Family medicine aims to reintegrate and personalize health care for patients, who are increasingly frustrated with the fragmented and complex health care system. It is a deviation from physician-centered traditional models of care, such as specialist care. The family medicine model of care seeks to provide patients with a personal medical home through which they receive a full range of services within the context of a continuing relationship with their family physician.
Family physicians deliver acute, chronic, and preventive care, either directly or indirectly through established relationships with clinicians outside their practice.
The family medicine model of care depends upon:
- Using a team approach to care
- Reducing barriers to care through open access scheduling, expanded office hours, and improved communication between office staff and patients
- Implementing advanced technology and information systems to better serve patients
- Promoting quality and safety
- Providing care in the context of the individual, family, and community
There are many ways to deliver this model of care. Diverse practice settings and emphases exist within the inclusive field of family medicine.
Practice Settings for Family Physicians
Family doctors enjoy a multitude of options for where and how they can practice medicine. These opportunities provide real choice for physicians when it comes to lifestyle, income, and career goals.
Private Practice: Solo Owner or Group
The physician staffing agency Merritt, Hawkins and Associates(www.merritthawkins.com) noted that, in 2007, about one-third of family physicians were in solo practice, while 60% were in group practices of three or more physicians. Family physicians enjoy the career flexibility between running their own practices and working with colleagues in a group setting.
Some physicians elect to be employees of a hospital, community health center, or multispecialty group practice. Not having to pay overhead costs or deal with staffing and administrative issues is appealing to many. It is important to talk with physicians in each setting to better understand the pros and cons of these practice arrangements.
Multispeciality Group Practice
More than 20% of family physicians are part of a practice comprised of physicians from different specialties. Practices may include specialists from family medicine, orthopaedics and cardiology in one building to enhance patient access. One of the advantages of working in a multispecialty group practice is that multiple patient services are provided at one location, enabling better communication and convenience for patients.
Family physicians may choose to practice medicine part-time in order to take care of their families, pursue other interests or prepare for retirement. Part-time practice is economically viable for many family physicians, but can be financially challenging for others. Another alternative to full-time practice is job sharing, one full-time equivalent (FTE) position shared by two physicians who each work part-time. This option is advantageous because it frequently cuts down on paperwork and administrative duties.
The geographic spread of family physicians across the country more closely matches the geographic spread of the general population than any other medical specialty. While 79% of the U.S. population is found in urban areas, 76% of family physicians practice in urban settings. And while 21% of the U.S. population resides in rural areas, 22% of family physicians practice in rural areas. In treating underserved populations, physicians in rural areas encounter illiteracy, poverty, and limited community resources.
The National Rural Recruitment and Retention Network (3RNet)(www.3rnet.org) helps to locate practice sites in rural and underserved areas. The Graham Center’s one-pager on “The Family Physician Workforce: The Special Case of Rural Populations” offers more detailed information about the impact family physicians can make in rural areas. The January 2010 edition of the AAMC’s Careers in Medicine newsletter(www.aamc.org) (PDF) also profiles a rural physician.
The Patient Centered Medical Home (PCMH)
Family medicine seeks to provide patients with a personal medical home through which they receive a full range of services within the context of a continuing relationship with their family physician.
The Patient Centered Medical Home (PCMH) practice model aims to provide greater satisfaction to patients, physicians, and the health care team. Learn about PCMH »
Practice Emphasis in Family Medicine
The broad scope in family medicine training prepares physicians to practice in a wide variety of situations. As a family physician, you’re free to practice your passion, where and how it fits your career and lifestyle goals.
Many physicians choose to join the National Health Service Corps(www.hrsa.gov), which places primary care physicians in medically underserved (often rural) areas, or the Indian Health Service(www.ihs.gov), where physicians currently provide health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 states. Some family physicians consult on grant projects, lead working groups or guide task forces to look at disease epidemiology, health promotion and disparities research. Other family physicians pursue additional training in public health (a Master’s degree or PhD) to become medical directors in county or state health departments.
Hospitalist / Inpatient Medicine
Family physicians possess unique attitudes, skills and knowledge which qualify them to provide continuing and comprehensive medical care to each hospital patient regardless of sex, age or medical problem. They regularly act as the hub of medical care in the hospital, coordinating care and advice between other specialists.
Family physicians can choose to be dedicated inpatient physicians, or hospitalists, on a full-time or rotating basis, depending on the demand and level of inpatient care needed. More than 66% of family physicians choose to have hospital privileges. By having hospital privileges, they can offer continuous care to their patients during hospital stays. Forty percent treat patients who have been admitted to a critical care unit (CCU), and nearly 50% treat those in an intensive care unit (ICU).
Emergency and Urgent Care
Family physicians who have hospital privileges sometimes choose to work exclusively in emergency departments or urgent care centers.
Family physicians often provide the majority of emergency care in rural areas that do not have a designated emergency care doctor.
Family physicians in traditional practice settings enjoy being able to perform a number of office procedures, including: maternity-related procedures (eg, caesarean delivery, ultrasound imaging), procedures related to family planning and early pregnancy evaluation and management, colonoscopies, endoscopies, IUD placement, colposcopies, skin biopsies, suturing lacerations, vasectomies, and more.
By joining the medical school faculty as a professor, clerkship director or even dean, family physicians can incorporate teaching and working with medical students into their career. Serving as a community preceptor, an attending for a clinical rotation or joining a residency program as a faculty member are additional ways that family physicians participate as educators.
International and Wilderness Medicine
Because family physicians care for all people – regardless of sex, age or disease state – they are uniquely prepared to address a myriad of health problems under a broad range of circumstances, including in areas where resources are scarce or in extreme conditions such as those following a natural disaster. Family medicine’s emphasis on community and public health also enables family physicians to do a community assessment in addressing needs.
A growing interest in sports medicine has led some family physicians to take on the role of team physician for various sports (notably football), for which they are well suited because of their ability to treat orthopaedic as well as general medical problems. The AAFP encourages family physicians to serve as sports medicine doctors in their communities, and many family medicine residencies sponsor sports medicine fellowships as well.
All family physicians are trained in obstetrics, and some offer a full scope of maternity care services, encompassing pre- and post-natal care as well as deliveries (including caesarean). In underserved or rural areas, the provision of maternity care may be an essential service that family physicians provide.
Research is an important component of family medicine. Some family physicians collect data about the patients and communities they serve, exploring specific clinical problems or the way in which primary care is organized and delivered. Others may seek opportunities to do research on a full-time basis, as primary investigators of federally funded projects and/or in research positions in academic settings.
For more information on the role of Family Physicians in the provision of health care services contact the American Academy of Family Physicians at www.aafp.org.