I get mail, this from a healthy 20-something reader who’s just moved to a new city:
What’s the difference between doctors listed as Family Practice, Internal Medicine, and General Practice? Also, what are some things I should consider (that I might not already be considering) when finding a primary care physician?
That’s a bit of a loaded question, not because of any bias of mine (perish the thought!) but because each of those terms is used in different ways, by different people, at different times, for different purposes. So here’s the rundown on each of them in turn.
What it’s supposed to mean: Designates a physician who has completed a three-year postgraduate training program in Family Medicine, trained to provide primary care to patients of all ages, presenting with conditions of any organ system, including care of acute conditions and ongoing management of chronic diseases.
What doctors hope people think it means: Some doctors think having themselves listed as “Family Practice” is good marketing. This irks me. (Trust me: an irked dinosaur is not a pretty sight. You wouldn’t like me when I’m irked.)
What it really means: As long as you check for Board certification, pretty much what it’s supposed to mean. (And remember: no news is NOT good news. No mention at all means no certification. Just like no mention of any marital status on a dating website means “Married”.) Otherwise it means someone trying to horn in on what I do because they think the term is inclusive.
What it’s supposed to mean: Indicates that a physician has completed a three-year postgraduate training program in General Internal Medicine. Bear in mind that the vast majority of graduates of those programs goes on to further specialty fellowship training. Precious few of them actually go out at that point and hang up a shingle, opening their doors to a practice specializing in the care of patients with multiple complex diseases.
What doctors hope people think it means: In this new day and age of enhanced prestige marketing appeal of primary care, plenty of specialists with sagging revenues and appointment slots to spare believe that a listing under “Internal Medicine” will lure more patients. They have no problem with this double-dipping, but I do.
What it really means: Technically, it could indicate someone who couldn’t get accepted into any fellowship program. Most likely it’s a specialist trying to get listed twice in the directory. As a practical matter for a generally healthy adult, it’s a perfectly acceptable option for a primary care physician.
What it’s supposed to mean: In the olden days, physicians hung out a General Practice shingle after one year of internship. Specialists were the only ones who went on for more advanced residency training. After everyone started doing residencies, it was osteopathic physicians who used the term General Practice, while MDs went on to fine-tune the training and certification that became Family Medicine (which now welcomes osteopathic graduates).
What it really means: Either an older MD who only did a one-year internship, or a younger DO who did a three-year residency. By now, though, even this is a little dated, so I’m surprised that there are physicians listed at General Practice. What it really means is that you need to carefully explore training and certification.
What else to look for:
Given that the reader failed to specify what he was already considering in terms of his physician search (presumably such vital indicators as Board certification, convenience of office hours, and courtesy of staff, among other things) the main thing I would do is provide reassurance that it is okay to go with one’s gut. Pick a doctor you like. More importantly, don’t be afraid to STOP going to a doctor you decide you do not like. Trust me; the doctor is not going to care. There are plenty of other patients out there.
Think in terms of finding a doctor who “gets” you. Someone you’d feel comfortable going to when you’re uncomfortable. Someone you can trust. That’s really the bottom line, whatever section of the directory they’re listed in.
*This blog post was originally published at Musings of a Dinosaur*