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The article “The State of Family Medicine” [January/February 2012] contained interesting information, including a quote by Robert Phillips Jr., MD, MSPH, who stated that the value of family medicine is diminished as its scope of practice shrinks.

I would argue that the biggest reason family medicine is undervalued is the proliferation of nurse practitioners. On the one hand, we as a group of family medicine doctors are touting our unique qualifications to provide high-quality, comprehensive health care. On the other hand, we are telling our patients that seeing the nurse practitioner is an acceptable (and implicitly an equivalent) option.

It is no wonder that patients view these physician extenders as equivalent to doctors and often mistakenly refer to them as doctors, especially those who do business in their own facilities without a doctor on site. As Walt Kelly famously stated through his creation Pogo, “We have met the enemy and he is us.”