The AAFP’s e-mail discussion list on practice management has recently carried some dialogue about specialists who disparage family physicians, denying the claim that family medicine can be a specialty. (Yes, that again.) A specialist, it has been said, is someone who knows more and more about less and less, until finally he knows everything there is to know about nothing at all. It’s childish, but I often think about that definition when I hear a subspecialist in whatever badmouthing family physicians. There’s something appealing about the implication that the mind can only hold so much – that as you learn more about X, you necessarily know less about everything else; that as you get deeper, you get more narrow-minded. I suppose the specialist with a childish bent would turn it around and say that a generalist is someone who knows nothing at all about everything in the world. I frankly don’t think that position is defensible, but it’s fun to think about.

Actually, the specialist in whateverology who looks down on “family practitioners” is demonstrating a fundamental misconception of the nature of specialization. A specialist, it seems to me, is someone who is trained to do a specific kind of job better than anyone else. The difference between whateverology and family medicine is simply the kind of job involved, and any attempt to transmute that into a difference in status just betokens ignorance or insecurity.

If I may indulge in some of the mental geometry I started with, it seems to me that the mental sphere of a family physician is just that: a sphere. It’s wide enough to encompass a significant breadth of knowledge, but not so wide that it doesn’t also permit reasonable depth. And it’s just as capacious as the whateverologist’s deep but narrow slice of knowledge. One often hears in discussions of family medicine that a special part of the family physician’s mental equipment is a knowledge of where his or her limits are: Family physicians know when to call in another physician. That’s certainly important, but I hope it’s not unique to family physicians. It should certainly not be taken as an indication of special limitations. Our whateverologist had better know his limits just as well. He could do a lot of damage if he didn’t. After all, could he do your job? Not without further training. The poor guy is undereducated.

The Future of Family Medicine is upon us

Family physicians have been trying to educate the medical establishment about family medicine and carve out a place for the specialty for more than three decades now, and so far the results are mixed. But something new is coming, and it’s going to be big. The publication of the report of the Future of Family Medicine (FFM) project as a supplement to the March/ April issue of the Annals of Family Medicine¹ marks the beginning, not the end, of a massive, specialty-wide effort to redefine family medicine, or rather to redesign and redefine it, in a way that everyone can accept and honor – not just the whateverologists, but also insurers, patients, government bureaucrats, the public and family physicians themselves. Whether the FFM vision is realized or not, the effort to make it real will be enormous. It has all the major national family medicine organizations behind it, and if they have their way, the changes ahead for the specialty will be as significant as those that accompanied its birth.

Jennifer Bush’s article, “Recommendations for the Future of Family Medicine,” page 34, provides a good introduction to the future toward which the specialty is striving. If you haven’t already read the report itself, this is a good place to start. Bush lists the 10 major recommendations that the national family medicine organizations have already started working to implement, and she does a good job of putting them into perspective. But there’s more – a good deal more. Be sure to read the FFM supplement to the Annals. Chances are good that you’ll get a copy, either with the journal or in a special mailing, but you can also get to it easily online at http://www.annfammed.org.cgi/content/full/2/suppl_1/S3. You need to know what’s in this report. It may be what’s in your future.