Georgetown University Medical School and Providence Hospital have announced their joint development of a residency program in a fast-growing medical specialty - general, or family, practice.
At a time when 42 per cent of the nation's medical school applicants say they want to practice family medicine, the Georgetown-Providence program will turn out physicians with basic training in medicine, obstetrics, pediatrics and minor surgery.
This and similar programs are designed to produce the generalist in the age of specialists, the classical family physician who followed his patient from birth through adulthood.
Traditionally, the family practitioner was a physician who had completed a one-year rotating internship, which meant he had a smattering of training in most specialties but no specialized training in any.
The program at Georgetown, however, like those recently created at many other medical schools, is a three-year residency program. It gives the physician enough specialized training in several areas to enable him to handle "80 to 90 per cent of the problems that are brought to him, either alone or in consultation with a specialist," said Dr. Robert R. Huntley, chairman of Georgetown's Department of Community Medicine and Internation Health.
According to Huntley, the development of family practice programs is part of an even larger trend toward the training of so-called primary care physicians who deliver basic health care such as handling colds, stomach aches and check-ups. "Residency programs are developing what they call primary care tracks," said Huntley, meaning that the graduates of those "tracks" serve as general practitioners as well.
The family practice programs are also designed to fill the ever increasing need for physicians willing and able to practice medicine in small towns, rural areas and on the outer fringes of suburbia.
The development of the programs coincides with an increasing interest in such small town rural practices on the part of medical students.
According to a survey by the Association of American Medical Colleges of all students applying to enter medical school in the fall of 1975, 52 per cent intended to go into practice in areas with less than 50,000 population.
While up to 50 per cent of those students may well change their minds during their four years of medical school, a spokesman for the AAMC said that because other students will also change their minds about what and where they want to practice, the figures will remain generally accurate.
Family medicine is now an official, recognized, medical specialty, with its own board qualifications, the same as general surgery, cardiology or any of the more traditional specialties.
According to Huntley, "there are about 3,000 to 3,500 slots for (family practice) residents around the country. Georgetown is one of the last schools to develop such a program.
"State schools developed them first because they were more directly responsive to this type of need," he said, "and the urban schools lagged behind the rural schools because the family practice program was seen as a way to solve the doctor shortage in the rural areas."
In addition to their three years of intensive in-hospital training, the residents in the Georgetown-Providence program will practice at Providence's satellite facility at the Fort Lincoln new town in D.C.
The residents "will get a longitudinal experience going through all three years giving continuing care toa group of families whom they will serve for the three years," said Huntley.
"A number of family physicians are chosing not to do obstetrics," he continued. "In the cities there's not a lot of demand for it (because there are so many gynecologist-obstetricians) and it's also a question of whether a man wants to do a solo or group practice."
Huntley said that virtually no solo practitioner today is handling obstetrics because of the need to be constantly on call.
"We at Georgetown think practicing in groups with nurse practitioners is the way to go," said Huntley. "That's the way we'll be teaching." A nurse practitioner is a specially trained nurse who performs many of physicians' tasks such as health checkups.
The aim, said Huntley, is to train physicians who will set up self-sufficient medical practices with nurse practitioners in rural areas. That's the way we're going to run the model practice and that's the way we hope they'll practice when they go out. But the best ones now are being gobbled up as faculty for the new programs."