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January 15, 2003

Challenges Facing Family Practice and Primary CareChallenges Facing Family Practice and Primary Care

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(3):297-300. doi:10.1001/jama.289.3.297-a

In Reply: We agree with Dr Flint that maternity care plays an important role in the practice of many family physicians and the communities they serve. It was not our intent to comment on specific elements of the scope of family practice, but to provide a broader overview of the context of specialty medicine within which it must function in the future.

The comments of Dr Fried and Drs Mundinger and Kane provide useful observations, albeit from very different perspectives, about the challenges facing professionals in the arena of primary care. The fragmentation of medical practice that is being driven by the business arrangements for funding health insurance coverage is unacceptable. In the face of a growing recognition that a relationship of continuity between patients and a personal physician has positive impact on the health status of the patient, barriers to the establishment of such a relationship are a constant factor in everyday practice. The difficulties cited by Fried in maintaining a viable and rewarding practice are echoed by his colleagues across the country. Although Mundinger and Kane would seem to suggest that a different model of primary care (the increasing use of nurse practitioners in lieu of physicians) might succeed in the current context, the recent sharp downturn in graduates from such programs suggests that the shifting elements of today's practice environment may be affecting the career choices of more that just physicians.1

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