Focused practices are complementary to comprehensive care

I take issue with Dr McElroy’s letter published in the December issue of Canadian Family Physician, “Erosion of comprehensive care and professionalism.”¹

Many of our colleagues have already taken to Twitter and other social media to express their concerns. I will, however, reserve my comments for his take on focused practice, which I have provided below:

One can still play a very important role in primary health care while having an office-only practice. Unfortunately there seems to be a trend of too many FPs opting for a narrow field of practice (a field that might not deserve focus), thus reducing the number of FPs providing comprehensive care. I am not referring to emergency medicine physicians or hospitalists. Family physicians who wish to offer focused care should only be permitted to do so after 5 years of comprehensive care. They should then be obliged to also continue to provide comprehensive care to their core patients.¹

In November 2018, I was honoured that the Hospice of Windsor and Essex County was named as the Ontario College of Family Physicians Family Practice of the Year for focused practices. It is the first time ever that a focused practice was recognized for this achievement. Providing high-quality palliative and end-of-life care 24 hours a day, 7 days a week, 365 days a year to community-based and hospice patients is a privilege. I and the other 9 focused-practice family physicians in our group see nothing unfortunate about this. By mentioning only emergency and hospitalist medicine, Dr McElroy either does not approve of a focused practice in palliative care or simply omits to mention it. While Dr McElroy might not feel that some fields are deserving, my patients are certainly deserving of the care we provide for them. I, for one, see all focused-practice physicians as complementary to our comprehensive care colleagues and find these type of comments to be unproductive, maybe even unprofessional themselves. We would all be better off moving forward together and working toward providing the best possible care for our patients.

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