I address Tom Bailey’s 4 key points: that family medicine has long been recognized as a specialty in many countries; that family medicine has a defined body of knowledge; that generalism is not owned by family medicine; and that acknowledging family medicine as a specialty will enhance the image of our discipline in Canada.
Elsewhere, family medicine’s recognition as a specialty has not had impressive results. Since it was declared a board specialty in the United States, the proportion of US residents in family medicine has diminished. In the United Kingdom, the incomes of GPs are competitive with those of hospital-based consultants and the government recognizes the importance of general practitioners; the sustained strength of UK general practice can be attributed more to these 2 factors than to a claim of specialty status.
I agree that family medicine has a defined body of knowledge.
To say that generalism is not owned by family medicine is a concession we must qualify carefully. Agreed, the Royal College of Physicians and Surgeons of Canada should modify its balance of subspecialties with stronger programs in its general specialties. But none of these practitioners will open their practices to all problems, all ages, and both sexes. Only family medicine offers such unlimited access and hence lays legitimate claim to comprehensive medical generalism.
Calling family medicine a specialty without addressing the real causes of its poor image will not make a difference. The real causes are non-competitive incomes (a problem that will be rectified only when our provincial organizations meet their commitments to us in negotiating fee schedules); the fact that colleagues, residents, students, health administrators, and even some of our own accept put-downs of family practice without challenge; and provincial government department silos (especially in health care and post-secondary education) that fail to collaborate and adequately support the important academic work of teaching and research that is fundamental to achieving high-quality practice.
This debate is about generalism and specialization, and it is about sacrificing the essential generalist function. Because the public recognizes our value and because research shows that countries with stronger primary care have better health outcomes,1 we must proceed as the central generalists in medical system strategic planning and must deal more directly with the real causes of our sagging polls in those several constituencies that notably do not include Canada’s general public.
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