Sustaining the 4 principles of family medicine in Canada.

In the mid-20th century, concern over the declining role of the general practitioner as medical knowledge rapidly expanded and specialization flourished stimulated the Canadian Medical Association and some visionary general practitioners to found the College of Family Physicians of Canada (CFPC). Development of CFPC Certification in 1969 brought clarity to the role of family physician. During the 1980s and 1990s, an aging population and the evolution of 55 specialties and of the role of nurse practitioners as deliverers of primary health care made family physicians’ role in the health care system less clear. In the mid-1980s, the CFPC produced the 4 principles of family medicine to provide guidance and direction for practitioners, residency programs, and the CFPC when making educational policy decisions. Even with the 20th century’s dramatic changes in health care, people still need a physician who will help them when they are sick or in pain and will assist them with any problem. This is particularly true for people with comorbidity who have been found to function best under the care of a single healer rather than multiple specialists.1 Throughout the past decade, evidence has accumulated demonstrating that a strong primary health care system is vital to improving the health of a country’s population by reducing stroke mortality, reducing child mortality, and extending life.2-4 First-contact access to appropriate primary care is important in minimizing costs and improving outcomes.5-7 People expect their personal physicians to be expert clinicians, scholars, scientists, appraisers of new medical knowledge, skilled interviewers, health advocates, adaptable learners, collaborators, stewards of precious resources, and healers.8 All of these roles can be addressed with minor modifications to the 4 principles.9 Comparing Canada’s 4 principles of family medicine to principles developed by 10 international organizations representing more than 30 countries shows that only 1 area is underemphasized in the Canadian principles. The important concept is adaptability and professionalism. This comparison suggests that the principles are sustainable with only minor modification.