What does a Family Physician do?

What does a family physician do? I am asked this question regularly today. Much more often than 20 years ago. Everyone knows that specialty medicine has been growing for years. Unfortunately, even family physicians have begun to specialize. Hospitalists, sports medicine, urgent care, and ambulatory medicine are just a few of the areas that family physicians have gravitated to over the years. The family doctor is rapidly moving towards extinction. My partner Jim Long, PA-C and I are trying to stop this trend in Williston.

According to the American Academy of Family Medicine (AAFP), the definition of family medicine was updated in 2005 to the following:
A 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.
In 2008, the AAFP expanded their definition with the following:
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.

When I came to Nature Coast Regional Health System, fragmentation of the local healthcare delivery system was evident. Most of the physicians in the area were practicing ambulatory medicine only. Adults were seen in some practices and children went to others. The hospital in Williston had only 1 physician on its medical staff. Admissions to the hospital were far and few between. Patients told me that they were traveling to Gainesville 30 miles away to get their diagnostic studies, labs, and specialty medical care. Williston is a rural community. Where was the family doc?

A great deal is changing at our health system nine months later. Comprehensive, continuous, patient-centered care is becoming the norm. Patients' are happy to get as much of their care by their family doctor (i.e., me and Jim) as can be provided in Williston. Patient admissions to the hospital are up. Patients are getting their labs and diagnostic studies (i.e.,x-ray, ct scan, ultrasound, labs, etc) in our hospital. Specialty medicine has come to Williston (e.g., Orthopedics) to see patients in our family health center. Complementary and alternative medicine is finding its way to Williston, as well, with chiropractic, acupuncture and midwifery setting up shop in our family health center. Unattached patients ( i.e., patients without a family doctor) are joining our practice after admission to the hospital because they understand the value of having "their family doc" attend them regardless of the venue for medical care. This is how following the principles and practices of healthcare stewardship can make a difference with respect to quality, cost and access. Providing evidence-based medicine in a lower cost venue with easy and friendly accessibility to health care services is healthcare stewardship at its best. Healthcare stewardship requires primary care physicians to be able to function at the patient level, health system level and population level. What are the health care functions provided by primary care that will contribute to healthcare stewardship? More on this later in my next blog.
Dr. Dale