while herpmed writes a helpful response, i have to think it's written through rose-colored glasses. in decent-sized population center (ie, city with at least a few hundred thousand people) it seems like FM gets mostly lifestyle diseases like cholesterol, diabetes, and hypertension, while the more complicated medicine, pediatric, or gynecologic pathologies are seen by those practitioners. i have tons of respect for FM, but if had thyroid disease or my kid had developmental issues or whatever, i'd want the person with more expertise to handle it. while i believe a FM doc can definately be well-rounded in their knowledge base, i also think there's truth to the adage "practitioner of all, but master of none." the fact that many FMs are hiring PA and ARNPs to see many of their patients speaks volumes to the truth that most FM patients are straightforward enough such that a well-trainined and experienced mid-level provider can meet the majority of the routine healthcare needs, with the FM seeing their own patients and helping out the mid-level on more complex cases. this is a model i've seen a lot of in tampa and its suburbs.
While I respect the considered opinions asserted in discussions such as these, I note that you are a MS-4. You must recognize that you do not have a full appreciation of the daily realities of medical practice. After you graduate and complete residency, your perceptions will have a greater breadth. Only after independent practice in the private sector will you develop a pragmatic comprehension that will temper your impressions formed from exposure during training periods. I do not intend these comments as personal affront or insult, rather as comments formulated from experience.
I am a practicing family practitioner/biomedical scientist working in a population far larger than Tampa (specifically, NYC) and certainly do not see anything through "rose colored glasses". Many of my colleagues and I see very complicated patients far beyond "bread and butter" cases. In addition, those "lifestyle diseases" you mention are of critical import to the health care system in the US, produce an enormous economic and public helath burden and, when left unmanaged by a PMD, are often the primary portals to the need for sub-specialty management. Many of the most common causes of morbidity and mortality in the US are traced to uncontrolled HTN, DM and lack of appropriate/effective preventative medical practice. Lifestyle can certainly influence their course, however, HTN and DM, as examples, have strong genetic influence and require aggressive intervention PRIOR to lifestyle impacting their natural history and evolution.
The amount of training, procedural expertise and specific knowledge of various specialties, etc is dependent on the degree of credentialing accomplished during residency and fellowship. In most FM and IM programs, there are a minimum number of expected and required procedures, etc that are required by each ACGME committee in order to successfully complete a given residency. One can choose to seek procurement of increased skill/procedures in a given specialty (ie marrows, endoscopies, etc) and a greater number of routine procedures in order to become more hospitalist-oriented (a greater number than the minimum of central lines, vent management, etc). Many FM programs encourage the procurement of extra skill in a given area of interest. Some programs will look the other way and allow their residents to sleepwalk through the program and meet the bare minimum. This is true of IM as well. The main point is that one cannot generalize on a given practitioner's skills simply in relation to their specialty. Your opinion re "jack of all trades and master of none" has some validity. However, as you meet more practicing FPs you will find that many have areas of strength and lesser areas of familiarity. This is no different than a primary track IM practitioner. In fact, many IM with sub-specialty training (often cards or GI) will attempt to function as both sub-specialists and PMDs, This often is a disservice to their patients as their familiarity with many common presentations in general medicine has waned.
The comment re PAs was well addressed by the poster above. I might add that in NYC MOST IM offices have at least two middle extenders as do almost all sub-specialists. This is due to the need to maintain greater patient numbers in order to achieve greater compensation. This is necessary to meet incerasing expenses, decreasing compensation from medicare/medicaid and the increased malpractice premiums in NY state (raised 16% recently by the NY state legislature). Again, when you actually practice in the private sector these issues will become daily concerns and not transient observations.
By the way, most of my immediate colleagues and I strictly see our own patients and do not use middle level extenders. However, I freely admit, if the current state of primary care compensation continues, we may have to unfortunately change our practice.
nice one.
