• Adam Tabriz, MD

Family Practice Medicine: A Medical Specialty Or A Primary Care Bureaucracy

The Shift Between Devaluation And Idealization Of Family Practice Specialty Is An Epitome Of How Physicians Must Steer The Healthcare Domain

This article was initially published by Illumination on Medium!


Photo by Julia Zyablova on Unsplash

Idealization and devaluation are two psychological phenomena we often encounter in the social and behavioral context.

I start my piece here by using the latter spectacles. After reading an interesting article published in the most recent edition of Medical Economics, I evolved a new impression of the concept of Primary care Medicine.

Some medical specialties, including Family Practice, Internal Medicine, and Pediatrics, may have been the target of "Splitting" or victims of psychologically opposing thoughts, feelings, or beliefs.

Splitting is one of the essential sub-conscience elements of a person's behavior with Borderline Personality Disorder. (BPD) An individual with BPD constantly and cyclically idealizes and devalues an idea, person, or thing to alleviate their anxieties.

Metaphorically speaking, primary care medicine is the epitome of the Borderline Personality Disorder inflicted on the Family medicine, Internal Medicine, and Pediatrics specialties over the past few decades.

From here on, I intend to use the name "Family Medicine"; however, the concept merely applies to other specialties affected by the "Primary Care Medicine Splitting." That stands for the swinging between idealizing the role of family medicine as a primary care specialty on the one hand and devaluing it on another.

Family Practice Medicine Is Not Equal To Primary Care Medicine.

By the large, family practice specialty is the clinical discipline that covers a broader range of human health, including their families. That is in contrast to other medical things that focus on one specific part of the human body but emphasize it in-depth, like Ophthalmology which deals with diseases of human eyes and vision, and a cardiologist specializing in detailed diagnosis and treatment of human heart condition. Family Medicine discipline melds various biological, clinical, and behavioral sciences with a patient's age or sex, organ system, and disease entity.

"Family physicians and the fight against the health system" is the title of the recent article I encountered recently. The piece's author in Medical Economics Journal, June 2022 edition, points out how the American health system devalues family practice. It has done so through relatively lower reimbursement rates and increasing burdens by adding preventative medical care tasks on top of the already indicated administrative tasks to encumbered family physicians. Not surprisingly enough, The author also quotes:

“There is the rhetoric that primary care and prevention matter much more now to insurance companies, hospitals, and doctors’ offices. Sure, maybe in a few areas like chronic disease management where primary care medicine and family doctors have been asked to do more for patients.”

The Primary care concept is not a novel one. It is a managed care bureaucratic concept designed to concentrate on placing the heaviest burden on physicians with a broader skillset base vs. those holding in-depth sub-specialties skills, hoping to reduce costs and devise some organization.

Primary care has been in existence under various names in history. The initial movement reaches back to the intuition of barefoot doctors in the 1920 rural construction movement in China. During the time, Y.C. James Yen and Liang Shuming started a pilot program in rural China to train rice farmers to provide primary medical care to their constituents.

Later, the modified and modernized version of the Barefoot Doctor concept was adapted in the 1978 international conference on primary care held in Alma-Ata. That was the first kind of initiative in history. It upheld the vision of "health for all." It was further underscored in 2004 by the founder of Microsoft, Bill Gates.

In a practical sense, primary care is nothing but a profile of a sector of medical specialties elected to do more and get paid less.

Primary care title has been invariably used throughout the recent decades to devalue family practice as a specialty. Corporate healthcare leaders have implemented value-based physician reimbursement protocols, placing the responsibility of preventative care on family medicine physicians. The healthcare bureaucrats have created an assortment of value and quality metrics to force those physicians to perform at the pace of corporate prerequisite; the latter resembles the "carrot on the stick through primary care guidelines metaphor."

Today, healthcare leaders use "primary care" out of clinical specialty to devalue the family practice medicine role. In contrast, at other times, they utilize its schizophrenic nature to glamourize how family practice doctor plays a prominent role in preventative care. Such a splitting pinnacle of the modern-day travesty has played well for the corporate profiteering by reimbursing family practice specialists less than their other specialist counterparts for the same task. For instance, most insurance companies would compensate family practice physicians smaller for controlling a patient's blood pressure than a cardiologist, even if both use the same medication and spend a comparable amount of time to address that problem. After all, if the reimbursement is quality-driven, I assume it would not be sincere to devalue the work solely based on the healer's title.

Primary care medicine is a wastebasket of the healthcare profession. The family physicians must carry the gatekeeping burden for other specialties while accepting the ever-increasing protocol-driven preventive care.

The shift between devaluation and idealization of family practice is the epitome of how physicians navigate monopolistic medical care delivery system politics. Bureaucrats created this kind of monopoly by collaborating with politicians, corporate leaders, and prominent healthcare industry stakeholders in the name of primary care medicine. That is precisely why Primary care has not only failed to create health equity and quality efficiently but has even failed, if not contributed to increasing healthcare costs.


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