Wanting family medicine without primary care

We applaud Dr. Lerner for bringing this forward for open discussion. His article digs at the heart of an uncomfortable conversation that we have been having at the College for quite some time, but are now poised to move beyond. How do we support continuing comprehensive care family physicians while ensuring that we remain the professional home for those with special interests or focused practices?

To be clear and unequivocal from the CFPC’s perspective- there is no family medicine as a discipline without primary care. Dr. Lerner suggests that we have two choices - embrace focused practices OR generalism. This is unnecessarily divisive and misses a critical perspective. The practice of family medicine is not a zero-sum game, but rather nuanced based on context. Our paradigm of practice, while important, is secondary to our responsibility in meeting the health care needs of Canadians whatever that looks like. Take for example the development of our CAC in Enhanced Surgical Skills (ESS). What we have learned from our rural colleagues is that general surgical and obstetrical services are linch pins that keep rural hospitals open and able to offer care close to home. Family physicians with enhanced surgical skills are a key part of this solution in some regions. Our support of comprehensive continuing care should be reinforced but it may look differently across communities depending on the composition of health care teams.

As an organization, we have embraced CACs and their role in providing an enhanced scope of practice within the broader concept of a patients' medical home. In addition, these practitioners contribute greatly to family medicine in the form of teaching and research capacity. Family physicians with enhanced skills have a diversity of practice patterns and are not all in focused practices. Those in focused practice concern themselves with, and are committed to, the aims of comprehensive primary care. Family physicians, regardless of practice pattern, embrace a common approach and philosophy of practice. We take pride in this professional identity and it unites us. These are some of the messages of the new CFPC Family Medicine Professional Profile; a position statement developed with broad input and wide support including the CFPC Communities of Practice (CPFM) Section. Drs. Lemire and Charbonneau elaborate further in their articles appearing in the same February 2018 issue of CFP.

The CFPC Section of "Special Interest Focus Practice" (SIFP), now called the “Communities of Practice in Family Medicine (CPFM”), evolved out of a need to find a practice home for family physicians with diverse practice interests to network, collaborate and conduct scholarly activity. It was a time when debate over generalism verses specialization within the college was quite polarized. The Section was deliberate in trying to bridge that philosophical gap and the last 10 years has seen progress with physicians in focus practice supporting comprehensive family doctors. The majority of members of the CPFM are generalists with a special interest. It is under this premise that CPFM helped create documents such as "The Best Advice Guide" for the Patient Medical Home. This document highlights how special interest physicians can truly fill health care gaps and embellish the group based comprehensiveness that we see evolving in Family Health Teams, Family Health Networks and in many other group practices across the country. There has been a deliberate process at CPFM meetings to engage rural and comprehensive colleagues in moving activities and initiatives forward; from creating an opioid strategy to developing surgical skills to support primary care obstetrics in rural communities.

For medical students trying to decide, we agree that the CFPC should be clear in what to expect from a training program and a career in family medicine. Here goes…Family medicine is a good choice if you are interested and committed to the front lines of care, want to contribute to the health of a community, are dedicated to the primacy of the physician-patient relationship, accept the challenge of being a good generalist and are turned on by the dynamic and responsive ways that these skills can be used (sometimes this means focused practice). If you know now that you are drawn to a very specific dimension of care, and that’s exclusively what you want to do then you are better to choose a specialty targeted at this interest. No hard feelings.

Dr. Nancy Fowler, CFPC Executive Director, Academic Family Medicine
Dr. Frank Martino, CFPC Section Chair, Communities of Practice in Family Medicine
Dr. Victor Ng, CFPC Physician Advisor
Dr. Jeff Sisler, CFPC Executive Director, Professional Development and Practice Support
Dr. Roy Wyman, CFPC Director, Certificates of Added Competence