Military family practitioners join the ranks of The Journal of Family Practice

Charles E. Henley

As a member of The Journal of Family Practice Editorial Board and a lieutenant colonel in the Army Medical Corps, I would like to take this opportunity to welcome the family physician members of the uniformed services who, with this issue, have been added to the list of those who received copies of The Journal.

Family practice in the military, which began in the early 1970s, is a concept embraced by all branches of the uniformed services. The US Army, Navy, and Air Forces all run training programs in family practice. The six programs in the Army are divided equally between medical centers and community hospitals. All these training programs are accredited, most for the full 5 years, and the faculities in these programs enjoy the full scope of academic medicine including practice, teaching, and research. For family physicians practicing outside a teaching program, there are several practice sites where family practice physicians represent the predominant physician group in the hospital and manage most of the patient care. These physicians function as true gatekeepers in the sense that entire communities of eligible patients are empaneled and the family practice physicians manage nearly all access to tertiary consultants. In fact, a new graduate going into practice at a military community hospital would be assigned a large panel of patients and would be involved in obstetrics, inpatient care, and outpatient procedures, such as vasectomy, flexible sigmoidoscopy, colposcopy, and treadmill testing. Family medicine at a military site represents a full practice, and the residency programs are oriented accordingly.

One of the things that military residency programs never seem to worry about is having enough clinical material. They also do not have to worry about applicants for the graduate medical education (GME) programs. Virtually all first-year GME slots are filled by applicants from the Health Professional Scholarship programs or the Uniformed Services Medical School in Bethesda, Maryland, and enviable position for program directors.

Family physicians who choose careers in the military do so for a variety of reasons, and there are obviously some situations that are unique to being in the military. For example, a family physician who is also a flight surgeon in the Navy may get flight hours hurtling off the end of an aircraft carrier in the middle of the night; or in special operations, the family practice may be a ranger group and a house call may require parachuting out of a perfectly good airplane. Physicians who choose these operational medicine assignments know that they offer an opportunity to experience things that they would never be able to do in civilian practice. However, for the majority, family practice in the military is similar to a civilian HMO or large group practice in the military is similar to a civilian HMO or large group practice in that all retirees and active duty personnel and their families are cared for in one setting.

The military family practive community is rather close-knit. These are over 300 family physicians in the Army, and the six training programs graduate approximately 45 new family physicians per year. The Air Force and Navy programs are only slightly smaller. Various branches of the military are combined under the banner of the Uniformed Services Academy of Family Physicians (USAFP), which is a state chapter under the American Academy of Family Physicians (AAFP). There is also a foundation for this organization that acts as the philantrophic arm and supports educational and research activities. The USAFP has an annual convention at which 350 to 400 family physicians get together for quality continuing medical education programs. One of the main events at this gathering is a research competition, which in 1993 had over 50 submissions. Military family physicians also are involved in the activities of the AAFP, sometimes serving on committees or commissions, as well as the activities of the Society of Teachers of Family Medicine and the North American Primary Care Research Group.

It is hoped that some of the olde sterotypes of the military physician just doing sick call ans induction physicals have been removed. Today’s uniformed family physicians take great pride in their military identity, training, and capabilities, but also want to be acknowledged as part of the mainstream of family medicine. It is for this reason that receiving The Journal of Family Practice is so important. It is an acknowledgement that uniformed family physicians are a part of the “family” of family prectice and contribute to the wealth of family practice experiences that define our discipline. I thank the publishers for their decision on this matter, and look forward to a renewed interest among uniformed family physicians, as readers and authors, in what is certainly one of the best professional journals in the country.

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