AAFP Family Medicine Career Test (ATC)

Primary care is integrated and accessible health care that addresses most of a person's health needs while developing a sustained relationship between the patient and health care team. Primary care clinicians frequently serve as the patient's first point of contact with the health care system.

Primary care includes preventive services, health maintenance, diagnosis and treatment of disease, counseling, patient education, and coordination with other health professionals.

Characteristics of primary care

• First contact — primary care is often the patient's first entry into the health system for a new concern. Example: a patient visits a physician because of unexplained fatigue.
• Continuity — patients receive care from the same physician or team over time. Example: a physician manages a patient's diabetes for several years.
• Comprehensiveness — a wide range of preventive, acute, chronic and behavioral health needs are addressed. Example: one physician provides vaccinations, treats infections and manages hypertension.
• Coordination — primary care connects the specialists and other health professionals involved in a patient's care. Example: a family physician integrates recommendations from a cardiologist and an endocrinologist.

Undifferentiated health problems

An undifferentiated health problem is a medical concern for which the underlying diagnosis has not yet been established.

For example, fatigue may eventually be found to result from anemia, hypothyroidism, infection, sleep deprivation, depression or another condition. Primary care physicians commonly evaluate patients before the specific cause of their symptoms is known.

Primary care and family medicine are not synonymous

Primary care describes a type of health care. Family medicine is a medical specialty that frequently provides primary care.

Primary care specialties

• Family medicine — may treat patients throughout the entire lifespan: infants, children, adolescents, adults, pregnant patients and older adults. Particularly associated with continuity of care and the ability to care for multiple generations of the same family.
• General internal medicine — general internists primarily care for adults, commonly managing chronic and complex adult illnesses such as hypertension, diabetes, cardiovascular disease and multiple coexisting conditions.
• General pediatrics — provides primary care primarily to infants, children and adolescents.
• Geriatrics — focuses on older adults, particularly those with multiple chronic diseases, polypharmacy, cognitive decline, impaired mobility and functional limitations.
• Internal medicine-pediatrics — Med-Peds physicians receive combined training in internal medicine and pediatrics, and therefore care for both children and adults.

High-yield distinctions

These are especially worth memorizing, because they easily become multiple-choice distractors.

• Primary care vs. family medicine — primary care is a type of care; family medicine is a specialty.
• Family medicine vs. internal medicine — family medicine treats children and adults; general internal medicine primarily treats adults.
• AAFP vs. ABFM — the AAFP supports the profession; the ABFM provides specialty board certification.
• Residency vs. fellowship — residency is required specialty training; fellowship is optional advanced training.
• Urgent care vs. primary care — urgent care is generally episodic; primary care emphasizes continuity.
• Direct primary care vs. family medicine — DPC is a payment and practice model; family medicine is a specialty.
• Fee-for-service vs. value-based care — fee-for-service emphasizes services and volume; value-based care emphasizes quality and outcomes.
• MD vs. DO — both medical degrees can lead to family medicine practice.

The scope of practice of family medicine is broad, because family physicians are trained to treat patients of different ages and to manage many different types of medical problems.

Family physicians may provide preventive care, diagnose acute illnesses, manage chronic diseases, treat behavioral health conditions, perform procedures and coordinate specialist care.

Preventive medicine

Preventive medicine attempts to prevent disease, or to identify it before serious complications develop. Common preventive services include:

• vaccinations
• blood pressure screening
• cholesterol screening
• diabetes screening
• cancer screening
• smoking-cessation counseling
• nutrition counseling
• exercise counseling
• obesity management
• annual wellness examinations

Preventive care is an important part of family medicine because family physicians frequently maintain relationships with patients over many years.

Acute care

An acute condition develops relatively quickly and generally requires short-term evaluation or treatment. Family physicians commonly treat:

• upper respiratory infections
• influenza
• ear infections
• urinary tract infections
• headaches
• minor injuries
• rashes
• abdominal pain
• musculoskeletal pain

Because family physicians often serve as first-contact clinicians, patients may initially present with symptoms rather than established diagnoses.

Chronic disease management

A chronic disease persists for an extended period and often requires ongoing medical management. Common chronic diseases treated in family medicine include:

• hypertension
• diabetes mellitus
• asthma
• chronic obstructive pulmonary disease
• hyperlipidemia
• obesity
• arthritis
• depression
• anxiety

For example, managing a patient with diabetes may include monitoring hemoglobin A1C, adjusting medications, providing dietary counseling, screening for kidney disease and arranging eye examinations. This combines continuity, comprehensiveness and care coordination.

Behavioral and mental health

Family physicians frequently evaluate and treat common behavioral and mental health conditions, including anxiety, depression, substance-use disorders, insomnia and stress-related conditions.

Some conditions may be treated directly by the family physician, while others require collaboration with psychiatrists, psychologists, counselors or social workers.

Procedures in family medicine

Depending on training and practice setting, family physicians may perform procedures such as:

• suturing lacerations
• skin biopsies
• removal of skin lesions
• joint injections
• gynecologic procedures
• musculoskeletal procedures

Some family physicians also provide maternity and obstetric care.

An individual family physician's exact scope varies according to training, additional certifications, local community needs, hospital privileges, rural or urban location, available resources and personal professional interests. Not every family physician performs every procedure available within the specialty.

Coordination with specialists

Family physicians frequently refer patients to medical specialists while continuing to manage the patient's overall health.

For example, a family physician may refer a patient with heart disease to a cardiologist. After receiving the specialist's recommendations, the family physician may continue managing the patient's medications, diabetes, blood pressure, preventive screenings and other medical needs.

This illustrates care coordination, rather than simply transferring responsibility for the patient.

Family medicine is practiced in a wide variety of settings. The breadth of training allows family physicians to follow several different career paths.

Outpatient practice

Outpatient or ambulatory clinics are among the most common family medicine settings. Typical responsibilities include:

• preventive examinations
• chronic disease management
• same-day illness visits
• medication management
• minor procedures
• long-term patient follow-up

Physicians may work for hospital systems, private medical groups, community clinics or independent practices.

Private practice

Family physicians may own or co-own medical practices. Ownership may provide greater control over scheduling, staffing, clinic policies, patient volume, technology and practice philosophy.

However, physician owners may also be responsible for billing, payroll, hiring, insurance contracts, regulatory compliance and business operations.

Direct primary care

Direct primary care (DPC) is a practice model in which patients generally pay a recurring monthly or annual fee directly to a primary care practice. The fee covers an agreed-upon group of primary care services, and DPC may reduce reliance on traditional insurance billing for those services.

Note the distinction: direct primary care is a practice and payment model, while family medicine is a medical specialty.

Hospital medicine

Some family physicians work primarily as hospitalists, caring for hospitalized patients. Responsibilities may include hospital admissions, inpatient treatment, consultation with specialists, monitoring hospitalized patients and discharge planning.

A hospitalist differs from an emergency physician because hospitalists generally manage patients after admission to the hospital.

Urgent care

Family physicians may work in urgent care centers treating relatively immediate but non-life-threatening conditions, such as minor injuries, respiratory infections, rashes, urinary infections and mild allergic reactions.

Urgent care is generally more episodic than traditional primary care: primary care emphasizes long-term relationships, while urgent care more frequently involves isolated encounters.

Rural medicine

Family physicians are particularly important in rural communities where specialist access may be limited. A rural family physician may provide outpatient primary care, emergency care, hospital care, minor procedures and maternity care.

The scope of rural family physicians may therefore be broader than that of physicians in areas with many nearby specialists.

Academic medicine

Academic family physicians may combine patient care, medical student teaching, resident education, research and administration, working for medical schools or university health systems.

Public health and government

Family physicians may work in public health departments, military health systems, Veterans Affairs facilities, government agencies and federally supported community health centers.

Telemedicine

Telemedicine involves providing medical care remotely using communication technologies such as video visits. Potential uses include medication follow-ups, behavioral health visits, chronic disease monitoring, follow-up consultations and selected acute complaints.

Telemedicine can improve access, particularly for patients living far from health care facilities. However, it cannot replace in-person care when a physical examination, procedure or diagnostic testing is necessary.

Locum tenens

Locum tenens refers to temporary physician employment. A physician may temporarily work at a medical practice or hospital to cover another physician's absence, address staffing shortages or provide temporary clinical services.

There is no single lifestyle shared by every family physician. Working conditions vary considerably according to career setting.

An outpatient physician may have relatively predictable weekday hours, while a physician providing obstetric care may have overnight call responsibilities. Urgent care physicians may work evenings and weekends, while hospitalists commonly work scheduled shifts or blocks.

This variation contributes to the career flexibility of family medicine.

Work-life flexibility

Family physicians may choose among careers involving:

• outpatient medicine
• hospital medicine
• urgent care
• telemedicine
• academics
• public health
• rural medicine
• practice ownership

Physicians may also change their practice focus during their careers.

Patient relationships

Continuity of care allows family physicians to develop long-term relationships with patients. A physician may care for a child, then the child's parents, then the child's grandparents, and continue treating the family for many years.

This multigenerational care is particularly characteristic of family medicine.

Variety of patients

A family physician may see a wide variety of patients during a single day. For example:

• 8:00 AM — child with an ear infection
• 9:00 AM — adult with hypertension
• 10:00 AM — teenager receiving a sports physical
• 11:00 AM — patient with anxiety
• 1:00 PM — diabetic follow-up
• 2:00 PM — older adult with arthritis
• 3:00 PM — minor procedure

The specialty therefore requires knowledge across numerous areas of medicine.

Compensation

Family physician compensation varies according to geographic location, hours worked, practice ownership, patient volume, procedures performed, rural versus urban location, call responsibilities and employment model.

When HOSA or AAFP materials provide an average salary, remember that an average does not mean every family physician earns that exact amount.

Becoming a family physician in the United States generally requires undergraduate education, medical school and a family medicine residency.

Typical pathway

• Undergraduate education — approximately 4 years
• Medical school — approximately 4 years
• Family medicine residency — approximately 3 years
• Fellowship — optional additional training

A typical path is therefore roughly 4 + 4 + 3 = 11 years after high school before completion of family medicine residency.

Undergraduate education

Students generally complete a bachelor's degree while satisfying the prerequisite courses required by medical schools.

A student does not have to major in biology. Applicants may major in many subjects, as long as they complete the appropriate medical school prerequisites.

Medical school

Medical school generally lasts four years. Students may earn either:

• MD — Doctor of Medicine
• DO — Doctor of Osteopathic Medicine

Both MD and DO physicians can enter family medicine residency programs and become family physicians.

Family medicine residency

Family medicine residency typically lasts three years. Residents progressively gain greater responsibility for patient care.

• PGY-1 (Post-Graduate Year 1) — training may include inpatient medicine, outpatient family medicine, pediatrics, obstetrics, emergency medicine and internal medicine.
• PGY-2 — residents generally receive greater clinical responsibility, additional outpatient experience, elective opportunities and more independent decision-making.
• PGY-3 — training increasingly emphasizes leadership, advanced clinical decision-making, independence and preparation for independent practice.

Continuity clinic

Family medicine residents participate in continuity clinic, where they repeatedly care for many of the same patients over time. This teaches residents how to manage chronic diseases, preventive care, long-term relationships, follow-up and coordination of care.

Fellowship training

A fellowship is optional additional training completed after residency. Family physicians may pursue additional training in areas such as sports medicine, geriatrics, palliative medicine, maternity care and academic medicine.

Fellowship is not required for every family physician.

Board certification

A physician may pursue specialty board certification after completing the required medical education and residency training. Two organizations are especially important to distinguish:

• AAFP — the American Academy of Family Physicians, a professional organization supporting family physicians through advocacy, continuing education, career resources, clinical information, practice support and professional networking.
• ABFM — the American Board of Family Medicine, responsible for family medicine board certification and maintenance of specialty certification.

A common HOSA trap: the AAFP does not certify family physicians. ABFM means board certification; AAFP means advocacy, education and professional support.

Strong primary care systems are associated with improved health outcomes, because primary care emphasizes prevention, early diagnosis, chronic disease management and coordination.

Disease prevention

Primary care may prevent or identify disease through:

• vaccinations
• cancer screenings
• blood pressure screening
• cholesterol testing
• diabetes screening
• lifestyle counseling

Earlier detection can allow treatment before severe complications develop.

Chronic disease control

Primary care physicians routinely manage conditions such as hypertension, diabetes, asthma and hyperlipidemia.

Effective management can reduce the risk of complications including stroke, heart disease, kidney disease and hospitalization.

Continuity of care

Long-term physician-patient relationships allow clinicians to understand a patient's previous illnesses, medications, family history, baseline health, lifestyle and social circumstances. Changes may therefore be easier to recognize.

Reduction of fragmented care

Patients with several specialists may receive recommendations from multiple clinicians. Primary care physicians can integrate those recommendations into a single overall treatment plan.

This may reduce duplicated testing, conflicting medications, unnecessary health care utilization and confusion among patients.

Modern primary care continues to change in response to technology, workforce demands, health care costs and patient needs.

Team-based care

Team-based care distributes patient-care responsibilities across different health professionals. A primary care team may include:

• physicians
• nurses
• medical assistants
• pharmacists
• behavioral health specialists
• social workers
• care coordinators

The goal is to allow each team member to contribute according to their professional training.

Telehealth

Telehealth can improve access by allowing certain encounters to occur remotely.

• Potential advantages — reduced travel, easier follow-up, greater rural access and improved convenience.
• Limitations — inability to perform some physical examinations, technology barriers, privacy concerns and inability to perform procedures remotely.

Value-based care

Traditional fee-for-service medicine generally reimburses clinicians according to the services provided.

Value-based care attempts to connect payment more closely with health outcomes, quality, coordination, affordability and population health.

An easy way to remember it: fee-for-service means volume; value-based care means outcomes and value.

Artificial intelligence

Artificial intelligence is increasingly used in medicine for tasks such as documentation, clinical decision support, record summarization, population health analysis and administrative assistance.

An ambient AI scribe may listen to a clinical conversation and create a draft medical note. The physician should still review, correct and approve the documentation.

AI tools are intended to assist physicians, not to replace physician clinical judgment.

Integrated behavioral health

Integrated behavioral health places physical and mental health services closer together. For example, a primary care clinic may include behavioral health clinicians who help manage depression, anxiety, substance-use disorders and chronic disease-related stress.

The American Academy of Family Physicians (AAFP) is a professional organization representing family physicians, residents and medical students. It was founded in 1947.

Its activities include professional advocacy, physician education, research resources, career development and practice support.

Advocacy

The AAFP advocates on issues affecting family physicians and primary care, including:

• physician reimbursement
• health policy
• administrative burden
• physician workforce
• access to primary care
• medical education

Education

The organization provides continuing medical education, conferences, clinical guidance, educational publications, and student and resident resources.

Practice support

AAFP resources may assist physicians with billing, practice management, technology, payment models, administrative issues and career development.

AAFP is not ABFM

This is a common exam distractor. The AAFP supports the family medicine profession through advocacy, education, practice resources and professional development. The ABFM — the American Board of Family Medicine — is the organization associated with family medicine board certification.