Tuesday, July 12, 2011

Why does GME matter?

Today the medical blogosphere abounds with posts about #SaveGME. 

As a family medicine residency educator, I have to admit that it feels a bit awkward to write about this issue.  I can see how readers might perceive it as rather self-serving, since GME funding is responsible for a significant portion of my salary.  I wonder if other residency educators share my reticence and the reason behind it.  Many people want a smaller, balanced federal budget, but nobody wants their particular piece of the pie cut.

But I am grateful to Mike Sevilla for challenging us to think about this issue, because it really is about more than my job and the jobs of other family medicine teachers.  It's about more than ensuring that the specialty of Family Medicine survives and thrives, and it's about more than making sure that we have enough family doctors for now and the future.

It's about wellness - the wellness of individuals, families, communities, and our nation.  Most medical specialties focus on some body part or system.  Family doctors look instead at the big picture, using both medical knowledge and biopsychosocial training to look at our patients as whole human beings.

This Family Medicine systems approach extends beyond our individual patients.  Because family doctors are wired to think about all of the environmental factors and life choices that affect health, we are better equipped than any other specialty to think about community and population health. 

I recently posted about Dr. Starfield's research findings regarding primary care; at the risk of over-generalizing an impressive lifetime of work, her findings unequivocally demonstrate that primary care helps people to live longer for less cost.  Too many specialists per capita, on the other hand, equals shorter lives and more expensive health care.

Our nation needs a robust primary care infrastructure.  We need primary care leadership to guide local and national decision making related to health - and, let's face it, just about every policy decision relates back to health somehow. 

This point is where we circle back to needing family doctors - and the teachers who train them.  We can't grow those family doctor leaders if we don't train them as family doctors first.  If we don't have a new generation of family doctors waiting in the wings, then our current docs won't get involved in advocacy - they'll be too overwhelmed dealing with the primary care shortage that already exists.

If the health of your family, your community, and your nation is important to you, I urge you to learn more about this issue and make your voice heard.  Dr. Sevilla's post for today (http://www.familymedicinerocks.com/family-medicine-rocks-blog/2011/7/11/what-savegme-means-to-me.html) is a great place to start.

#Save GME.  The future of our nation's health depends upon it.


  1. I agree completely with your arguments in support of family medicine - I firmly believe that family physicians are in a great position to look after the whole health of patients and that they provide very good value for their cost. But please don't insult the other fields of medicine in making your point! Good specialists do think about the entire patient (comorbidities, personal values, lifestyle) while focusing on their area of expertise. And while specialists may not provide the best bang for your buck, so to speak, they play an essential role in the treatment of conditions that are beyond the scope of family medicine practice. We need to create room (and funding) in medicine for both generalists and specialists if we want to bring about the optimal health of patients and our society.

  2. Thank you for your comments. I apologize if my comments came across as insulting - I completely agree with you that we all need to work together to provide the best care for our patients. And you are certainly right, I know some specialists who are excellent "big picture" thinkers.

    My frustration comes from the tilted playing field, in funding and in reimbursement, toward non-primary care specialties. We cannot maintain a healthy primary care-specialist balance until those forces are evened out. But I am sincerely sorry if that frustration read as disrespect toward my specialty colleagues. I appreciate that you took the time to share your thoughts.