How would you describe the state of the specialty? So much is going on – good stuff, bad stuff, and stuff that hasn't announced itself yet – that it's at least hard to characterize. Let's see, there's improvement in the Match, a growth in practice sales, a massive economic downturn, government incentives for health information technology, convulsive efforts to computerize patient records despite the expense and technical immaturity of the electronic health record systems currently available, chronically poor third-party payments (with congressional brinksmanship posing additional threats to payment), ICD-10, shrinking scope of practice, NCQA certification of patient-centered medical homes (PCMHs), PCMH pilots with the promise of better reimbursement, the growth of e-visits, nurse practitioners practicing independently, endless Medicare rules, the Obama health care reform package, accountable care organizations forming here and there (and beginning, maybe, to elevate family medicine to the level of importance it deserves), an impending presidential election, and ... what have I missed? I'm sure there's more.
This issue provides an overview of the state of the specialty, but with tens of thousands of family physicians practicing in a bewildering variety of settings across the country, I can imagine that each individual view might be different. Conditions vary so much from place to place, from independent practice to employed practice to faculty practice to residency, from rural health clinic to urban practice, and from the beginning of a career to the end, that the range of practice situations in family medicine is probably even broader than the range of problems family physicians are called upon to treat.
What is your vantage point, and how do things look from there? I'd be fascinated to hear, and I'm sure your colleagues in other parts of the country would be too. If you can take the time, please write and let us know how you are faring in the sea of change, what's going well and what's not, and how the future of your practice and of family medicine as a specialty looks to you. Just e-mail me at email@example.com. The editors of FPM will share a selection of thoughtful responses through our Letters department in upcoming issues.