“How do you feel about the fact that our nation’s most prestigious medical schools don’t have a family practice department?”

This was a question that was asked of me by a generalist physician colleague at the Robert Wood Johnson Foundation-sponsored workshop that I am attending in Princeton, NJ.

The question is part of a theme of work being undertaken by leaders here, and also in my travels in the last several months now. What about primary care and how should it be supported?

So I thought about this overnight. I am a family practitioner. I went to medical school hoping to be a family practitioner. I left medical school hoping to be a family practitioner. My interest in being a family practitioner is to provide patient and family-centered care, and promote it in my profession and in all of health care, in order to reduce disparities. This is really what’s at the heart of all of my work in health information technology.

I would therefore pursue a different question, which is, “How do I feel about any medical school that doesn’t teach patient and family-centered care?” My answer would be similar to the question, “How do I feel about a health system that doesn’t involve patients and families in their care?”

A family practice department and a transparent health system go hand in hand with a patient centered approach. We should continue to support the thinking about patient-centered approach in every educational institution. A sign on a door doesn’t make that happen. It’s the icing on the cake.

It has been a delight to spend time with fellow alumni of Robert Wood Johnson Foundation fellowship programs this week. We are sharing a diversity of health issues and interests with each other. The thing that our interests have in common, in my opinion, is the desire to support a health system that respects patients, their families, and their communities. The experience has been very affirming of the Foundation’s commitment to health and health care.


Good question. I know that most Canadian medical schools have departments of family practice. McGill has one and I have seen McGill included in discussions about the most prestigious medical schools in the US because it is so popular with American students. I heard of one convocation speech where the dean quipped that for the best and the smartest students there was general practice and the others could specialize.

In reality it is not that the generalists or the specialists are smarter it is as Marsden Blois wrote that they work in different information domains. The generalist have to make decisions when there is not much information to deal with and the specialists work in an environment where there is lots of information and they have to make sense of it. Each environment has its own challenges the generalist has to deal with a lot of unknowns and the specialist has to understand all the details.

Have there been any medical schools where the dean was a generalist physician?


It's been a while since I wrote that post, I needed to get up to speed on what I said back then!

I don't know the answer about medical schools, maybe it's worthy of a tweet to find out. Do you want to do it or shall I?

I agree with your points, and whether or not any group of physicians is smarter gets away from the real question, which is, "are they working together to deliver the best care?" That really is not dependent solely on intelligence (of the scientific kind, anyway).

All of that said, I do know several large medical groups where the President/CEO is a generalist physician,


Ted Eytan, MD