Don't tell me I'm a specialist.

M y (rural) auto mechanic is a generalist. He will fix my Corolla as easily as my Chrysler minivan. There actually isn’t enough work in our town for someone to specialize in a foreign make. Our town also can’t support an orthopedist, but there is enough work for our general surgeon (a real generalist surgeon who does a bit of orthopedics and the occasional cesarean). There should be no shame in this — it’s actually a virtue. Yes, the system that rural Canada has by necessity has evidence for the best outcomes for society. The best health care systems in the world are predominated by generalists. Health care systems that depend on the family doctor, who has an office where he or she sees a recurrent caseload, reduce all-cause mortality and mortality caused by cardiovascular and pulmonary diseases. They also reduce the need for emergency department visits and hospital admissions as well as giving better preventive care, including better detection of breast cancer and reduced incidence and mortality caused by colon and cervical cancer. We also give better patient satisfaction with less testing and less medication use, and a much lower total cost to society. Volume does not improve results for most garden-variety diagnoses as a rule. It’s only the rare diagnosis, such as prematurity, and highly complex procedural work, such as esophagectomies, pancreatic cancer surgery and angioplasty, that have been shown in Canada to be best done in high-volume hospitals. Specialization, and especially specialization of family practice, is a threat to rural medicine as we don’t have the volume to sustain it. I’m a generalist who has a hand in hospital care, emergency care, chronic care, maternity care and prevention, as well as that centre of continuity: office care. I am that most general of generalists, the rural general practitioner, and am mighty proud of the work that we as rural doctors do for our communities. Don’t tell me I’m a specialist.