I think a lot of subspecialists (even pediatricians and internists) are critical of FM not because they think we can't do what they do, but because they know we can do a great deal of it, and they are more than a little threatened by that.
If you look through my posts, you'll note that I am pro-FM despite being a pediatrician (
http://forums.studentdoctor.net/showthread.php?t=513052&highlight=family+practice+pediatrician post #40). I chose subspecialty medicine because that is where my heart lies, but I am also pro-primary care (FM, IM, and Peds; frankly, on occasion I even miss primary care peds) and think that the state of affairs right now is a shame for ALL the primary care folks.
That being said, I respectfully submit that the above statement is crap. I've never met an internist or a pediatrician that was threatened by FM docs. Now, I have met some who did not TRUST FM docs (in a clinical sense) and I think this stems from something akin to fear of the unknown (even if exposed to FM during med school, the internist or pediatrician is still limited to that time of exposure for knowledge of the training/practice of FPs) and a sense of that which is different (from their own frame of reference) is not as good.
As a pediatrician I admit that I am sometimes concerned about the exposure that some FM residencies give their residents to pediatric patients. I obviously trained to be an expert in inpatient and outpatient pediatrics (and my program was probably a little more inpatient focused) so it skews what I think someone's training in peds should include. The ACGME stipulates a need for 4 months of pediatric training during an FM residency (
http://www.acgme.org/acWebsite/downloads/RRC_progReq/120pr07012007.pdf p23) and goes on to say that "the time must include experience in the following areas: neonates, infant care (both well-baby and ill), hospitalized children, ambulatory pediatrics, emergency care of children and adolescent medicine. This may include experience gained on the Family Medicine Inpatient Service, in the emergency department, in the pediatric hospital and clinic, and experience in nursery care associated with OB experience, provided that appropriate documentation of such experience is maintained for each resident." But the division of that time seems to be somewhat variable from residency to residency. Kent did a great job explaining the similarities in the pediatric scope and nature of practice between FPs and Pediatricians, but ALL primary care docs are faced with the need to determine "sick or not sick" at times and may need to acutely stabilize a patient (including a kid for the FPs and Peds). Frankly, I'm fine with it being an FP, but I'm much more comfortable if I know that they have had substantial experience in caring for both well and sick kids during their [FM] training (initial and CME). Others in the Peds (and I imagine the IM) world are less open minded and can't imagine that someone who didn't spend
5 months in the NICU taking care of critically ill neonates, 2+ months in the PICU taking care of critically ill 0-24 year olds, 9+ months in the inpatient pediatric service taking care of mild to moderate to heading-down-to-the-PICU 0-24 year olds, and rotating through required outpatient pediatric rotations (developmental, adolescent, clinic) and electives could take care of kids as well as they do (understand my point in writing that last statement: it was not to point out the inadequacies of the FM trained, but rather to point out the differences that people see from their own frame of reference. I again reference Kent's sticky on pediatric practice of FPs and outpatient pediatricians for an explanation of why I think that this mindset is infrequently valid).
As someone who is training to be a subspecialist, I feel even less threatened. You should very easily be able to distinguish a benign from pathological murmur in a child. But beyond that, what part of my job do you think I'm afraid of losing to you (and frankly, I really wish you and the other FPs and Pediatricians would make the "benign murmur" call in your office a little more often)? Other than colpos and suturing, what procedures that you share with some subspecialties are you going to steal from a pediatric subspecialist? Are FPs doing colonoscopies on 5 year olds often?
(So after my long aside) back to the original statement: Sophie, this is akin to DOs saying that MDs are threatened by us because we can do everything they can do plus some. There are some DOs that believe this crap, but have you met many MDs that feel threatened at the thought of losing business to you because of your degree? Or, if you have met anyone who has thought lesser of your degree (though if you've had similar experiences to mine, the answer may blessedly be "no") was it for similar reasons to the above?
So why did I spend so much time typing up what essentially amounts to an overly wordy aside? Because, folks, the "primary care" crisis does not apply only to FPs. The pediatricians and internists suffer from a screwed up system as well. I'd suggest that maybe pissing on your colleagues who are in the same boat as you might be self defeating. Unification of all primary care specialties toward a goal of more fair reimbursement may be a more seemly goal. Frankly all medical specialties have a vested interest in improving the screwed up areas of medicine (screwy reimbursement, abuse of EDs, defensive medicine which leads to inappropriate use of specialists...Oh, and before anyone jumps on a subspecialist for bringing up screwy reimbursement, just remember that the peds subs have the most reason to complain. You just can't tell me why when hearts like
are stock in trade for my field, why I most likely make >$100,000 less than my adult counterparts?)
