Every department that is a member of the Association of Departments of Family Medicine includes the term “family medicine” in its title. Fewer than one-half our member departments, however, only have family medicine in their titles. Many titles acknowledge the other major elements of work being done by the teachers, clinicians, researchers, and learners who make up our departments. We are Departments of Family Medicine AND: Community Medicine; Community Health; Social Medicine; Public Health Sciences; Rural Health; Comprehensive Care; and Geriatric Medicine. One department even has the titular trifecta of Family, Community and Preventive Medicine (Table 1).
Departments of Family Medicine AND…
Some of these names reflect formal administration of degree programs in public health or residency programs in preventive medicine that have been integrated into our clinical departments. Some highlight specific mission areas, such as rural health or geriatrics. Others speak to the leadership role of many family medicine departments in “population health” as health systems move to value-based care models. (Recognizing that the term “population health” conjures up many different meanings, ADFM has recently taken on the challenge of developing a working definition; this will be the focus of a future commentary.)
Among departments that have names that include terms in addition to family medicine, the most common additional word is “community.” This reflects a long history of the importance of community to the discipline of family medicine. About one-third of departments had “community” in their title a decade ago—many with this name dating back to their inception. Many departments were founded by leaders who, in the late 1960s and 1970s era of activism, social movements, community health centers, and Community Oriented Primary Care, had an understanding that family medicine departments needed to make explicit their commitment to community engagement and health system change. Among departments that have not always had “community” in their name, however, there has been a clear move in this direction in recent years; in the past decade, the percentage of departments of family medicine that include “community” in their titles has increased from 36% to 41%.
What does this change signify? Perhaps it shows a growing appreciation of social determinants of health and the role of family medicine clinicians, teachers, and researchers in addressing these community factors. From a series of posts on the ADFM Chairs’ listserv over the last few years, it is clear that many departments have changed their name to better acknowledge what they were already doing, with a scope of work focusing on clinical family medicine AND on health generation, upstream prevention, and care in the community in interprofessional teams. Some listserv comments noted that the change was a decision to outwardly signify a commitment to providing primary care and training in underserved communities, including community-based services such as student-run free clinics, health screenings in churches, and food pantries. One chair remarked that adding “community” to the department’s name was a way to highlight “a commitment to a culture and set of academic and professional skills that are distinct from, but complementary to, Family Medicine.”
In the national context of growing attention to social determinants and movement of health systems towards a population-health model, we anticipate that this trend toward expanded departmental names will continue. Our organization may be the Association of Departments of Family Medicine, but the scope of our association’s work will need to encompass the broader activities of our member departments that span boundaries with their focus on community and population health.
- © 2019 Annals of Family Medicine, Inc.
