family medicine

Family medicine in USAFollowing World War II, two events shaped the advent of family medicine. First, medical specialties and subspecialties increased in popularity, having an adverse affect on the number of physicians in general practice. At the same time, many medical advances were being made and there was concern within the "general practitioner" or "GP" population that four years of medical school plus a one-year internship was no longer adequate preparation for the breadth of medical knowledge required of the profession.[7] Many of these doctors wanted to see a residency program added to their training; this would not only give them additional training, knowledge, and prestige, but would allow for board certification, which was increasingly required to gain hospital privileges.[7] In 1969, family medicine (then known as family practice) was recognized as a distinct specialty in the U.S.[8]

Family physicians complete undergraduate school, medical school, and three more years of specialized medical residency training in family medicine.[9] Their residency training includes rotations in internal medicine, pediatrics, obstetrics-gynecology, psychiatry, and geriatrics.[10] The specialty focuses on treating the whole person—acknowledging the effects of all outside influences—through all life stages.[11] 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.

In order to become board certified, family physicians must complete a residency in family medicine, possess a full and unrestricted medical license, and take a written cognitive examination.[12] Between 2003 and 2009, the process for maintenance of board certification in family medicine is being changed (as well as all other American Specialty Boards) to a series of yearly tests on differing areas. 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. Three hundred hours of continuing medical education within the prior six years is also required to be eligible to sit for the exam.[13]

Family physicians may pursue fellowships in diverse topics including adolescent medicine, geriatric medicine, sports medicine, sleep medicine, and hospice and palliative medicine.[14] The American Board of Family Medicine offers Certificates of Added Qualifications (CAQs) in each of these topics.[15] Recently, new fellowships in International Family Medicine have emerged. These fellowships are designed to train family physicians working in resource poor environments.[16]

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.[citation needed] In the United States, there is a rising contingent of physicians dually trained in internal medicine and pediatrics, which can be completed in four years, instead of the three years each for IM and pediatrics.[citation needed] 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.[citation needed] One suggested difference is that the IM/Peds-trained physicians are more geared towards subspecialty training or hospital-based practice.[citation needed] Even so, there are groups with FM-trained and IM/Peds-trained physicians working in seamless harmony.[citation needed]

While many sources cite a shortage of family physicians (and also other primary care providers, i.e. internists, pediatricians, and general practitioners)[17], the per capita supply of primary care physicians has actually increased about 1 percent per year since 1998.[18] Additionally, a recent decrease in the number of M.D. graduates pursuing a residency in primary care, has been offset by the number of D.O graduates and graduates of international medical schools (IMGs) who enter primary care residencies.[18] Still, projections indicate that by 2020 the demand for family physicians will exceed their supply.[18]

The number of students entering family medicine residency training has fallen from a high of 3,293 in 1998 to 1,172 in 2008, according to National Residency Matching Program data. Fifty-five family medicine residency programs have closed since 2000, while only 28 programs have opened.[19]

In 2006, when the nation had 100,431 family physicians, a workforce report by the American Academy of Family Physicians indicated the United States would need 139,531 family physicians by 2020 to meet the need for primary medical care. To reach that figure 4,439 family physicians must complete their residencies each year, but currently the nation is attracting only half the number of future family physicians that we will need.[20]

The waning interest in family medicine is likely due to several factors, including the lesser prestige associated with the specialty, the lesser pay, and the increasingly frustrating practice environment in the U.S. Salaries for family physicians in the United States are respectable but lower than average for physicians, with the average being $129,295 [21] and ranging from $110,000 to $204,000[22], but when faced with debt from medical school, most medical students are opting for the higher paying specialties. Family physicians are trained to manage acute and chronic health issues for an individual simultaneously, yet their appointment slots may average only ten minutes.[23] Physicians are increasingly forced to do more administrative work, and to shoulder higher malpractice 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.[citation needed] Things are starting to change as more insurance carriers consolidate.[citation needed] They are not stressing performance but more and more volume, thus increasing insurance company profit margins.[citation needed] 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.[citation needed]

Most family physicians in the US practice in solo or small-group private practices or as hospital employees in practices of similar sizes owned by hospitals. However, the specialty is broad and allows for a variety of career options including education, emergency medicine or urgent care, inpatient medicine, international or wilderness medicine, public health, sports medicine, and research.[24] Others choose to practice as consultants to various medical institutions, including insurance companies.

There is a current trend among family physicians to adopt a practice model called the micro practice, or "Ideal Medical Practice".[citation needed] These practices focus on reducing their overhead and increase their utilization of technology.[citation needed] 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.[citation needed]

kaynak:http://en.wikipedia.org/wiki/Family_medicine