To the Editor:

I read “Is It Time to Re-examine Family Practice?” [September 2001, page 43] and want to thank you for addressing this important subject. As a recent graduate, I see improving family practice residency training somewhere at the top of the list of things that must be done to secure the future of our specialty. Defining our specialty requires far more than advertising. Done correctly, it will pay huge dividends in making our role clear to the public, HMOs and other specialties. Here are several ideas that would improve residency training by helping to narrow and further define our competencies:

Some rotations, like surgery during the second post-graduate year, should be sacrificed. Others, like community medicine, while having some important potential, do not provide specific training for future practice. The core curriculum guides could use more specifics and more detail. This would naturally lead to a more structured and defined certification/recertification exam process. I propose we graduate with competency in primary internal medicine (inpatient/hospitalist and ambulatory), pediatrics, obstetrics/gynecology and geriatrics as the core. These core areas are a challenge to manage as experts, but I believe they can be handled comprehensively with the emphasis on primary care treatment and appropriate consult. I think other areas force us to disperse too much. Electives should provide needed flexibility.

I’d like to see the AAFP and the American Board of Family Practice form committees for each of the core areas I’ve mentioned to maintain up-to-date guidance. (The AAFP’s Advanced Life Support in Obstetrics (ALSO) course is a shining example of this idea.) We also need to implement clear standards of competency for procedures (e.g., the minimum number of supervised procedures performed by a resident unassisted).

With such a package of competence, we can clearly demonstrate a need for physician-level primary medicine. No other specialty can do this. I think our future is bright as long as we can demonstrate our competence in primary care clearly and specifically.