the types of diagnostic procedures that family physicians can do in their practice, visit the practice profile surveys.

The Society of Teachers of Family Medicine (STFM) has outlined recommended procedural training in the Family Medicine journal article "Advanced Procedural Training in Family Medicine: A Group Consensus Statement(7 page PDF)".

Public Health
Many physicians choose to join the National Health Service Corps(www.hrsa.gov), which places primary care physicians in medically underserved (often rural) areas, or the Indian Health Service(www.ihs.gov), where physicians currently provide health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 states. Some family physicians consult on grant projects, lead working groups or guide task forces to look at disease epidemiology, health promotion and disparities research. Other family physicians pursue additional training in public health (a Master’s degree or PhD) to become medical directors in county or state health departments.

Research
Research is an important component of family medicine. Some family physicians collect data about the patients and communities that they serve, exploring specific clinical problems or the way in which primary care is organized and delivered. Others may seek opportunities to do research on a full-time basis, as primary investigators of federally funded projects and/or in research positions in academic settings.

Rural or Urban Practice
The geographic spread of family physicians across the country more closely matches the geographic spread of the general population than any other medical specialty. While 79% of the U.S. population is in urban areas, 76% of family physicians practice in urban settings. And while 21% of the U.S. population resides in rural areas, 22% of family physicians practice in rural areas. Both rural and urban physicians often face similar challenges. In treating underserved populations, they encounter illiteracy, poverty, and limited community resources. While caring for the disadvantaged can be challenging, it can also be extremely fulfilling. To better understand the similarities and differences in rural and urban practices, talk with family physicians in both settings. 

The National Rural Recruitment and Retention Network (3RNet)(www.3rnet.org) can help locate practice sites in rural and underserved areas. This network consists of several non-profit organizations and can help a variety of health professionals.

The Graham Center's one-pager on "The Family Physician Workforce: The Special Case of Rural Populations" offers more detailed information about the impact family physicians can make in rural areas.  The January 2010 edition of the AAMC's Careers in Medicine newsletter(www.aamc.org) (PDF) also profiles a rural physician.

You can also check out the AAFP's resources in the Rural Family Physician Community.

Solo vs. Group Practice
The physician staffing agency Merritt, Hawkins and Associates(www.merritthawkins.com) noted that, in 2007, about one-third of family physicians were in solo practice, while 60% were in group practices of three or more physicians. Some physicians enjoy the opportunity to run their own practice, especially if they can establish themselves in underserved rural areas, while others find advantage in working with colleagues; having the option to do one or the other is appealing to family physicians.

Sports Medicine
A growing interest in sports medicine has led some family physicians to take on the role of team physician for various sports (notably football), for which they are well suited because of their ability to treat orthopaedic as well as general medical problems. The AAFP encourages family physicians to serve as sports medicine doctors in their communities, and many family medicine residencies sponsor sports medicine fellowships as well.