General Practitioners in US Medical Practice Compared With Family Physicians

The Article in Brief

General Practitioners in US Medical Practice Compared With Family Physicians

William R. Phillips , and colleagues

Background Among the mix of primary care clinicians in the US are general practitioners who provide primary care services, but whose role has evolved over the past 50 years. Historically, most generalist physicians were called general practitioners (GPs) and entered practice with 1 to 2 years of hospital-based training that was not designed to prepare physicians for community-based primary care practice. The specialty of family medicine was built on this foundation, addressing problems of insufficient access to primary care, fragmentation of care, and increasing costs. In 1969, the American Medical Association (AMA) Council on Medical Education and the independent American Board of Medical Specialties approved the American Board of Family Practice (now Family Medicine ABFM) to set standards for residency training, examination, and ongoing certification. ABFM certification requires completion of 3 years of residency training and passing of the examination. There is no certification in general practice recognized by the American Board of Medical Specialties. Those outside the medical profession, including researchers and policy makers, tend to treat GPs and FPs as a single undifferentiated group, thereby risking misclassification bias in their work and threatening the validity of their findings.

What This Study Found In this study, which was supported, in part, by the American Board of Family Medicine Foundation, family medicine researchers from the University of Washington, University of Wisconsin, University of Kentucky, and the ABFM analyzed national data on physicians in direct patient care, linking records from the AMA to ABFM board certification status, as well as to data from the Centers for Medicare and Medicaid Services and the US Department of Health and Human Services. In their analysis of all 102,604 MD and DO physicians in the United States, the authors of this study describe the personal, professional, and practice characteristics of self-identified general practitioners (GPs) as compared with American Board of Family Medicine certified family physicians (FPs). They found significant differences between the two groups. GPs are more likely to be older (average age 64.6 years for GPs compared with 49.4 for FPs), male (77% of GPs vs. 58% of FPs), DOs (28% vs. 10%), and graduates of non-US medical schools (41% vs. 23%). Few GPs have family medicine residency training (9%); less than half have any residency training directly relevant to primary care (48%). GPs and board-certified FPs practice in similar geographic locations, but GPs are less likely to participate in Medicare (53% vs. 76%) or work in hospitals (13% vs. 22%). GPs are slightly more likely to provide nursing home services (13% vs. 11%) and to make home visits (3% vs. 1%). The American Board of Family Medicine is among the Annals of Family Medicine�s seven sponsoring organizations.

Implications

• General practitioners in the United States are a varied group that differ significantly from board-certified family practitioners. The authors recommend that GPs and FPs be considered separate groups for research, workforce, and policy purposes.