Posted on 07.16.10 by Ronald Fong, MD

Sponsored by CAFP, Paul Grundy, MD, MPH, IBM's Global Director of Health Care Transformation, spoke at the UC Davis Department of Family and Community Medicine in early June.  He focused on the implementation of the Patient Centered Medical Home (PCMH).  To gain support and respect from other stakeholders in health care reform, Dr. Grundy urged primary care physicians to redefine "generalists and specialists" as "comprehensivalists and partialists," respectively.  Throughout his presentation, he identified the physician-leader in the PCMH model as a "comprehensivalist."

As Dr. Grundy continued to cite "comprehensivalist" consistently and seamlessly, I began to see the wisdom of defining family medicine's mission and merits on our terms instead allowing others to continue to marginalize our contributions.  The abortion debate provides a prime example of the importance of protecting identity ownership.  The opposing sides have declared themselves as either pro-life or pro-choice.  Neither would accept the labels of anti-choice or anti-life, respectively.  To do so would compromise each camp's convictions.

Have we tacitly complied with the popular view that a primary care physician (generalist) is a jack-of-all-trades and a master of none over the last two decades?  Is this view partially responsible for the declining interest in family medicine among medical school graduates during that time period?  The public is skeptical of anyone being able "to know too much about much."  The default assumption is that a family physician is one who lacked the intellectual fortitude to pursue specialty training.  Therefore, this practitioner of limited skill deserves a corresponding limited compensation.

By advocating "comprehensivalists" in professional settings, we establish a mind set and change the dynamics of the dialogue.  In this mind set, family physicians can clearly delineate that providing coordinated and comprehensive care to patients in the setting of a long-term relationship is a skill that needs to be valued by all in order for health care to improve for everyone.