Turf war? Where ya been?

Over on Kevin.MD (a well-known and very well-done medical weblog), Kevin takes exception with this study by the Robert Graham Center that shows that Family Physicians spend less on care do internists or subspecialists.  He asks if this is a good time to start a turf war…

I am generally against wars…even the turf kind…but I’m afraid this one has been going on for years.  Publication salvos about quality and cost of care have been traded in the journals for the 15+ years I’ve been a family doc and probably longer.  We should be excused for feeling a bit defensive as we often have to argue with hospitals and health systems (not infrequently with internists, but with other specialities too) for privileges despite adequate documentation of competence.  This is simply a continuation of that argument…another salvo, if you will.  It’s not a Machiavellian move, it’s self-defense.

Is it appropriate to keep up with the salvos in an environment where primary care is threatened?  When I talk to the admittedly few students who have chosen family medicine, I hear passion for primary care.  Does that passion exist in Internal Medicine anymore?  I’m asking because I don’t see it – not in the students I encounter who match in medicine, and not much from their role models in academic internal medicine.  It is only with extremely rare exception that a family doc does not end up doing primary care – the most frequent exception is emergency/urgent care, but as we know…that sometimes is the only primary care people get (another discussion…another day…)

We’re trained from the beginning to deliver primary care (including behavioral health, women’s health, child health, etc., etc.) – for everyone that walks in the door.  That’s our job description; that’s our mission; and our vision is that everyone should have a family physician (not an ob-gyn or an internist who calls themselves a family doctor).  When there’s data to support that we’re doing well at our life’s work, why hide it?  No other specialty would.