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Fam Pract Manag. 2010;17(1):10-12

I applaud Dr. Starfield's attempt to define our specialty in terms of person-focused care rather than disease-focused care in “Family Medicine Should Shape Reform, Not Vice Versa” [Opinion, July/August 2009]. The problems with her wish list, and mine (as expressed in an editorial I wrote in April 2006, “Reinventing Family Medicine”), are that family practice residency programs still train doctors along disease-focused models, and they don't teach them how to run an independent practice so they can have the time to do person-focused, comprehensive, coordinated care.

It is somewhat ironic that midlevel providers, who aren't expected to see as many patients per hour as physicians, are better suited to handle these tasks. The corporate model of health care simply doesn't allow enough time for family physicians to provide the kinds of services that Dr. Starfield advocates.

If we can't compete with specialists in treating disease, and if we can't compete with midlevels in giving of our time, then we are rudderless as a specialty and cannot be saved by electronic health records or the other technologies that are propounded in the patient-centered medical home model.


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