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Medical students frequently have questions about the specialty of Family and Community Medicine.  After all, what are the boundaries, if any, of Family Medicine and what do Family Practitioners actually do?  The actual practice details between Family practitioners often vary, according to their geographical locale and the population served, although the broad principals of practice are the same.  Listed below is a collection of questions about Family and Community Medicine that are often asked.  If you do not find your question in this list, or seek a more elaborate answer, please contact the department.

 


What is Family and Community Medicine?

The American Academy of Family Physicians (AAFP) defines a Family physician as one who is trained and educated to provide comprehensive medical care, health maintenance and preventive medicine services to all members of the family regardless of age, sex and the type of problem - i.e. biologic, behavioral or social.  

As the name suggests, the emphasis of a Family physician is on the Family and not just disease process or pathophysiology.  Family Medicine requires it's practitioner to be not just a clinician, but also an advocate, coordinator, counselor , information resource and at times support for their patients.  

By breaking free from the limitations of age, sex and type of problem in defining their scope of practice, Family physicians are in an unique position to understand and treat the protean manifestations of clinical, behavioral and psychosocial problems across  the entire frame of a lifetime.

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In what settings do Family Practitioners work?

The clinical settings in which Family physicians work are as varied as the scope of their practice.  Most often, Family physicians work as solo or group practitioners with both office and hospital care of their patients.  The also work in emergency departments, hospitals, nursing homes, sports fields, occupational health sites and industry and the family home!  

Family physicians who develop a special interest in certain fields also work in substance abuse and detox programs, assist surgical procedures in Operation rooms, do outpatient or office procedures and also work in Labor and delivery suites.  Some physicians choose career paths in administration, public health or teaching.

Family physicians have work schedules that vary considerably.  On an average, Family physicians work 53 hours per week with about 80% of this time spent in direct patient care.

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What is involved in Family Medicine Residency training?

Family Practice residency is a structured three year residency program, that provides future family physicians an integrated inpatient and outpatient learning experience. Different residencies provide varying opportunities to develop specific office procedural skills.  Some programs emphasize urban population care while others emphasize a rural training track.  

In 1998, there were 475 accredited programs for Family Practice providing more than 10,500 residency positions.  Feedback from graduating residents suggests that satisfaction with Family Practice residencies tends to be high.

The three years of training teaches residents how to comprehensively manage the multiple problems of patients and their families.  It also emphasizes the need to build long term relationships with patients and their families, over time.  Efficiency with regards to time and cost management are emphasized.

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How do you specialize in being a generalist and will I ever learn enough?

On looking at the wide spectrum of disease entities and psychosocial issues that are dealt by a Family physician, it is understandable to ask - How will I ever know all of that?  The truth is, Family medicine is based on continuity of care.  The patient-physician relationship is central to this process.  The Family physician focuses on treating the patient rather than just a disease entity and such treatment is uniquely affected by the individual circumstances of each patient.  

Most Family physicians find a very comfortable balance between the knowledge of clinical medicine and knowledge about their patients.  The AAFP encourages continuing medical education (CME) activities to keep abreast of the new developments in both principles and practice.  

Family Practice was the first specialty to require CME and the first specialty board to require periodic recertification.  As in any medical specialty, Family physicians continually add to and reinforce their knowledge base with clinical practice and teaching experience.

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Can I train further, or develop a special interest in one area of my field?

Family physicians can go on to developing a special interest in any of the areas in their field.  Fellowships after residency are available to develop a particular area of interest.  Types of Fellowships that are available include Sports medicine, Geriatrics, Obstetrics, Adolescent medicine, Preventive medicine, Faculty development, Substance abuse, Rural medicine and research.  Many Family physicians also develop interest in areas of alternative or complementary medicine.

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How is Family Medicine different from other Primary care specialties like Med - Peds ?

Unlike Family medicine, dual certification programs emphasize on hospital based or inpatient medicine.  There is much less emphasis on continuity of care.  

Only about half of the physicians in Med-Ped programs end up practicing both medicine and pediatrics.  In contrast more than 90% of Family Practice residents practice Family medicine on graduation.  There is no evidence that shows that graduates of combined programs are more effective in practice or obtain more privileges than Family physicians. 

In addition to this, graduates of dual programs often need to maintain board certification status in both their boards to satisfy the requirements of managed care organizations.  The number of dual programs for Med-Peds is approximately 100 with a residency training that is four years in duration.  Managed care organizations consider Family physicians to be the specialist of choice because of their breadth of skills, quality of care provided and their skills in preventive care.

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What is a Family Physicians lifestyle?

Family physicians lifestyles are as varied and diverse as the scope of their practice.  Most surveys show Family physicians to be amongst the most contented in their professional and personal lives.  Not being dependent on a hospital for treating the majority of their patients gives Family physicians far greater flexibility and control of their time. Being Family and community oriented in their practice, most Family physicians find a satisfying balance between personal and professional life.

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What is the average income of a Family Physician?

The 1990s have seen a tremendous spurt in earnings for Family physicians.  Family physicians led the list for advances in income amongst all primary care disciplines.  In addition to this newly graduating Family physicians start at a higher initial earning than more established physicians.  Many underserved communities offer loan forgiveness programs to attract family physicians.  Given the wide variety of practice arrangements available, Family physicians can expect to achieve a comfortable lifestyle and pay off student loans.

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What is the future of Family Medicine?

With the profession of medicine changing ever so rapidly, it appears that Family physicians are faring better than most physicians in the evolving medical environment.  The increase in demand for Family physicians is certainly linked to their cost effective care, their ability to coordinate care and their wise and effective use of resources.

Opportunities and challenges for Family physicians are perhaps more than for any other specialty.  Family physicians are suited for practice in the smallest and largest of communities.  Their challenge is to ensure that all Americans have access to effective primary care.

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