Family medicine

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Family medicine differs from the traditional European general practitioner. In the U.S. family practitioners usually complete an undergraduate degree and then complete either the Doctor of Medicine degree (M.D.) or a Doctor of Osteopathic Medicine degree (D.O.). A physician who specializes in family medicine (also known as a family physician), however, must complete a three-year family medicine residency in addition to their medical degree, and is eligible for the board certification now required by most hospitals and health plans.

The term "family medicine" is used in many European countries instead of "general medicine" or "general practice". In Sweden, certification in family medicine needs five years working with tutor, after the medical degree. Similar systems have been implemented in other countries.

Most family physicians practice in solo or small-group private practices or as hospital employees in practices of similar sizes owned by hospitals. Still, many choose to teach medicine at medical schools or family medicine residency programs, though usually for much less pay. Others choose to practice as consultants to various medical institutions, including insurance companies.

[edit] Family medicine in USA

Starting in the 1970s, many family physicians in the United States began to consider the terms "general practitioner" and "GP" as somewhat demeaning and derogatory, discounting their additional years of training. It was not until 1969 that family medicine (formerly known as family practice) was recognized as a distinct specialty in the U.S.^[1]

A family physician is board-certified in family medicine. Training is focused on treating an individual throughout all of his or her life stages. Family physicians will see anyone with any problem, but are experts in common problems. Many family physicians deliver babies in addition to taking care of patients of all ages. Family physicians complete undergraduate school, medical school, and three more years of specialized medical residency training in family medicine. In order to remain board certified, family physicians take a written examination every six, seven, nine or 10 years, depending on what track they choose regarding the maintenance of their certification. Three hundred hours of continuing medical education within the prior six years is also required to be eligible to sit for the exam.

Between 2003 and 2009 the board certification process is being changed in family medicine and all other American Specialty Boards to a series of yearly tests on differing areas within the given specialty. The American Board of Family Medicine, as well as other specialty boards, are requiring additional participation in continuous learning and self-assessment to enhance clinical knowledge, expertise and skills. The Board has created a program called the "Maintenance of Certification Program for Family Physicians" (MC-FP) which will require family physicians to continuously demonstrate proficiency in four areas of clinical practice: professionalism, self assessment/lifelong learning, cognitive expertise, and performance in practice.

Certificates of Added Qualifications (CAQs) in adolescent medicine, geriatric medicine, sports medicine, sleep medicine, and hospice and palliative medicine are available for those board-certified family physicians who meet additional training and testing requirements. Additionally, fellowships are available for family physicians in adolescent medicine, geriatrics, sports medicine, rural medicine, faculty development, hospitalist, obstetrics, research, and preventative medicine.

The family medicine (FM) paradigm is bolstered by primary care physicians trained in internal medicine (IM); although these physicians are trained in internal medicine only, adult patients provide the majority of the patient base of many family medicine practices. In the United States, there is a rising contingent of physicians dually trained in internal medicine and pediatrics ("peds", pronounced /ˈpiːdz/), which can be completed in four years, instead of the three years each for IM and pediatrics. A significant number of family medicine practices (especially in suburban and urban areas) do not provide obstetric services anymore (due to litigation issues and provider preference), and as such, this blurs the line between the FM and IM/Peds difference. One suggested difference is that the IM/Peds-trained physicians are more geared towards subspecialty training or hospital-based practice. Even so, there are groups with FM-trained and IM/Peds-trained physicians working in seamless harmony.

There is currently a shortage of family physicians (and also other primary care providers) due to several factors, notably the lesser prestige associated with the young specialty, the lesser pay, and the increasingly frustrating practice environment in the U.S. Physicians are increasingly forced to do more administrative work, and to shoulder higher malpractice premiums due to insurance monopolies that charge excessive premiums, thus forcing doctors to spend less and less time with patient care due to the current payor model stressing patient volume vs. quality of care. Things are starting to change as more insurance carriers consolidate. They are not stressing performance but more and more volume, thus increasing insurance company profit margins. Physicians are starting to shun insurance carriers to lessen the paperwork in order to focus more on patient care as they are originally trained to do. The average starting salary in the United States for family physicians is $120,000 to $150,000 a year.

There is a current trend among family physicians to adopt a practice model called the micro practice, or "Ideal Medical Practice". These practices focus on reducing their overhead and increase their utilization of technology. Because the overhead is reduced, the need to see a high volume of patients to generate more revenue is diminished. This allows the doctor to spend more time with their patients, which results in higher satisfaction for the patient and the physician.