Isn’t it ironic that just as America is waking up to the importance of primary care medicine, our own representative organizations are selling us down the river?
The training of primary care physicians has for decades allowed us to branch out and follow our patients in multiple sites of care. We are the masters of managing care across this continuum.
Government and big business are finally recognizing that they need to bolster primary care to manage patients in the new chronic care medical home models. They are finally recognizing the need to better supply, equip, and finance primary care physicians.
The American College of Physicians (ACP), the American Academy of Family Practice (AAFP), and the American Medical Association all appear to support this concept. So where is the irony?
The American Board of Internal Medicine (ABIM), along with the aforementioned groups and others, continues to carve medicine into ever increasing sub areas, based on sites of care and interests. Hospitalists (who already have three branches—general hospitalists, proceduralists, and nocturnists) are seeking special certification recognition through ABIM. Palliative care is a new certification. These branches of medicine deserve recognition, but do we need all these fractured certifications?
Soon, no primary care physicians will be certified as capable of practicing in multiple sites of care without multiple certifications for each separate site and individual function. Soon there will be no “general” primary care physicians. Can hospitalists equally manage the whole continuum of care, or will they need to become generalists again to do the job?
Medicine teaches us to care for the whole person—body, mind, and spirit—not just individual parts. I urge the ABIM, the ACP, the AAFP, the AMA, SHM, and others to stop this fracturing of primary care. Now is the time to promote the generalists. Now is the time to lift all primary care-related areas of medicine together, leaving no one behind.
John M. Colombo, MD
Crozer Keystone Health Network