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30-Year Checkup on Family Practice Finds Specialty in Good Health but Still Challenged

FOR IMMEDIATE RELEASE
Tuesday, September 03, 2002

Contact:
Leslie Champlin
American Academy of Family Physicians
(800) 274-2237, Ext. 5224
lchampli@aafp.org

WASHINGTON  After three decades, family medicine has realized much of the vision laid out for it in the 1960s: community-based physicians with broad clinical competence. In a 30-year checkup of the specialty published in this week’s Journal of the American Medical Association, the authors examine the development of the specialty since its establishment and the challenges it faces in an increasingly fragmented health care system.

“We identified the challenges that are unique to the discipline of family practice,” said Robert Graham, M.D., lead author of “Family Practice in the United States: A Status Report.” “Other specialties were created largely in response to forces within the medical profession. The move to create the specialty of family practice arose out of a combination of public and professional concerns and was intended to preserve a type of physician who would treat the patient as an individual and not only respond to isolated disease or organ system problems.”

After three decades of development of the specialty, family physicians play a significant role in the U.S. health care system. In 2000, 199 million of the 822 million patient visits (24.2 percent) to physicians were to family and general physicians. Studies support the importance of family physicians and other primary care physicians to health care systems. Counties where the supply of primary care physicians is relatively high have relatively high rates of early-stage detection and likely cure of colon and breast cancers. Multinational comparisons demonstrate that countries with the best health care system performance - as shown by quality of life indicators such as longevity and infant mortality - and patient satisfaction have the highest percentage of family physicians.

However, family practice faces significant hurdles in today’s health care system:

The central tenets of family practice  comprehensiveness, coordination, continuity, and patient focus – are often in conflict with the highly fragmented pattern of care in the current system.
Many centers of academic medicine continue to resist the development of family practice and primary care.
The scope of clinical services provided by family physicians may be subject to changes in medical markets, reimbursement patterns, and lifestyle decisions of individual physicians.
The broad clinical domain of family practice and its high degree of patient satisfaction have created an attractive market for other health care professionals.
Managed care offered the potential for better coordination and efficiency of health care but disrupted long-standing relationships that many patients had with their primary care physicians.
Research in family practice remains an area of underdeveloped opportunity.
Medical student interest in family practice as a career has fluctuated.
The medical profession as a whole will face increasing scrutiny in coming years regarding issues of the quality of practice and medical errors.

“Family physicians, confronted on a daily basis with the stresses of managed care, market competition, and a patient population that may not always share a commitment to prevention and health maintenance, may occasionally wonder if they are treading the path envisioned by the founders of the specialty. But, as recently as 1996, the Institute of Medicine offered an updated definition of primary care and a desirable model of care: ‘the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients and practicing in the context of family and community.’ The Institute of Medicine definition provides … an eloquent description of the core values and attributes of family practice,” conclude Graham and his co-authors.

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The Journal of the American Medical Association can be accessed at http://jama.ama-assn.org.
Founded in 1947, the AAFP represents more than 93,000 physicians and medical students nationwide. It is the only medical society devoted solely to primary care.

Nearly one in four of all office visits are made to family physicians. That is 215 million office visits each year – nearly 48 million more than the next medical specialty. Today, family physicians provide the majority of care for America’s underserved and rural populations.

In the increasingly fragmented world of health care where many medical specialties limit their practice to a particular organ, disease, age or sex, family physicians are dedicated to treating the whole person across the full spectrum of ages. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.

To learn more about the American Academy of Family Physicians and about the specialty of family medicine, please visit www.aafp.org.

For more information about the AAFP's positions on issues and clinical care and downloadable multi-media on family medicine and health care, visit the AAFP Media Center.

For more information about health care, health conditions, and wellness, please visit familydoctor.org.