Are you a family physician or a generalist?

I remember back to the days of medical school and residency, when people used to ask me what speciality I was going into. “Family medicine,” I replied. They would stare at me and reply, “so. . . nothing?” Or “what speciality is that?” (Cringe).Others would say, “oh, so you’re a generalist?” Sigh. FAMILY MEDICINE! I internally raged. Why is this not considered “a speciality”? (Yes, I know—the CMA and many other organizations official recognize it as a specialty but the general perception remains.)Still, why was I being labelled a “generalist” when family medicine required me to know literally something about everything?These encounters left me feeling as though family medicine was looked down upon, almost belittled compared to other physicians. Some patients still call their family physicians a GP, short for general practitioner. Sometimes, family doctors are also called “primary care providers or practitioners.” Neither of which I prefer. Read: Dr. Marina Malak: ‘The therapist will reply to you now’Many argue that it doesn’t really matter what we as family physicians call ourselves; we know the work that we do is valuable, challenging and comprehensive. We are the cornerstone of healthcare for our patients. If you practice family medicine, take a moment and think about what you call yourself as a physician: are you a family doctor? A primary care provider? A general practitioner? Why? What implications does this title have for you, the work that you do for your patients and how you see your role intersecting with others and the healthcare system?Now think about what your patients, colleagues, the government and the media call you. Do you cringe at being called a general practitioner? Do you mind if someone calls you a primary care provider? Is there a certain value, or lack of, attached to being called a family doctor?Years ago, these names and titles were all interchangeable. Then, some provinces—British Columbia and Alberta stand out in my mind—stated specifically that the title would be “family physicians.” They officially recognized family medicine as a speciality, highlighting the important and unique work that family doctors do. In the U.S., the title “primary care practitioner” is a broad title that applies to nurse practitioners, family physicians and other medical professionals who manage primary preventative care. Clearly, doctors are not alone in doing various forms of primary healthcare but lumping us with other providers that have different scopes of practice is not ideal. Role clarity is essential—and having a umbrella term for our professions is confusing, misleading, and unfair to family physicians. In my opinion, being called a general practitioner minimizes the hard work we do as family physicians. It is not enough to say that family doctors need to have general medical knowledge; indeed, I often find that when dealing with my complex patients, reading other specialists’ notes, or educating patients, quite a bit of knowledge is required on my part to provide patient-centred and competent care! We are specialists in everything that we do. Nor do I only practice primary care. I am involved in health promotion, mental and physical health, occupational exposures, disability claims (more on that later…), familial discord and acute and long-term issues.Family medicine is a speciality, just like all the other residency programs that one can apply to. Yes, we provide primary care to our patients, and need to know knowledge about several conditions, but this doesn’t even begin to define the work that we do. As family physicians, we have the privilege and responsibility of seeing patients care from delivery, through midlife and until the grave. We make diagnoses and provide prescriptions, we co-ordinate care plans, we sift through hundreds of clinical notes from other providers, we counsel and educate patients and we support broader communities. I am a family physician. That is my speciality. That is my job title, and the job description for it is far deeper than what the names of general practitioner or primary care provider entail.Dr. Marina Malak is a family physician in Mississauga, Ont.

Are you a family physician or a generalist?

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