In the US, the specialty of Family Practice remains poorly understood. While we care for millions of patients, there are many more who have never been cared for by a family physician and/or consider what we do equivalent to the "GP" that they had "years ago."
Family Practice was established as a specialty in 1969. A short history of the establishment of this specialty can be found on the American Board of Family Practice Website:
The American Board of Family Practice was born many years before it was officially recognized in February, 1969 as the 20th primary medical specialty.
The history of the Board is a fascinating saga of travails, with frustrations and impediments punctuating its formative days. Despite the fact that by the early 1960's the number of physicians in a general type of practice was dwindling rapidly, the medical establishment opposed the creating of a specialty that would fill this void. Therefore, the founding fathers of the Board deemed it necessary and rational, particularly in the face of this opposition, to document meticulously and persuasively the need for the specialty.
Various studies in the 1950's and 1960's concluded that "General Practice" was moribund. An analysis was made of specialty distribution of all graduates of every medical school by five-year periods since 1900 and from this data it was learned that the number of general practitioners was rapidly and steadily dwindling. In 1964, the percentage of graduates going into General Practice fell to 19% down from 47% in 1900 and continuously diminishing. It was also noted that the ratio of physicians in private practice was dropping rather rapidly, and the deficit was obviously in what was termed the "Family Physician Potential."
The general response to this precipitous decline was, "this is an age of specialization." The founders of the Board could only affirm this fact, believing that this response to the dearth of General Practitioners strengthened their argument for a new generalist-type of specialty called "Family Practice." Many students expressed the concern that the broad body of knowledge required for general practice was too great. This concern was also based in truth, in light of the tremendous expansion of medical knowledge and skills in the past few decades. Four years of medical school and a year of internship was indeed not adequate. The inadequacy of this training could be remedied only by having residency programs in a new specialty, Family Practice, argued the proponents of the specialty.
Additional factors explaining the decline were the lack of "prestige" assigned to the general practitioner in comparison to his/her more "specialized" colleagues as well as the difficulty experienced by the general practitioner in obtaining hospital privileges which were being given increasingly only to those physicians who were board certified.
In view of the data gathered by the Board proponents, it was proposed that:
- Family Practice IS a specialty, and
- as a specialty, Family Practice deserves well-defined but flexible graduate training programs, and
- that a Board of Family Practice is essential for the certification of competency of Family Physicians and for the participation in the guidance and approval of training programs.
The specialty of Family Practice, based on the heritage of General Practice, would have graduate programs (residencies) for physicians whose training would encompass 1) first contact care; 2) continuous care; 3) comprehensive care; 4) personal care (caritas); 5) family care; and, 6) competency in scientific general medicine.
The key difference, then, between family practice and the General Practitioners trained in the 1960's and before is that we have been explicitly trained to practice primary care. The GPs did a rotating internship (usually in the hospital) for one year after medical school and then went out to practice medicine. While many of them were (are) wonderful physicians, many (appropriately) argue that they were inadequately trained to skillfully manager the complexity of problems that we face on a daily basis.