The differences that unite us

Family medicine is an amazing discipline. The broad and extensive skill base allows for so many career options. Perhaps the greatest strength of the profession is that family medicine can be so many different things. Our challenge—our choice—is allowing those differences to be our strength or to lead to division and conflict. It’s possible that focusing on differences is part of human nature. I think a career in family medicine offers a good opportunity to recognize similarities and celebrate the differences between the different paths it offers.

I was partway into my first degree, trying to decide what I’d be when I grew up. I was waffling between teacher, researcher, and doctor. A few years later I was accepted into medical school, and I hesitated. I looked further and discovered that doctors could also be teachers and researchers. I could make a decision and remain indecisive.

In medical school I liked virtually all the rotations but my enthusiasm waned for most. Family medicine was the best: complex, diverse, and challenging, with great colleagues and meaningful relationships with patients. Like all of medicine, it presented the possibilities of teaching and research, but it also provided different areas of focus and practice options. Colleagues were delivering babies and providing palliative care, house calls, addictions medicine, emergency medicine, long-term care, comprehensive care, and more—providing any number of these services in part or in full. Some were travelling with their skills—contributing to relief efforts, providing care on cruise ships, fulfilling locums, or acting as doctors for sports teams. The depth and breadth of the skill base required gave us countless options. It was perfect.

Now, decades later, I recognize the differences among the options create problems. For example, there are issues with how physicians are compensated or with inadequate physician supply in different areas of practice. However, to explore the differences even deeper, we need to consider how we as family physicians see our profession’s various career opportunities.

During most of my career, I did comprehensive family medicine. While in the military, early in my career, I got extra training in aviation medicine, hyperbaric (diving) medicine, and addictions medicine to help fill needs in my community. Around the same time, I worked at walk-in clinics to maintain skills in managing younger and older patients. Then I became an academic and although I worked in a clinic 3 days a week, in the eyes of some colleagues I was part of the ivory tower. I have been fortunate enough to have sampled many opportunities within family medicine.

It is in our nature to note differences and compare. That behaviour is important in many ways, such as in finding the right job for each of us, addressing the needs of our communities, and describing our world. Too often we use these differences to draw lines of distinction, to separate “us” from “them.” In family medicine, we have comprehensive versus focused practices, academics versus “front-line” clinicians (non-academics), urban versus rural, etc. And within comprehensive family medicine we can distinguish further: “Do you do deliveries?” “Do you do emergency medicine?” and so on. Even in academia, there are divisions between those doing teaching versus research, or even between what you’re teaching or researching! The ways to divide may be infinite.

In 2011, Dr Iona Heath gave a Harveian Oration titled “Divided we fail.”¹ She referred to the rift between family medicine specialists and other specialists. However, the principles that deepen that rift are the manifestation of our nature to differentiate and divide. It also happens within family medicine too often, for too many reasons.

There are so many challenges facing family medicine, it can sometimes feel like playing Whac-A-Mole. However, internal difficulties, like divisions within the profession, are the ones that should be the easiest to manage. Divided we fail but united we are stronger. We should be celebrating our broad and detailed training and the opportunities it presents. These are our strengths; differences are inevitable, while division and conflict are choices. Let’s lean into our strengths together, and acknowledge and celebrate the different faces of family medicine, which are the reason many of us love the profession. If we can agree on this, we’ll build unity and strength in family medicine—an amazing discipline.

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