The late Barbara Starfield declared comprehensiveness – caring for patients and families across the spectrum of their lives and providing most of the care that they need – to be one of the four foundational virtues of primary care. Family medicine has long prided itself as being the most comprehensive of the primary care disciplines, with training to care for patients across the widest array of health care delivery settings and services, and from “cradle to grave.” Many of us cherish this breadth and depth as fundamental to our specialty choice and attribute broad scope of care as one of the things that brings us joy in practice. Despite this, there has been a general reduction in the scope of practice among family physicians over the last 20 years. Fewer family physicians care for pregnant women; see children; and attend to the care of their hospitalized patients.https://www.ohioafp.org/wfmu-article/family-medicine-and-comprehensiveness-of-care-what-are-the-risks-of-declines-in-scope-of-practice/
At no time in the history of our specialty have our diplomates faced greater complexity or more rapid transformation of the health care delivery system,nor such incredible uncertainty and dynamism in their future roles within it.1In addition to tackling the most complex clinical encounters, 2 graduates now leave training expected to immediately under-stand a health system shaped by such towering forces as rapidly increasing consolidation, value-based and alternative payment models, measurement, internecine scope-of-practice battles, disruptive delivery innovations, genomics, big data, artificial intelligence, and machine learning.
Introduction: Opioid use disorder (OUD) is a major and growing public health concern, and Medicare patients have nearly double the proportion of OUD prevalence compared with those with commercial insurance. This study examines provider-level characteristics to delineate the wide variation behind buprenorphine provision, which is the mainstay of medication-assisted treatment for OUD.
Methods: Using Medicare Part D Public Use Files claims data from 2013 to 2016 in all states, we assessed prescribing patterns of buprenorphine formulations for the specialties of family medicine, internal medicine, psychiatry, and general practice.