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FAMILY MEDICINE

Michael Mendoza and Zoe Gravitz

The specialty of family medicine encompasses such a wide range of clinical care that it is difficult to define a single scope of practice within the discipline. Most physicians manage a harried clinic full of adults, children, and elderly in varying states of wellness and sickness while some devote their time to high-risk obstetrics and operative deliveries. Many others are actively engaged in research, health policy, and community advocacy. In the tradition of this community-based specialty, family physicians are well integrated into their communities and actively address issues in their patients’ lives other than medical problems. This is why family physicians serve as advocates—for patients, health care systems, and social change. No matter the role, these specialists in family medicine emphasize health maintenance, disease prevention, and chronic illness management, always aware of the psychosocial dimensions of their patients’ lives.

As national focus on health reform heightens, now is an exciting time for students interested in pursuing family medicine. As the most highly recruited medical specialty for the last 10 years,1 there is growing recognition of the important role family physicians play in creating and maintaining healthy communities. With the expanding popularity of family medicine comes more practice versatility and geographic flexibility for those in the field, and an increasing need to develop and apply innovative practice models. It is an exciting time to be a family physician.

DEFINING THE SCOPE OF PRACTICE

The American Academy of Family Physicians (AAFP) defines family medicine as “the medical specialty [that] provides continuing and comprehensive health care for the individual and family . . . [and] integrates the biological, clinical, and behavioral sciences.”2 In essence, there are few limitations to what family physicians can do when it comes to practicing medicine.

It is no wonder that many medical students contemplating a career in family medicine have some trepidation about assuming such a breadth of practice in a single specialty. For others, this very breadth of practice is motivation to select family medicine as their career. No other specialty can possibly match family medicine when it comes to its diverse practice environments, wide spectrum of patient demographics, and embrace of the entire breadth of clinical medicine. Being a family physician requires the ability to solve challenging problems of all organ systems, to take comfort in your scope of knowledge and practice, and to accept universally all factors (biological, clinical, and behavioral) that can affect your patients’ physical, emotional, and mental state of wellness.

Because of the wide diversity within this specialty, the specialty of family medicine is responsible for most of the health care delivered in the United States. In 2014, out of the 890 million patient visits to physicians, 21.8% of visits were with general and family physicians, compared to 14.3% with general internists and 11.0% with general pediatricians.3

As a family physician, you will draw your clinical knowledge base from internal medicine, obstetrics–gynecology, pediatrics, psychiatry, and surgery, among other areas. You may wonder how specialists in these specialties can require 3 to 7 years to master any one of these fields, while family physicians spend only 3 years on all of the above. The answer: as all residents discover upon entering the world of practice, completion of residency confers upon its graduates’ competency, not mastery, in an area of specialty. A physician who receives training in family medicine can competently manage patients presenting with diverse clinical and social complaints and also speak confidently about the nature of that complaint and how to diagnose and treat it. No properly trained graduate in family medicine or in any other specialty, however, will be able to say that he or she knows everything. The competent family physician knows what is within his or her practice and similarly what is not. It is worth mentioning that some family medicine training programs offer a fourth year during which residents may obtain additional exposure to focused areas of clinical or scholarly interest.

The ability to manage a variety of problems is the cornerstone of clinical family medicine. Unlike a specialty setting where patients arrive with a referral for a specific problem, patients often present to family physicians with what may seem to be vague symptoms—weakness, dizziness, lower back pain, or abdominal pain. The competent family physician must elicit the correct information and obtain the proper clinical data to make the correct diagnosis, initiate the proper treatment, or make the appropriate consultation. If the problem at hand is beyond their experience or knowledge, they initiate a referral to another specialist. Although referral rates to subspecialists across all primary care specialties have increased in recent decades, the vast majority of office visits to family physicians do not result in a specialty referral.4 Family physicians not only diagnose but also are able to treat most clinical problems in the outpatient setting.

The academic challenge of family medicine is that you must be content knowing something about everything, but not everything about anything. It comes as no surprise that family physicians must be adept at approaching the widest variety of clinical complaints. Compared to all other specialties, patients identify family physicians most commonly as their usual source of care for atherosclerotic cardiovascular disease (56%), stroke (56%), hypertension (63%), diabetes (67%), cancer (60%), COPD (62%), asthma (58%), and depression (62%).5 In addition to these chronic illnesses, family physicians provide health maintenance services which include pediatric anticipatory guidance, women’s health, preventive screening, and end-of-life care.

Family physicians are most commonly identified as patients’ primary care physician. In a recent analysis of outpatient visits, 46.3% of visits to a primary care physician were with a family physician, 30.3% were with a general internist, and 23.3% were with a general pediatrician.6 In addition, family physicians often see patients with a variety of symptoms but no pre-established diagnosis. Forty percent of patient visits to family physicians are for reasons not listed among the 25 most common complaints in primary care visits, reflecting the broad scope of family medicine and the diversity of its diagnostic challenges.7 From the patient’s point of view, one key advantage of having a family physician is that the patient can receive the vast majority of his or her preventive care, chronic illness care, and preventive services from one physician without having to visit a variety of specialists who might provide a subset of these services independently.

Providing continuity of care often takes form in settings outside the traditional outpatient clinic setting. For family physicians, this means the opportunity to participate in a wide range of a patient’s clinical care, including hands-on procedures and a variety of inpatient types of care. There are many office-based diagnostic tests that family physicians perform, such as electrocardiography, excision of suspicious moles, endometrial biopsy, spirometry, vasectomy, colposcopy, and obstetrical ultrasound. In addition to office-based minor surgical procedures many family physicians are trained in and perform more involved operative procedures, either independently or with consultation with a surgeon. If you choose to include obstetrics as part of your practice, you will definitely have a lot of hands-on work delivering babies and even performing caesarean sections (depending on your training, experience, and community). Family physicians receive training in intensive care and emergency care as well. In a survey of family physicians, more than 15% of the respondents reported regularly caring for patients in intensive care units. In addition, over 30% of them care for patients in emergency room settings.8

SPECIALIZING IN PRIMARY CARE AND GENERALIST MEDICINE

A common question that students ask is “How can one be a specialist in generalist medicine?” The answer to this is that providing comprehensive primary care to patients of all demographics requires specialized knowledge in the diagnosis and treatment of the breadth of undifferentiated clinical problems. A career in family medicine, however, goes far beyond understanding a breadth of clinical problems. Over a span of months or years, the emphasis during office visits is on continuity, prevention, and health maintenance (unlike specialty clinics or inpatient settings where visits are sporadic or single problem focused). For example, family medicine encourages you to think comprehensively about a patient’s abdominal pain, not simply as a pathologic process that can be medical or surgical in etiology, but rather as a manifestation of an occurrence in a person’s life. It may be acute or chronic and may have resulted from any number of medical, surgical, or social factors that greatly impact that person’s ability to function in his or her job, family, or spiritual life. So the practice of family medicine, with its many dimensions of medical care, is as much a philosophy or an approach as it is a body of medical knowledge or a clinical skill.

As generalists, family physicians have a special focus on disease prevention. They derive great satisfaction from preventing illness—just as much as they do in treating it. Routine physicals, well-child checkups, school and camp physicals, and cancer screenings are all important examples of this type of care, and they are especially meaningful when they occur in the setting of years of continuity with the patient and family. Family physicians epitomize what primary care medicine is all about: preventing illness, maintaining health, managing a person’s total care, and being the entry point into the health care system. They also practice cost-effective medical care, taking into account the scientific and clinical evidence, the patients’ specific medical needs and preferences, and the values of the patients and their families. As generalists, the skills and knowledge they need differ according to the patient population of the particular community. For instance, family physicians working in the inner city have to address different types of problems than those working in rural geographic areas.

Inevitably, physicians responsible for family-centered primary care confront complex interpersonal social and behavioral issues. As such, all residency programs include family and individual therapy as part of training. For example, if a child presents with enuresis and encopresis (inability to control urination and defecation) at the age of 12, it would not be uncommon for other family members to feel some effect of their loved one’s medical concerns. For instance, a parent may suffer from depression while attempting to cope with this situation. Other siblings may feel alienated if the focus of the family turns heavily toward one individual, perhaps further exacerbating the situation. Although pediatricians and internists are well trained to address the individual concerns of the children or adults, in this scenario the family physician is uniquely trained among primary care physicians to handle the behavioral and medical concerns of everyone involved. In addition to referring to an appropriate behavioral specialist, the family physician may have a family visit to explore the entire context of one family member’s condition.

Due to their large numbers and broad medical focus, family physicians contribute immensely to public health and primary medical care. For instance, in areas of the country with a large supply of primary care providers, colon and breast cancers are more likely to be detected at earlier stages, leading to higher cure rates.9,10 Furthermore, countries with the best health care systems (as measured by longevity, infant mortality, and patient satisfaction) have the highest percentage of family physicians.11 Socioeconomic status, however, is the only powerful factor that surpasses access to a family physician as a predictor of a person’s health.12 Although the relationship between physician workforce composition and the state of health care is complex, there is clearly a positive association between access to quality primary care and improved health outcomes.

The United States relies on family physicians more than any other physician to supply primary health care to underserved areas. The federal government designates health personal shortage areas (HPSAs) based on the shortage of primary care physicians per capita; namely, a ratio of people per primary care physician greater than 3500 to 1. As the demand for primary care continues to increase across the nation, the projected shortage of primary care physicians will continue to an even greater degree.13

THE DOCTOR–PATIENT RELATIONSHIP

The long-term relationship between family physicians and their patients is one of the core aspects of this specialty. The level of bonding can be intense. Family physicians typically spend every appointment discussing issues in their patients’ lives that may not seem to have anything to do with their current complaint. Family physicians guide patients through illnesses, problems, and other landmarks of life, from delivering babies to controlling high blood pressure, from treating cancer to coping with the loss of loved ones. In these relationships, patients develop great trust in their family physicians. You learn about their hopes, dreams, and fears. You are with them through both good times and bad. This privilege is like none other in medicine and is not found in other specialties quite like it is in family medicine. Many patients consider you part of their family, especially if you are a family physician practicing in small, intimate communities where everyone knows each other.

Only in family medicine does continuity with patients span the entire life cycle and all the biological and social influences that bear upon it. It is not uncommon, for example, for a family physician to deliver and care for multiple generations of newborns in a single family. Even within the context of a single medical problem, the primary care physician is the one who integrates contributions from various specialists into a single treatment strategy. After establishing a plan and passing the acute phase of a disease, family physicians are able to manage most of these conditions. Specialists in different organ systems, although their contributions are invaluable, typically do not provide ongoing comprehensive care for patients with medical conditions outside their specialty.

As you can see, family physicians have the unique opportunity to care for all the members of a family simultaneously. It is common, in fact, for a family to present for care as a whole, with the family physician caring for all members in the clinic room at once. When emphasizing preventive measures, the family unit is a key consideration. A family with a long history of diabetes and high blood pressure, for example, will cue the family physician to emphasize proper nutrition and exercise as a means of primary prevention for all members of the family, not simply those who might currently have risk factors for cardiovascular disease. You cannot simply educate a teenager about exercising or avoiding an unhealthy diet without addressing the eating habits and psychosocial dynamics of the entire household.

Family physicians are also often called upon to initially manage complex medical problems in the context of “the family.” If, for example, an adult family member is diagnosed with a condition thought to be hereditary, the family physician may already have clinical relationships with other family members. They can easily encourage them to seek appropriate counseling and diagnostic testing. Although physicians in other specialties certainly participate in family-centered care, family physicians are often more likely to know other family members. Family physicians know that their relationships with patients are special because they take into account everything about the patient when making clinical diagnoses. Listening to their symptoms and examining for physical signs of diseases are just the beginning.

Family doctors pay close attention to the patient’s feelings, look at his or her behavior, and take into account the patient’s social and family history. If a patient presents with fatigue, an astute family physician will consider medical diagnoses while also looking for clues in the patient’s home, family, job, or other relationships that might suggest a mental health or behavioral concern.

Not all of your patients will require chronic medical care. Some just have problems that are bothering them and need someone to talk to and express their feelings. When it comes to caring for patients, a good family physician knows when to “wait and see” and is not overly aggressive with tests and treatment. In family medicine, medicine is not always about ordering blood tests, prescribing medications, scheduling procedures, and giving referrals. Many times you are simply there for your patient as a compassionate human being who can provide simple reassurance when it is appropriate to do so.

LIFESTYLE CONSIDERATIONS AND PRACTICE OPTIONS

Lifestyles in family medicine are as varied as the specialty itself. The practice of most family physicians centers on comprehensive ambulatory medicine. By seeing dozens of patients every day in the clinic, you will lead a very busy life. Work schedules of course depend on the type of group and practice setting. Most are flexible for part-time work, maternity leave, and shared practice arrangements. In group practice, you do not have to take call all the time after office hours. You will instead share call with the other members of your group and cover its entire patient base. But the inpatient side of the practice is also important. Many family physicians choose to round on their patients who require admission to the hospital. If a patient is ready to deliver a baby, and your practice includes obstetrics, you may have to leave what you are doing—whether seeing a patient in clinic or having dinner with your family—to deliver the baby at the hospital. Thus, the lifestyle is very dependent on how much inpatient and obstetrical responsibility you choose to carry.

Some family physicians choose comprehensive practices involving obstetric care and surgical activities, whereas others define their scope more narrowly. Some may be the only physician for a large population, whether it is a rural community, an underserved urban community, a nursing home, or a Native American reservation. Those who practice a narrower scope of medicine may work within a multi-provider arrangement with specialists from other fields. In the last decade, there has been a gradual trend among family physicians toward practicing in larger groups. In 2007, 60% of family physicians were in group practices of three or more physicians and more than 20% of family physicians were a part of a practice comprised of physicians from different specialties.14 In a larger group setting, a family physician’s practice may focus on pediatric, adolescent, or adult populations while still emphasizing family care, prevention, and education.

Because the role of the family physician in health care today is as complex as the specialty’s scope itself, family physicians are often faced with the question of whether additional training beyond residency is necessary. Although many family physicians supplement their residency with additional training in clinical subspecialties, public health, or business, it is certainly not a requirement to practice good family medicine. Many physicians discover ongoing training by learning what is necessary to care for a particular patient or population. Others choose to devote time to their families and extracurricular pursuits. Although the years of residency are rigorous, the life that follows for many is one of immense possibility, filled with the same complexity and life-long inquiry as in any other medical specialty. You can find family physicians heading local departments of public health, conducting health services research, leading national movements for universal health care, or seeing dozens of outpatients a week in a local practice. Most enjoy a good degree of free time, autonomy, and increasingly competitive financial compensation packages that allow them to comfortably integrate their personal and professional goals.

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MEDIAN COMPENSATION

    Family medicine (with obstetrics)

$256,898

    Family medicine (without obstetrics)

$234,706

Source: American Medical Group Association.

For many family physicians, the broad education and emphasis on systems-based (rather than individual-based) delivery of care provides the ideal foundation for a career in public health. Although formal graduate-level training is not a prerequisite to such a career, a master’s degree in public health affords one a certain level of legitimacy among public health professionals. Within this field, the possibilities for career development are endless. Family physicians often work as directors of public health in the same underserved areas where they developed their practice or were trained as a resident. Others become more involved in community-oriented primary care, effecting local changes to strengthen a particular group’s capacity to access care and prevent illness. Yet others may find their calling in a joint academic appointment in a medical and public health school, helping to shape future health professionals’ thinking about communities and society.

FUTURE CHALLENGES FOR FAMILY MEDICINE

Although today’s health care system challenges all physicians to be flexible when caring for their patients, some challenges are unique to family medicine. The core-defining philosophies of family medicine—comprehensive, continuous, coordinated, and patient-focused care—are often inconsistent with the apparent goals of the current health care system. For instance, some patients and payers seem to value incidental medical interventions without continuity of provider over the relationship-based and more cost-effective care of family physicians.15 In this era of health system reform, family medicine and primary care specialties in general have grown crucial in achieving the Institute for Healthcare Improvement’s triple aim: improved patient experience, reduced cost, and improved population health. It has been well documented that countries that have greater capacity to provide primary care enjoy improved outcomes and it is equally clear that increased spending on health care does not guarantee better care. In order to reduce spending while improving outcomes, health systems have looked to primary care to make improvements, yet primary care clinicians still depend on traditional fee-for-service reimbursement models to remain viable.

In an effort to maintain quality while exploring new ways to contain cost, most practices have discovered the need to revisit old assumptions about how to provide primary care. One paradigm for re-envisioning care is captured in the “Ten building blocks of high-performing primary care.” Published in 2014, this model offers a roadmap for primary care practices to achieve excellence in primary care and align with the triple aim. The cornerstone of these building blocks is team-based care which, among other advances, seeks to ensure that all who provide care are doing so at the top of their level of training. In this way, all members of a team are appropriately challenged with tasks that are well suited to their background, freeing up time for those with specialized training to attend to work that previously went uncompleted.16

Medical students who might be interested in family medicine encounter multiple barriers. Several academic medical centers continue to resist the development of family medicine and primary care. Most medical schools still emphasize the subspecialties in their curricula and encourage students to choose them for future careers. In these environments, family medicine remains a true counterculture. As a result, students may experience discouragement as they show interest in pursuing family medicine as a career. In addition, the structure of undergraduate medical education cannot fully capture the richness of family medicine or other primary care specialties. Because medical students frequently rotate from one rotation to the next, they are unable to experience longitudinal outpatient primary care with the same patient more than once or twice. Further, because much of the clerkship experience is hospital based, few students will ever fully appreciate community-based public health or many of the other practice settings in which family physicians work. In addition, participating in the intergenerational care that underlies family medicine is not possible in the course of medical school or even medical school and residency. Compared to other medical specialties, it is difficult to experience the scope of family medicine before deciding to enter it. And, finally, primary care family medicine is undergoing tremendous change. As our health care system transitions toward a system that values outcomes and increasingly recognizes the role of primary care, family physicians have seen immense change in the scope and nature of their work.

Because the scope of clinical research in family medicine is so broad, it may be difficult for students and other physicians to view family medicine as the academic specialty it has now become. Although recent initiatives demonstrate a broad range of interests, there is currently a lack of experience in and funding for academic family medicine. As a result, academic inquiries that have fallen out of the traditional organ- or demographic-based scope have found their home in a broader scope: health systems, public health, and health policy research. As these areas of academic investigation develop, family medicine will further define its contribution to the practice of medicine.

A final challenge for medical students entering family medicine is the growing misperception that family physicians will become obsolete as physician assistants and nurse practitioners become more popular. To the contrary, although these professionals broaden access to some primary care services, family physicians receive more comprehensive training and will be able to provide greater continuity for a greater variety of clinical situations. Some studies comparing the two providers show that nurse practitioners and physician assistants are preferable within specific circumstances, but none have yet demonstrated greater cost-effectiveness or a broader scope of practice compared to family physicians.17 Nonetheless, the proportion of physician assistants and nurse practitioner graduates entering primary care specialties is still not adequate to meet the demands of primary care and so team-based models of practice will need to capitalize on the strengths of physicians and advance practice clinicians alike. Family medicine and primary care should focus on expanding primary care capacity, not worrying about whether other health care professionals will replace them.

FELLOWSHIPS AND SUBSPECIALTY TRAINING

The majority of family physicians do not pursue a formal training program in order to subspecialize. However, many develop specific interests within family medicine and choose to pursue a special area of competence through fellowship or other postgraduate training. Graduates of family medicine residency can complete fellowship training in any number of subspecialties. Depending on the fellowship, further training may consist of 1 to 3 years beyond residency. The fellowships that result in board eligibility to obtain a formal certificate of added qualification (CAQ) in the specialty are limited to geriatrics, sports medicine, hospice and palliative care, clinical informatics, and sleep medicine.

Geriatrics

This fellowship is similar to the one offered to internal medicine residents. You will gain additional experience in the special medical issues relevant to older populations. As the population continues to age, there will be a greater need for physicians with specialized training in geriatric medicine. Many family physicians find a natural home within geriatrics owing to their training in comprehensive medical care, mental health, and family systems. Completing a fellowship in geriatrics allows the graduate to sit for the geriatrics boards and obtain a CAQ in geriatrics.

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FAMILY MEDICINE 2017 MATCH STATISTICS

    Number of positions available: 3356

    1797 US seniors and 4248 independent applicants ranked at least one FM program

    95.7% of all positions were filled in the initial Match

    The successful applicants: 47.0% US seniors, 30.9% foreign-trained physicians, and 17.9% osteopathic graduates

    Mean USMLE Step I score: 221

    Unmatched rate for US seniors applying only to family medicine: 3.5%

Source: National Resident Matching Program.

Sports Medicine

Similar to fellowships in sports medicine offered to emergency medicine and internal medicine residents, this program provides additional experience in the care of sports-related injuries. The approach, of course, is much more primary care and medical, rather than surgical. Completing a fellowship in sports medicine allows the graduate to sit for the sports medicine boards and obtain a CAQ.

HOSPICE AND PALLIATIVE CARE

Hospice and palliative medicine uses a team approach to prevent and relieve suffering to support the best possible quality of life for patients and their families, regardless of the stage of disease or the need for other therapies. This fellowship is typically 1 year in length and allows the graduate to become board-eligible for a CAQ in hospice and palliative care.

Faculty Development/Research

Fellowship programs, devoted either to faculty development or to research, prepare family physicians for a career in academic medicine, frequently as a medical student or resident educator, or as a dedicated researcher in family medicine. As a relatively new specialty, departments of family medicine are constantly forming and training new faculty members. If this sounds like a career for you, these fellowships provide varied experiences in research, teaching, leadership, and management, and can prepare you well for joining an academic practice in a faculty or research scientist role.

Preventive Medicine

Many family medicine graduates are inherently drawn to public health, and so many consider pursuing a Master’s degree in public health, or elect to complete additional residency training in preventive medicine. Some family medicine programs have combined with preventive medicine programs that result in dual board eligibility, while the majority still remains as separate programs with separate requirements. Completing a preventive medicine residency allows the graduate to become board-eligible in preventive medicine.

Obstetrics and Women’s Health

A fellowship in obstetrics allows the family physician to acquire intensive training in performing cesarean sections, amniocentesis, tubal ligation, and other obstetrical procedures. Without this experience, most family physicians that include obstetrical care in their practice only perform normal vaginal deliveries and manage fewer high-risk pregnancies.

INTEGRATIVE MEDICINE

These fellowships vary in length from 1 to 2 years and include the study of numerous integrative medicine techniques from acupuncture and osteopathic manipulation to naturopathy and mindfulness.

FAMILY PLANNING

Family planning is a 2-year fellowship focused on subspecialist training in research, teaching, and clinical practice in abortion and contraception. During their 2 years fellows pursue either an MPH or MS.

ADDICTION MEDICINE

As addiction is increasingly recognized as a chronic medical condition, many family medicine graduates consider additional training in addiction to supplement his or her training. Usually 1 year in duration, this fellowship trains physicians in the evaluation and treatment of patients with substance use disorders, behavioral addictions, and co-occurring psychiatric disorders.

ADOLESCENT MEDICINE

This fellowship typically lasts 3 years and confers a Master’s in public health, often with an emphasis on research and public policy. Fellows gain specialized knowledge and experience in areas including eating disorders, gender transition, homelessness, adolescent gynecology, adolescent obesity, substance abuse, and complex care.

CLINICAL INFORMATICS

Fellows in clinical or medical informatics are drawn to the flow of information within and between health settings. Conventionally thought of as the “electronic health record experts” these specialists are well versed beyond the intricacies of a particular electronic platform. Informaticists will often find themselves in leadership roles designing clinical systems, electronic system interfaces, and data management systems, among many other roles. As the role of information management becomes increasingly prominent in health care, the board-eligible graduate of a fellowship in clinical informatics will often have multiple varied job opportunities upon completion of training.

Other areas that family physicians have chosen for specialty training (but not necessarily through formal accredited fellowships) include occupational/environmental medicine, community medicine, family systems medicine, rural medicine, emergency medicine, sleep medicine, medical education, public health, health policy, medical communications, medical humanities, osteopathic manipulative medicine, health psychology, and hospitalist medicine.

WHY CONSIDER A CAREER IN FAMILY MEDICINE?

Since its creation as an official specialty in 1969, family medicine has fluctuated in popularity. Driven by technical and financial incentives, most medical students still choose to enter medical or surgical specialties (and subspecialties) instead of careers in primary care. But medicine became far too fragmented with the increase in specialization; therefore in the late 1980s, a movement began that encouraged students to consider entering primary care fields again. It worked. The popularity of family medicine jumped accordingly. More and more graduating physicians became family physicians. In spite of declining student interest in family medicine, demand for family physicians has been on the rise for the last decade.18 After all, family medicine is the perfect specialty for those who love everything about medicine and want to apply that knowledge to serve as a patient’s primary physician.

Family medicine is an essential specialty that meets much of the nation’s health care needs. As the only doctors who orient care toward the family and the community, family physicians treat nearly everyone, whether insured or uninsured. Knowing their patients’ life and clinical history better than anyone else translates into higher quality, individualized patient care—treating the patient, not the disease. As the initial point of contact, family physicians guide patients through the complex health care system, directing them to appropriate tests and specialist referrals when necessary. At every step, family doctors treat all problems, unless they require additional testing or evaluation by a specialist. You are, essentially, a patient advocate, making an incredible difference in their lives. Because of the universal need for family doctors across the country, they are well represented in both urban and rural areas, which means you have a great deal of career flexibility.

If you have a desire to be a primary care physician, then definitely consider this specialty. You will provide comprehensive care for a huge diversity of patients, have long-term rewarding relationships, and focus on preventive medicine and health maintenance. You will diagnose all types of diseases in kids and adults, deliver babies, and perform minor surgery. You may even become formally involved in health policy or public health. But most important, as a family physician you will apply concepts of medicine and health care to any community you choose to serve.

ABOUT THE CONTRIBUTORS

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Dr. Michael Mendoza completed residency training in family medicine at UCSF/San Francisco General Hospital. Following a fourth year as chief resident, Dr. Mendoza worked as a National Health Service Corps Scholar in community health centers in Chicago before relocating to Rochester, NY where he is now Commissioner of Public Health for the Monroe County Department of Public Health. A native of Chicago, Dr. Mendoza attended both college and medical school at the University of Chicago, where he served as a national officer of the American Medical Student Association. Dr. Mendoza earned his Master’s Degree in Public Health from the University of Illinois at Chicago and his Master’s in Business Administration from the University of Rochester. He may be reached by e-mail at Michael_Mendoza@URMC.Rochester.edu.

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Dr. Zoe Gravitz is a native of Maryland. She received her undergraduate degree at Oberlin College. She worked in the fields of HIV/AIDS and addiction before deciding to enter medical school. She recently graduated from the University of Rochester School of Medicine and Dentistry and stayed on to train at the University of Rochester/Highland Hospital Family Medicine Residency Program. During medical school Dr. Gravitz served as a Family Medicine Interest Group leader, was an administrator for the student-run free clinic, completed the Latino Health Pathway, and tutored local refugee students. She may be reached by e-mail at Zoe_Gravitz@URMC.Rochester.edu.

REFERENCES

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13. Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Workforce. http://www.graham-center.org/rgc/publications-reports/browse-by-topic/workforce.html. Accessed November 15, 2017.

14. American Academy of Family Physicians, Career Options in Family Medicine. http://www.aafp.org/medical-school-residency/choosing-fm/practice.html. Accessed November 15, 2017.

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