Picture a health system where family medicine and emergency medicine physicians work together as true partners within the same emergency department. Both specialties share responsibility for the same patients by providing comprehensive and coordinated care. This is probably how the founders of emergency medicine, many of whom were family physicians, imagined the future when they started this specialty.
Although this collaborative approach may seem new to some, it has been the foundation of how our county hospital has functioned for decades. Contra Costa County (CCC), located in California’s Bay Area, is home to Contra Costa Health Services (CCHS) which is comprised of the county hospital Contra Costa Regional Medical Center (CCRMC) and its affiliated clinics. This health system serves a community of over one million residents. Built and cultivated by clinical generalists who then became known as family physicians, CCHS has family physicians supporting its health care infrastructure in all areas including holding leadership roles such as chief medical officer, hospital director, hospital medicine chair, obstetrics and gynecology chair, public health officer, family medicine residency program director, medical staff committee chair, and even the former emergency department chair. Furthermore, family physicians contribute across nearly all CCHS departments including the respite center, skilled nursing facilities, primary care and specialty clinics, health care for the homeless, labor and delivery, the detention system, hospital medicine, and emergency medicine. This model of family physicians practicing full-scope medicine is commonplace in many areas of the country, particularly in community and rural emergency departments.
Family medicine residency programs are among the most comprehensive and diverse in all medical training programs. Historically, generalists and family physicians were the backbone of health centers due to this vast skillset. Therefore, it is no surprise that most emergency departments were staffed with these well-trained physicians as it was vital that the first point of contact for a patient needed to be with a clinician proficient in stabilizing any possible ailment that presented itself. However, today it has become harder for family physicians to secure jobs in emergency departments. Restrictions have been put into place to limit the scope of family physicians such as requiring emergency medicine residency training, denying board certification in emergency medicine without it, and in some cases, prohibiting family physicians from covering emergency departments alone. Concurrently, advanced practice providers (APPs) have been given expanded roles in emergency medicine despite having less required clinical training than a family physician. Considering the difference in clinical education and training, this practice of restriction of family physician hiring and certification is unfair to family physicians and negatively impacts patient care.
Family physicians bring broad training, compassion, and the judgment to involve specialists when needed. They appreciate the full course of a patient’s illness, from acute care to the transition of ongoing management, helping their patients safely navigate the complex journey between the emergency department and outpatient setting. While not every health system or emergency department mirrors our model, we encourage decision-makers to recognize the value, versatility, and patient-centered focus that family physicians offer. Their presence strengthens acute care environments, and we should support their continued involvement in emergency departments. We are recognized as vital clinicians of rural hospitals and outpatient clinics, and we need to be recognized for our strengths in emergency care too.
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How do we achieve greater inclusion of family physicians in emergency medicine? This progress will only happen if individual physicians, local hospitals, and family medicine leaders actively advocate for our essential role. The American Academy of Family Physicians (AAFP) already has clear policies supporting this, but they must be adopted more broadly in health care policy. As emergency medicine became a formal specialty, some emergency medicine leaders pushed to restrict staffing solely to emergency medicine residency-trained physicians. This move sidelined many family physicians and, ironically, resulted in the expanded use of APPs, who receive less training than family physicians. Now, with emergency medicine residency programs unable to meet workforce demands for decades to come in addition to high burnout rates and attrition of emergency physicians, especially female physicians, it’s time to clarify standards for emergency department staffing. Every emergency department patient deserves care from a qualified physician trained in emergency services. Family physicians must be recognized as skilled, competent providers of emergency care.
The AAFP policies on this need to be widely implemented to ensure family physicians are part of the future of emergency medicine.
“Family physicians are trained in the breadth of medical care and, as such, are qualified to provide emergency care in a variety of settings. In rural and remote settings, family physicians are particularly qualified to provide emergency care. Emergency department credentialing should be based on training, experience and current competence. Combined residency programs in family medicine and emergency medicine, or additional training, such as fellowships in emergency medicine or additional course work, may be of added benefit.”
The AAFP position paper emphasizes the strengths that family physicians bring to emergency care.
“The training environment for most of today’s emergency medicine residencies is one where specialty consultants and advanced technology are readily available to the emergency physician to assist in the assessment and care of their patients. Most rural and remote emergency departments lack those kinds of resources, and (family physicians) depend upon their own best clinical skills and judgment to a greater degree. In these areas, the ideal physician is a generalist with expertise in emergency medicine.”
I know that all health systems and emergency departments are not like mine. But I hope for those who are in a position to make hiring and/or policy decisions regarding family physicians, that the diverse training, persistent patient advocacy, and versatile qualities of a family physician are strongly considered. Family physicians belong in acute care just as much as they are valuable in the hospital or clinic. We should celebrate the full scope of family medicine and continue to promote the family physician presence in acute care settings such as the emergency department.
Angela Rodgers and Wray Anthony Gerard are family physicians.
