Family Medicine Activist: Why Bother?

Why write about Family Medicine?  Does it matter?  Can it help to make a dent in the huge shortage of Family Physicians?
Social Media has the potential of making issues "go viral".  "Going viral" may get out the word about both the need and the shortage.  Information matters.
So how does someone get to be a Family Physician?  First, one attends medical school and selects a specialty by the end of the third year.  The medical student signs up for the National Residency Matching Program (NRMP).  They interview in residency programs in their chosen specialty for the opportunity to "match" with their program of choice in March of their senior year in medical school.  If they choose Family Medicine like 8.4% of American medical school seniors this year, they had a high percentage chance of getting matched with one of the top three training programs of their choice, since the programs had to get international medical graduates to fill half of their slots.
Family Medicine Match Rate Increases Slightly

Why aren't more medical students choosing Family Medicine?   There are many theories and studies with commentary such as:  Medical Students Have Negative Perceptions of Physician Work Life

Writing about the situation helps.  Let's "go viral" soon.

Family Medicine Activist: What is Family Medicine?

America needs more Family Physicians, but many don't know of Family Medicine and what we do.  So, I'll start off with some definitions to help refresh most readers and educate many others.  


"Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity. (1986) (2010 COD)"  from the American Academy of Family Physicians


Family medicine is a three-dimensional specialty, incorporating (1) knowledge, (2) skill and (3) process. Although knowledge and skill may be shared with other specialties, the family medicine process is unique. At the center of this process is the patient-physician relationship with the patient viewed in the context of the family. It is the extent to which this relationship is valued, developed, nurtured and maintained that distinguishes family medicine from all other specialties.

In the dimension of process, the family physician functions as the patient's means of entry into the health care system and as the physician of first contact in most situations is in a unique position to form a bond with the patient. The family physician's care is both personal and comprehensive and not limited by age, sex, organ system or type of problem, be it biological, behavioral or social. This care is based on knowledge of the patient in the context of the family and the community, emphasizing disease prevention and health promotion. When referral is indicated, the family physician refers the patient to other specialists or caregivers but remains the coordinator of the patient’s health care. This prevents fragmentation of that care in both the outpatient and inpatient settings. The family physician serves as the patient’s advocate in dealing with other medical professionals, third party payers, employers and others and as such is a cost-effective coordinator of the patient’s health services.

Although all family physicians share a core of information, the dimensions of knowledge and skill vary with the individual family physician. Patient needs differ in various geographic areas, and the content of the family physician's practice varies accordingly. For example, the knowledge and skills useful to a family physician practicing in an inner city may vary from those needed by a family physician with a rural practice. Furthermore, the scope of an individual family physician's practice changes over time, evolving as competency in current skills is maintained and new knowledge and skill are obtained through continuing medical education. This growth in medical information also confers on the family physician a responsibility for the assessment of new medical technology and for participation in resolving ethical dilemmas brought about by these technological advances.

In summary, the family physician of today is rooted in the historical generalist tradition. The specialty is three dimensional, combining knowledge and skill with a unique process. The patient-physician relationship in the context of the family is central to this process and distinguishes family medicine from other specialties. Above all, the scope of family medicine is dynamic, expanding, and evolutionary.
(1992) (2011 COD)"   from the American Academy of Family Physicians (AAFP)

What? I'm An Activist?

OK.  I'm an Activist.  I just had activist training through the American Majority (www.AmericanMajority.org) last weekend.  As a result, I'm applying to be a precinct representative in my county for the Republican party (Only two parties are represented).  As such, I'll attend meetings and learn more about grassroots political processes and beyond.  I'll meet lots of my fellow citizens and learn their perspectives about our government.  As a citizen, I'm concerned about our country and its people.  I believe that I personally need to be more involved in the processes of government and help others do likewise.  Each voice matters. Multiple perspectives are needed as are more Activists.

As a Family Physician, I know that every person matters. Many people I've seen as patients have forgotten about their uniqueness in the human family.  One aspect of my calling to Family Medicine is to find a timely way to remind them that they matter.  This is not made easier by the electronic age and the mandates about Electronic Medical Records (EMR) and the move to make all aspects of medicine numerical.  Family Medicine is a relationship based specialty, whose existence is threatened by over-emphasis on technology and financial profit in medicine.

Only 8.4% of senior medical students chose Family Medicine this year in the specialty training match.  We need that to be 30% if America is to have the right primary care base to improve general health and diminish the excessive cost of care.  I'm an Activist for Family Medicine because I believe in my chosen specialty as one of my paths of service to others.  The Activist skills I learned from the American Majority and other experiences will also help to advocate for Family Medicine and health care for all.  Stay tuned.  What cause are you an Activist for?

Family Medicine: Present for Duty

We're still seeing lots of patients.  They have a wide variety of situations, needs, conditions and diseases.  We respond.  We also discern things about their values, goals and dreams over time.  Over time, we validate their sense of worth.  Oh, we also consider the context of their life to help our therapies to align.
Day after day, seeing lots of patients and caring.  They (You) matter.

Family Medicine: Reconciling our Wounds

"What are cows for?  To the bioengineer and corporate manager, they are machines; they are units of production."....David Loxterkamp, MD from "A Vow of Connectedness:  Views from the Road to Beaver's Farm" in The Country Doctor Revisited pp.80-86, Edited by Therese Zink, MD.  Kent State University Press 2010.

Doctor Loxterkamp eloquently expounded on the meaning of cows to the farmer, making a further point about the meaning of the Family Physician.  "the family doctor is rarely an agent of meteoric change.  But, every day and closer to the earth, we are its vehicle and eyewitness.  Doctors who remain deeply connected to their patients will know this privilege.... In modest ways, we accomplish the utterly profound, long before the prescription is filled or the blood test is taken.  We profit by the patients' periodic return and by the mutual exchange of friendship, intimacy, and trust."

I enjoy reading those words, but flinch at his lasting message about our frailty, humanity,  and vulnerability in another section of this piece:  "We realize that patient care is not portable and that the doctor who lives among his mistakes and prejudices becomes a healthier person less prone to severity in the judgment of patients or peers.  Lastly, family doctors are inevitably changed by the patients they serve.  The merely responsible physician, tempered by mercy and groomed by grace, adds to the stock of moral credibility that has sustained our profession over the milennia."

I was paused by the phrase "Lives among his MISTAKES and PREJUDICES", suddenly reflecting on, and again thankful for, the small town Family Physicians who trained me in the night clinic at Ohio State (Pete Dils, MD stands out since I later became his partner) and in my Family Medicine Residency at Hershey, PA. (Tom Leaman, MD; Hiram Wiest, MD; Doug Chervenak, DO; Bill Hakkarinen, MD).  These were sturdy Family Doctors, but with a certain, humble respect for patients and their stories.  All were willing to share stories of their humbling moments in patient care in the most genuine of ways, maybe hoping to help younger learners to avoid similar situations, but I think it's more likely they were preparing us for membership in the guild of Family Practice, where all have been wounded.

Vulnerability springs from compassion, and the wounded physician humbly carries the scars of living among their mistakes, quietly avoiding their duplication.  Over time, the wounds are reconciled into the essence of each Family Physician.  I'm comforted to know that so many of us quietly allow our reconciliation to happen, "tempered by mercy and groomed by grace, add(ing) to the stock of moral credibility that has sustained our profession..."

My deep appreciation to David Loxterkamp, MD for recording his reflections and insights so others may better light the path to reconciliation.