I read with great interest and agree with Dr Bailey’s statement regarding family medicine as a specialty (Can Fam Physician 2006;53:221–3). Whether family medicine was a specialty was not a question for me when I decided to specialize in family medicine. However, I think that several factors are contributing to the “non-specialist” stereotype of general practitioners (GPs) in the eyes of medical students when they consider family medicine as a career.
First, the Certification by the College of Family Physicians of Canada (CFPC) differs from the rest of physicians and surgeons. This reinforces the stereotype of GPs by separating family physician from other physicians (Fellows of Royal College of Physicians and Surgeons [FRCPS]) who are the “specialists.” In order to change the stereotype but continue to remain GPs, family physicians should be designated in the same way other physicians and surgeons are. Hence, the Certification in Family Medicine examination should be 1 among other Royal College of Physicians and Surgeons of Canada (RCPSC) examinations and lead to a designation of FRCPS in family medicine.
Second, tremendous efforts have been made to improve financial reimbursement of family physicians, who carry a substantial burden of patients’ care by providing primary, obstetric, emergency, hospital, palliative, geriatric, and other health services. Most rural communities rely almost solely on family physicians. This burden often leads to overworked physicians who, after years in practice, give up previously provided services. In spite of all the improvements to reimbursement formulas for family physicians, the improvements are not comparable with professional (eg, multiple problems per visit, obstetric and other commitments) and new financial demands (eg, electronic medical records, Internet) of general practice. This can be interpreted as a lack of appreciation for the great contribution that family physicians make to health care. This reinforces the stereotype of GPs among medical students.
Finally, patients’ appreciation of family physicians’ services, in addition to medical knowledge and skills, depends on the time spent with patients and the quality of interactions. Often inadequate remuneration limits the length of patients’ visits, and family physicians prefer to refer patients to other specialists for treatment and procedures of minor complexity. This produces an image among patients of a family physician as a referring physician, thus reinforcing the stereotype of GPs in the wider community, including medical students.
In spite of all this, I believe that those who choose family medicine as a career truly represent the specialty of family medicine.
Nevertheless, career choices of graduating medical students will continue to be influenced by this stereotype unless it is changed.
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