My Lord, you would think some of you were under the impression that it takes an internist to see every elderly patient, an OB to do routine deliveries, and a pediatrician to see every runny nose kid. I probably saw an average of 30 patients a day for 4 years straight in FM prior to leaving the PA profession and going back to medical school several years ago. I can count on one hand the number of times I had needed a pedi or an IM doc to bail me out with a patient. Lets face it, 99% of pedi stuff doesn't even need to be in the office anyway and could stay at home. We treat the parents more than the kids, but when the kid happens to be truly ill, the diagnosis is not usually all that difficult. Lets see, OM, Sinusitis, Bronchiolitis, RSV, Rota, Cpox, Roseola, Strep, Scarlet fever, Scabies, Eczema, Conjunctivitis. Anything much more serious than that and a pediatrician will be calling for a pedi-subspecialist as well. And as for elderly IM, can anyone say HTN, AODM, Hyperlipidemia, CAD, COPD, BPH, Overactive Bladder, OA, Gout, and all the other common elderly ailments....nothing real difficult there. Truth is, anything much more difficult than that and the internist is calling the subspecialist as well. The vast number of all primary care doctors are way too liberal with their referrals anyway because of the litigious society we are in.
You guys forget that until about 30 years ago, your family doctor was simply a GP who had done an intern year in some hodunk hospital somewhere, and they seemed to do just fine as well. They probably delivered many of you. In the city, it was rare to see an internist who even did well woman exams, so many patients like FP's because FP's are like one-stop-shopping. From my experience, a good internist is invaluable. But what I have seen is that many internists, like many FP docs, are only there because they could not do anything else, and thus one is no better than the other. A top-knotch FP doc can easily compete tit-for-tat with a sharp IM doc, and so what if they IM doc knows a few more zebras at the bottom of the differential list? When was the last time someone saw a pancreatitis that was caused by a scorpion bite? If I hear another IM resident pimp a med student over that BS I am likely to throw a chair or something!!!
Rural FP is where it's at!! Truly needed, and truly appreciated by the patients.