Declining Presence of Family Physicians in Hospital-Based Care

A Major Concern or Totally Makes Sense?

Peter J. Carek, MD, MS


J Am Board Fam Med. 2019;32(6):768-770. 

In This Article

Abstract and Introduction


Comprehensiveness along with continuity, coordination, and first contact serve as the 4 pillars of primary care.[1] Because of their training, family physicians (FPs) are specialists qualified to treat most ailments and provide comprehensive health care to people of all ages.[2] This comprehensive care to patients regardless of setting is an integral aspect of a highly functioning primary care system.

In this issue, Jetty et al[3] provide additional evidence demonstrating the contracting scope, or comprehensiveness, of practice by FPs. Data from the 2013 to 2017 American Board of Family Medicine Certification Examination Registration Questionnaire was used to examine trends in hospital care. Among over 46,000 respondents, the share of FPs reporting hospital care decreased by about 26%, from 34.1% in 2013 to 25.2% in 2017. Basically, this policy brief indicates that the proportion of FPs providing inpatient care has decreased since 2013, leaving approximately 1 in 4 FPs practicing hospital medicine. As noted by the authors and observed in other services often associated with comprehensive care (ie, prenatal care, home visits, nursing home care, and obstetric care), this new information further supports the evidence demonstrating a contracting scope of practice among FPs.[4]