Rebuttal: Is family medicine a specialty?: YES

Tom Bailey

As was learned in other countries, the debate surrounding family medicine as a specialty is not one of generalism versus specialization.

In many ways, Dr Hennen has reinforced the point that family medicine merits being recognized in the same manner as other medical specialties. He quotes Morrell in describing family physicians’ breadth of knowledge, reminds us of McWhinney’s and Stewart’s patient-centred method, and speaks of the importance of generalism to our branch of medicine. But many other specialties today also require considerable breadth of knowledge, employ clinical methods, and are increasingly embracing generalism. Rather than relegating family medicine to the sidelines as just another player in this expanding generalist sphere, there is opportunity today to propel our discipline to the forefront, where it can lead all others as the specialty with the greatest expertise in generalism.

Defining a specialty by its limitations is not a valid way to differentiate family medicine from other disciplines. The reality is that many other specialties today see themselves as very broad in scope of knowledge and skills required. At the same time many family physicians are responding to community and patient needs by limiting their own practices—yet still providing comprehensive family medicine services as part of networks or teams with other family doctors. All who practise according to the 4 principles of family medicine can legitimately be part of our specialty.

Acknowledging the discipline of family medicine as a specialty in Canada will not change what happens on the front line of health care delivery. Family doctors will remain “first-contact physicians” and will still provide most of the care for most of the people across Canada. What will change is how the discipline and its physicians are viewed and respected.

In his essay “Family Medicine’s Identity: Being Generalists in a Specialist Culture?”1 Howard F. Stein emphasizes that, unlike the situation that prevailed when family medicine first came to be, specialization today is simply part of our cultural ethos. One can be both a generalist and a specialist.

Family medicine—the bedrock of generalism—should be recognized in Canada as the specialty it is.