It’s Time for Advocacy, in Response to “Family Doctors Delivering Babies? It’s Time to Decide”

When I read the editorial by Drs Winnie and Saultz in the May issue it certainly hit home as I considered my own personal plight as one of the “endangered species” of family physicians who practices high-risk surgical obstetrics, endoscopy, and provides intensive care to patients.1 While the authors bring up important considerations concerning style of training and the merits of various methodologies, they miss one of the main reasons why a generalist cannot practice outside of the clinic.

Multiple times in my career I have had privileges restricted through overly-rigorous credentialing processes that do not account for quality measures, such as a family physician having excellent adenoma detection rates for colorectal cancer screening. If privileges are granted, soft-specialty discrimination frequently persists, and things like operating room time or specialty-biased referral processes are used to preclude the family physician from practicing. I am proud to have trained at a program known for producing generalists who go on to practice in rural or underserved areas, and now to teach at a different institution with a similar tradition. But a family physician should be able to practice those same skills wherever they hang their shingle or sign their employment contract.2

I am proud of our specialty’s response to the challenges of the last year, but I have also watched mentors and colleagues fight battles for patient access and justice with their entire careers despite less pay or specialty disrespect.3 In spite of challenges we are adjusting our strategies appropriately to ensure adequately trained residents.4 However, these same residents then graduate unempowered to practice because of external factors—because of decisions already made against them.

The way forward is not just with additional curricula, or tracks, or apprenticeships. It is through action, and through advocacy and policy change that allows family physicians to practice how they were trained. Advocacy is needed not only for the sake of our vulnerable patients, but for our vulnerable fellow family physicians and their plight to care for those patients.