Family medicine can of course encompass multiple settings outside the office, including the emergency department, case room and hospital ward. Yes, family physicians bring important knowledge and skills to these environments. However, when a family physician restricts almost all of his or her practice to an emergency setting, that individual resembles not a family physician but a specialist. He or she does not bring to these settings the perspective of long-term relationships with patients, as are cultivated in the physician's office, and is not as well positioned to act as a bridge between the office and hospital environments. The emergency department performs many important functions, but continuing care, preventive services and chronic disease management — all core functions of family medicine — are not among them.
No one disputes that physicians with CCFP(EM) certification who do full-time emergency medicine are providing an essential service, and my paper1 suggests many plausible reasons why these physicians would choose such a career path. Nonetheless, this study has raised some important questions about the CCFP(EM) certification program. Do we want our community hospital emergency departments to be staffed by full-time emergency physicians? If yes, is 2 years of family medicine plus 1 year of emergency training appropriate, or should there be more emphasis on the latter? If no, then are the candidates selected for the CCFP(EM) program people who want to do family medicine, rather than those looking for the fastest route to full-time emergency practice? Have we inadvertently created a culture where family physicians without this certification are made to feel unwelcome or underskilled for work in the emergency department? All of these questions merit careful consideration.
Benjamin Chan Senior Scientist Institute for Clinical Evaluative Sciences Toronto, Ont.
Reference
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