Background
The specialty of family medicine was founded in 1969 in response to a number of nationwide trends in health care in the United States. After World War II, the US saw a rapid movement toward specialization among physicians. In 1938, 20.8% of US physicians designated themselves as specialists and 79.2% considered themselves generalists. By 1970, 75.7% of physicians considered themselves specialists and only 17.3% designated themselves as general practitioners. A number of nationwide task forces were convened to address this disturbing trend in the early 1960's. The reports of these task forces were released in the mid-1960's. They contained remarkable agreement regarding the need to reestablish the importance of general practitioners in the US health care system and the need for a formal discipline with training programs to train these practitioners. Family medicine saw its first 36 residency graduates in 1970.
Definition of Family Medicine
The central elements of family medicine include the following components, taken from the Family Medicine Status Report, recently published in JAMA.
"The modern family practitioner should:
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Serve as the patient's personal physician and provide entry to the health care system;
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Provide a comprehensive set of evaluative, preventive, and general medical services;
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Maintain continuing responsibility for the patient, including necessary coordination of care and referral;
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Practice in a manner both sensitive and responsive to community concerns and needs;
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Provide care appropriate to the patient's physical, emotional, and social needs, in the context of family and community." (Graham, et al., 2002, p. 1098)
Family Medicine Contributions to the Health Care System
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Family physicians care for more patients daily than physicians of any other specialty. In 2000, family and general physicians saw 199 million patients in about 822 million patient visits. General internists accounted for 126 million patient visits that same year and pediatricians managed 104 million visits.
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Only 6.3% of visits to family physicians require referral to other physicians.
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In 1996, according to the Medical Expenditure Panel Survey, 62% of patients that indicated that they had an individual practitioner as their primary source of care cited a family physician as their primary care giver. 16% of those surveyed cited a general internist.
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If all family physician were withdrawn from the health care system, 58% of US counties would become Primary Care Health Professions Shortage Areas by federal government criteria. If all general internists, pediatricians, and obstetrician-gynecologists combined were withdrawn, less than 8% of counties would become Primary Care Health Professions Shortage Areas.
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In counties where the supply of primary care physicians is relatively high, the populations have higher rates of early-stage detection and likely cure of colon and breast cancers.
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Multinational comparisons of various health indices including longevity, infant mortality, and patient satisfaction reveal the highest performance levels in those nations with the highest percentage of family physicians. As of 2001, according to the World Health Organization, the life expectancy at birth in the United States is 77 years. For this index, the US ranks second behind Canada in the Region of the Americas and ties with Cuba. Worldwide, the United States ranks 16th in life expectancy at birth. Only socioeconomic status is a more powerful predictor of health status than access to a family physician.
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