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Frequently Asked Questions
Family medicine’s signature attribute is an ongoing, personal patient–physician relationship. Whereas other specialties are limited to a particular organ system, technology, disease, age or sex, family medicine integrates care for each person. Family physicians’ unique contributions to health care access stem from the breadth of their training and adaptability of their work, combined with a sense of social responsibility. Patients value a physician who listens to them, who takes time to explain things to them, and who is able to effectively coordinate and integrate their care. Since its inception, family medicine has been grounded in the core values of a continuing relationship between patient and physician, and the provision of comprehensive care that includes prevention, acute intervention, chronic disease management, end-of-life care, and coordination of care throughout the health care delivery system.
Sixty percent of family physicians care for newborns. About 15% of visits to a typical practice are from children. At the other end of the age continuum, more than 90% of family physicians treat Medicare patients. Most family physicians have a component of their practice outside the office. A large majority (82%) have hospital privileges, and more than 40% manage patients in the intensive care unit or coronary care unit. Of family physicians’ patients who are admitted to the hospital, most are treated by family physicians, their partners or a call group. Other family physicians choose to turn over the care of their hospitalized patients to full-time hospitalist physicians, many of whom are family physicians. In addition to patients treated in the clinic or hospital settings, typical family physicians also supervise the care their patients receive while in nursing homes, home health care or hospices. In some communities, family physicians include a significant amount of maternity care in their practice: 23% of residency-trained family physicians deliver babies, with an average of 2.4 deliveries each month.
The demand for family physicians in the United States has continued to rise since 2003. The Merritt, Hawkins and Associates’ 2006 Review of Physician Recruiting Incentives shows a steady increase in demand for family physicians, with family medicine being the second-most-recruited specialty. Job openings continue to be strong for family physicians. In a recent national survey of hospitals that were recruiting physicians, 45% were recruiting family physicians, whereas 32% were recruiting internists, 21% obstetricians, and 20% anesthesiologists. Similarly, classified advertisements for family physicians increased 12% from 2003 to 2004, and 20% from 2004 to 2005. Demand is expected to remain strong as the U.S. population grows and the need for medical care increases with the increasing prevalence of chronic disease. The mean salary of family physicians in 2004 was $143,600.
Personal rewards of practicing family medicine include the satisfaction of establishing continuous, long-term relationships with patients and partnering with patients in the management of their health. Family physicians gain great satisfaction from the rewards intrinsic to patient care, including a personal connection with and gratitude from patients.
Rewards of practice for Family Physicians include a role in integrating patient care; communicating with patients, listening to their secrets and fears, and educating them regarding their health status and care options; generating relevant new knowledge through practice-based research; intellectual stimulation from the variety of scope of family medicine; networking with other practices to provide the best care for their patients; opportunity to provide effective practice administration to support patient care; opportunity to make a difference in the lives of patients, their families, and their communities; opportunity to work in multidisciplinary teams to achieve better health outcomes; and using new information technology to deliver and improve care
Family physicians enjoy the challenge of making the right diagnosis from what may seem to be a series of unrelated and often vague symptoms. Family physicians are highly valued for their diagnostic and patient-advocacy skills. Providing care for patients throughout their lives helps ensure they get appropriate screening and preventive services well before they have established disease. Family physicians take pride in their ability to help patients understand the varied and subtle ways in which a person’s health affects the family and community.
In addition to routine inpatient and outpatient care, family physicians perform a wide range of procedures. Most family physicians (82%) perform skin and nail procedures; 35% regularly perform colposcopy; and 35% perform flexible sigmoidoscopy. Family physicians receive training in a variety of procedures, including joint injections, paracentesis, thoracentesis, intubation and advanced life support, ultrasonography, stress testing, colonoscopy, esophagogastroduodenoscopy, vasectomy, tubal ligation, cervical cancer treatment (loop electrosurgical excision procedure [LEEP], cryotherapy), and pulmonary function testing. Family physicians also receive training in maternity care, which includes prenatal management, intrapartum procedures, delivery, and management of maternal and neonatal complications.
Family medicine residencies, like pediatric and internal medicine residencies, last three years. Hospital training occurs during each year of family medicine residency training. Family medicine residents work and learn throughout the hospital, in the emergency department, labor and delivery department, the operating room, and intensive care units, and on numerous general and specialty wards. Family medicine residents care for their continuity patients in a supervised group practice at the residency clinical offices. Residents are assigned a panel of patients and provide continuous care for those patients throughout their training, including inpatient care, maternity care, and hospice care when necessary. Family medicine leads the primary care disciplines in outpatient continuity clinical hours. Behavioral science training, counseling, and community outreach are all features of family medicine residency training. There are more than 460 family medicine residencies in the United States. Combined residencies are hybrids of two residencies (e.g., family medicine and psychiatry, family medicine and internal medicine).
Med-peds programs combine three-year residencies in internal medicine and pediatrics into one four-year program, with most med-peds physicians pursuing subspecialty fellowships. The Accreditation Council for Graduate Medical Education does not accredit combined programs as one program but maintains the specialty distinction of the two programs. Graduates of combined programs are eligible to take two certification examinations, according to the expectations of each of the two specialties.
Traditionally, in university-based programs, family medicine residents train alongside residents in other specialties. Residents in university-based programs regularly have the opportunity to teach medical students. Community-based residency programs traditionally are in smaller hospital settings, where family medicine may be the only residency and student contact may be less than that in university-based programs.
Some students think family medicine residents in community-based programs are first in line for admissions and procedures and have more opportunities for supervisory roles, whereas family medicine residents at a university gain exposure to the latest innovations and research discoveries and have more opportunities to develop as teachers. However, these broad characterizations are often inaccurate. Students should decide which overall context will be the best for them, considering factors such as setting (rural or urban), program size, region, patient populations served, and procedural training offered. Most advisers recommend that students look at both university- and community-based programs in their research.
Family physicians have a variety of advanced training options open to them after completing residency training. Common reasons for pursuing advanced training include a desire to obtain research training, preparation to enter academics, and gaining more in-depth clinical skills to offer in one’s practice. Fellowship programs in geriatrics, sports and adolescent medicine lead to a certificate of added qualifications (CAQ) from the American Board of Family Medicine (ABFM). Successful CAQ candidates must be certified in family medicine. Other fellowships that are popular among graduates of family medicine residencies include faculty development, maternity care, preventive care, research and palliative care. Many of the fellowship programs listed in the directory are customized arrangements made between an institution and the trainee.
Family medicine was the first specialty to require continuing medical education (CME) of its members. Family physicians must earn a minimum of 50 CME credits annually; this training enables them to continue to learn and keep up with medical advances throughout their careers. CME is required for board certification in family medicine and for hospital and practice privileges in many locales. CME is delivered to family physicians through live courses (for new knowledge and for adding procedures to practice) and published materials (print, audio and video). Family physicians are increasingly obtaining CME through the Internet, where all types of CME are delivered.
Family physicians receive broad medical training that prepares them to care for patients in a wide range of settings. With good training, family physicians are competent to practice in a large hospital with many health care resources or in an international or wilderness environment where resources may be scarce.
Americans in rural areas depend on family physicians to deliver care in the communities and remote locations in which they live and work. The geographic distribution of family physicians is similar to that of the U.S. population: 24% of the population lives in communities of fewer than 10,000 persons, and 23% of family physicians practice in such communities. Without family physicians, many U.S. counties would be health professional shortage areas (HPSAs)—geographic areas, population groups, or medical facilities that the U.S. Department of Health and Human Services determines to be served by too few health professionals of particular specialties. If all family physicians were withdrawn, 58% of U.S. counties would become primary care HPSAs (PCHPSAs); in contrast, only 8% of counties would be PCHPSAs if all general internists, pediatricians, and obstetrician-gynecologists were withdrawn. Among physicians working in U.S. emergency departments, approximately 30% completed family medicine residencies.
Medical education debt has increased significantly in the past 20 years. According to the Association of American Medical Colleges (AAMC), the median level of debt of medical school graduates in the class of 2005 was $120,000, including undergraduate loans. The median level of debt of family medicine residency graduates in 2004 was $145,300, according to the AAFP. Medical education financial aid differs from financial aid for any other professional group of students. There is a wide and at times confusing array of options: government (direct) loans, Federal Family Education Loan Program loans, internship/residency forbearance, economic hardship deferments, scholarships, service commitment scholarships, graduated repayment plans, and extended repayment plans. Students and residents should consider the impact of debt and seek out the best information and advice. The most important source of information is a good-quality loan exit interview, which is required at all U.S. allopathic and osteopathic schools for all students with a federal loan. Financial aid officers have become extremely important resources for medical students, and their expertise should be sought out whenever questions arise.