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If family medicine stops being "a specialty in breadth," is it still family medicine?
Each year we scan the National Resident Matching Program results to see how our community-based family medicine residency program performed in the match. The data over the last five years has told a consistent story: Across the country family medicine has undergone a steady decline in numbers. According to AAFP figures, the 1,132 U.S. medical school graduates who matriculated to family medicine in 2006 represent a 25 percent decline from 2001.1 Over that same time there has been a concomitant increase in the number of medical students who elect for training in subspecialty programs.
Several theories have attempted to explain the demographic shift. One leading theory is that the growing financial burden associated with physicians' training is pushing more young physicians into the higher-paying subspecialized fields of medicine. The Association of American Medical Colleges estimates that the cost of private medical schools has risen 165 percent and the cost of public medical schools has gone up 312 percent over the last 20 years.2 A similar study by the American Medical Association found that medical school costs have increased substantially more than the Consumer Price Index.3 The result is often significant educational debt. In 2006, more than 62 percent of medical school graduates carried $100,000 or more in educational debt.4 Given this unprecedented set of financial burdens, it is easy to understand why young physicians would gravitate toward areas of medicine that are more highly remunerated or offer less call and more attractive lifestyles.
While our national leaders in family medicine have tried to reverse this trend and have been vocal in advocating for the importance of generalists with national policy-makers, we in family medicine have engendered own brand of subspecialization - what might be called "specialized generalism."
Specialized generalism
I have experienced aspects of this trend personally. Over the last year I have counseled several residents concerning their decision not to continue practicing obstetrics. More residents, mere months after electing to become family doctors on the heels of positive experiences during obstetrical rotations in medical school, are abandoning their care of pregnant patients. Recently, a second-year resident told me, "Obstetrics is simply too frightening. There is too much information to...