“What's in a name?” asks the Bard. “That which we call a rose by any other name would smell as sweet.” Or at least that's what my CliffsNotes say he said. Nevertheless, in our specialty a name may mean more than we realize. Jennifer Bush's excellent article “Is It Time to Re-examine Family Practice?” in the September 2001 issue of this journal (page 43) set my mind thinking. So much so that I ruminated on it over soggy corn flakes for about six months before finally putting my thoughts on paper. During these mental walkabouts, I found myself puzzling over the term family practice. You see, I graduated from a residency in “family medicine,” yet my board certification is in “family practice.” It's a dichotomy many of us live with, seemingly without issue.
Although I haven't researched the history of the terms thoroughly, I suspect that family practice and the related family practitioner are holdovers from before the founding of our specialty. The venerated general practitioner of old was the closest thing to what this new specialty was attempting to achieve, so the “practitioner” moniker was adopted, and family practice was born, signifying to the lay public a new generation of generalist physicians complete with three-year board certification and the ability to leap tall buildings in a single bound.
But wait a minute. Our friends in internal medicine don't talk about being in “internal practice” call themselves “internal tioners.” Moreover, across country, departments of family practice are changing their names to become departments of family medicine. What's going on, and why should that make any difference?
Practitioners and physicians
The word practitioner is commonly glued into terms such as yoga practitioner, voodoo practitioner, Zen practitioner – an assortment of “sub-specialists” who are probably at this very moment lobbying your state government for prescription privileges. The term family practitioner makes me picture myself entering an exam room and attempting to treat a patient by dancing around with one leg behind my head while waving a zebra tail. (It's not the therapy I object to; I understand there are some good clinical trials. I just have trouble finding an acceptable CPT code.)
If the public and third-party payers feel that we are merely practitioners of our art, we are not seen as initiators, researchers and scholars, but rather as riding on the coattails of our medical colleagues, and sometimes even as being out of touch with “real” medicine. Meanwhile the quiet re-engineering of “midlevel providers” has chipped away at our years of training to leave us dangling five letters away from being family nurse practitioners. The root of the problem may be in the use of the term “family practitioner” by the lay public, and even our own colleagues. In fact, many of our members don't realize that AAFP stands for American Academy of Family Physicians (that's right folks, it's not “Practitioners”).
To our patients this heavy discussion of semantics will certainly go unnoticed. Many of my older patients have never even caught on to the term family practice and still refer to me as a GP. I don't have a problem with that. If they ask, I'll patiently explain that I spent three years in training to become board certified as a family physician, after which they go on their merry way saying: “He still looks like he's in grade school, but he's sure a nice GP.” Insurance companies, on the other hand, take a different tack. Our local insurance monopoly pays me 15 percent less than my internist colleagues for the same CPT code, as if practitioner meant Deep Discount, Garage Sale and Blue Light Special.
So in family medicine, “To OB or not to OB” may not be the question. Rather, it is “Who are we?” One need look no further than the various organizations devoted to our specialty to see the disparity in titles. The Society of Teachers of Family Medicine. The American Board of Family Practice. The American Academy of Family Physicians. Are those three different specialties? I am certain this adds to the confusion of medical students interested in what we do, and we all know the lay public is confused enough. Just yesterday a new patient came in with a stye on her left upper eyelid: “I wasn't sure if I should see a dermatologist or an ophthalmologist,” she said, “so I thought maybe you could help me decide.” I congratulated her on having already made the correct choice.
The term family practice refers in fact to putting our knowledge into action: Even more properly, the term refers more to the office you work at, a family practice, rather than the field you trained in, which is family medicine.
Enough practice! Get it right
The simple question I wish to raise is this: Can we divorce ourselves from the evil term family practitioner without also having to give up the term family practice? I submit that insurance companies and the lay public do not distinguish between the terms; and unfortunately neither do a lot of family physicians. Some may feel I am throwing out the baby with the bathwater, but I think that the only way to completely avoid the negative connotations of the term practitioner is to universally adopt the term family medicine as the proper title of our specialty. Why? I went to medical school to become a physician. I wanted to practice medicine. Family medicine. Those are the terms I prefer and by which I define my career. “My doctor practices family medicine.” This represents the combination of two words much revered in our society, including the oldest and most revered description of our art and calling.
Will universally adopting the term family medicine as the title of our specialty cause the insurance companies to bow at our feet and “closed” hospitals to throw open their delivery suites with trumpets blaring and red carpet? Of course not. On the other hand, standardization of the terms family physician and family medicine could have a lot of impact over the next few decades on public perception by clarifying the nature of our specialty to laypersons, third-party payers, our fellow physicians and, of course, the next crop of medical students.