Focused practices, special interests

Richard Denton

I’m not a magician, I’m just an old country doctor.
Dr Leonard H. McCoy, Star Trek (1967)

When I gave up practising anesthesia after 10 years, I did not think I was a real doctor. When I gave up practising obstetrics after 18 years, I did not think I was a real doctor. When I gave up practising emergency medicine after 28 years, I did not think I was a real doctor.

I have argued for comprehensive, general family medicine, but I see that we are now a specialty. Dr Sandy Buchman, when he was president of the Ontario College of Family Physicians, asked about focused practices, subspecialties, and General Practitioners with Special Interests and got an overwhelming response from colleagues who felt marginalized in family medicine. Now we have a great number of subspecialities, as Dr Gutkin described in his December 2009 article.1 Dr Gutkin is old enough to remember the hyphenated Canadian, eg, Italian-Canadian, Irish-Canadian, or Ukrainian-Canadian. Maybe now is the time for the hyphenated family physician, eg, sports medicine-FP, geriatric-FP, anesthetist-FP. The Ontario Medical Association Section of General Practice has resisted this trend, but I now think that it is a good idea and it will give strength to our movement. Having many FPs sitting around the table with each representing his or her subspecialty will make us stronger than having just a few representing us all. Also, when someone asks for more money for his or her small section for something specific, such as a new billing code, it only affects a few of us and is barely a blip on the overall budget; this will add to our billings as compared with our other specialist colleagues.

I would advocate for special recognition of the subspecialties, similar to emergency medicine doctors getting an EM designation beside their names. Any subspecialty requiring an extra year of training (ie, PGY3), should get this as well. Such subspecialties for GPs and FPs, which are different from Royal College specialties, should include geriatrics and anesthesia. Developmental disabilities, environmental and community health (distinct from complementary, occupational, and environmental medicine), alternative funding programs (ie, those doctors in family health groups, networks, teams, and organizations), hyperbaric medicine, and rural or remote practice are other subspecialties to consider. Some of these are already recognized by provincial organizations, such as the Ontario Medical Association.

What constitutes a subspecialty, as Dr Gutkin suggested, 1 should be special training: a recognized third postgraduate year for younger graduates and a grandfather clause for older GPs and FPs, conferences and workshops, and a journal, website, or list server for each subspecialty. Other factors include having special billing codes and having each subspecialty recognized by local provincial jurisdictions.