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**
ACTION ALERT ** BACKGROUND: On
June 21 Peter Bach, MD published a column, “How Many Doctors
Does It Take to Treat a Patient,” criticizing the current
fee-for-service system where patients bounce around various
specialists without efficient coordination of care.
Dr Bach advocated for few physicians providing better
coordinated care. Over
the days that followed, the Journal published several physician
letters that assailed family medicine.
Letters
from specialty physicians included comments such as this: “Primary
care physicians no longer have the kind of training to equip them
to handle multiple disease problems. They are also the lowest
paid. They risk being sued if a bad outcome occurs and there was
no specialty consultation. All these factors and more have
diminished the role of the primary doctor. There is no doubt that
medical care is often fragmented as a result of this process, but
unless there are major changes in medical training and
reimbursements, this is the system we will have.” “Internal
medicine was once a four-year rigorous training program with board
examinations that many found difficult to pass because of the
depth as well as the breadth of medical knowledge required to
become a diplomate of that board. General practitioners, wanting
an elevation in their status, went on a PR campaign and reinvented
themselves as "family doctors." They are undertrained in
almost everything they do, serving primarily as triage officers
for specialists and subspecialists, who very often show them
little respect. In my community hardly any family doctors follow
their patients in the hospital, much less participate in actual
care when patients are seriously ill. The
re-establishment of general internal medicine, general pediatrics,
and obstetrics-gynecology to their rightful places in medicine
will assist greatly in coordinating medical care once again.” AAFP
Responds Aggressively
IF
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to the Editor
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