General Practitioners in US Medical Practice Compared With Family Physicians

William R. Phillips, MD, MPH; Mingliang Dai, PhD; John J. Frey III, MD; Lars E. Peterson, MD, PhD

Disclosures

Ann Fam Med. 2020;18(2):127-130. 

In This Article

Abstract and Introduction

Abstract

Purpose: General practitioners (GPs) are part of the US physician workforce, but little is known about who they are, what they do, and how they differ from family physicians (FPs). We describe self-identified GPs and compare them with board-certified FPs.

Methods: Analysis of data on 102,604 Doctor of Medicine and Doctor of Osteopathy physicians in direct patient care in the United States in 2016, who identify themselves as GPs or FPs. The study used linking databases (American Medical Association Masterfile, American Board of Family Medicine [ABFM], Area Health Resource File, Medicare Public Use File) to examine personal, professional, and practice characteristics.

Results: Of the physicians identified, 6,661 self-designated as GPs and 95,943 self-designated as FPs. Of the self-designated GPs, 116 had been ABFM certified and were excluded from the study. Of the remaining 102,488 physicians, those who self-designated as GPs but were never ABFM certified constituted the GP group (n = 6,545, 6%). Self-designated FPs that were ABFM certified made up the FP group (n = 79,449, 78%). The remaining self-designated FPs not ABFM certified constituted the uncertified group (n = 16,494, 16%). GPs differed from FPs in every characteristic examined. Compared with FPs, GPs are more likely to be older, male, Doctors of Osteopathy, graduates of non-US medical schools, and have no family medicine residency training. GPs practice location is similar to FPs, but GPs are less likely to participate in Medicare or to work in hospitals.

Conclusions: GPs in the United States are a varied group that differ from FPs. Researchers, educators, and policy makers should not lump GPs together with FPs in data collection, analysis, and reporting.

Introduction

Primary care requires an adequate workforce of appropriately trained generalist clinicians. Among the mix of primary care clinicans are general practitioners who provide primary care services, but whose role in US medical care has evolved over the past 50 years.

Historically, most generalist physicians were called general practitioners (GPs) and entered practice with 1 to 2 years of hospital-based training that was not designed to prepare physicians for community-based primary care practice. The specialty of family medicine was built on the foundation of the GP, addressing problems of insufficient access to primary care, fragmentation of care, and increasing costs.[1,2] (Supplemental Appendix, http://www.AnnFamMed.org/content/18/2/127/suppl/DC1). In 1969, the American Medical Association (AMA) Council on Medical Education and the independent American Board of Medical Specialties (ABMS)approved the American Board of Family Practice (now Family Medicine [ABFM]) to set standards for residency training, examination, and ongoing certification.[3] ABFM certification requires completion of 3 years of residency training and passing of the examination. There is no certification in general practice recognized by the ABMS.[4]

During the transition to family practice certification, GPs could qualify for ABFM certification through continuing medical education and examination. Many GPs chose not to become board certified and continued to practice, as either GPs or FPs.[3] Most early GPs have aged out of the workforce. Physicians ineligible for ABFM certification still enter practice as GPs or FPs. In the United States, neither federal nor state laws regulate how physicians label their specialty to the public. Little is known about physicians who call themselves GPs. Given the key role of primary care in US health care, it is important to identify GPs, understand who they are, what they do, and how they compare with FPs.

There is a potential problem with the common practice in health care research to combine FPs and GPs into an aggregate "FP/GP" group.[5] Lumping GPs and FPs together risks misclassification bias and threatens validity of findings. We examined US national physician databases with 2 study aims: (1) to describe the personal and professional characteristics and practice activities of GPs; and (2) to compare the characteristics of GPs with those of FPs.

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