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

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:

“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.