The specialty of generalism: Reclaiming patient care in a market-driven system
13 Aug 2026
By John Michael D. Deblois, MD, DFM, FPSHPM
(Editor's note: this article appeared in the 1st issue of MIMS Doctor magazine, 2026, in partnership with the Philippine Academy of Family Physicians, Inc. [PAFP].)
When Rosario coughed blood while in office, she decided to do as any middle-class pinoy patient would: Go to the ER.
A doctor saw her after a grueling four hours. When he ordered the tests, he told her, “Why only now?” Rosario was taken aback, but she knew, growing up in the slums of Tondo, what the correct response was: meek submission.
For she hadn’t known where to go. A friend recommended her pulmonologist, but it seemed an overkill for a simple cough; the cost of an appointment would’ve eaten up her budget.
Faced with an expensive bill, she signed a “home against medical advice”. In a few days, her cough worsened, her breathing grew heavier, her appetite crashed.
The Philippine healthcare system frequently asks Filipinos an impossible choice: to be subjected to an inefficient, expensive hierarchy or a waiver signifying their “refusal” to avail healthcare. The two-tiered private and public sector is a framework that casts these inefficiencies in an economic light, albeit toosimplistically.1
At the epicenter of these efficiencies are these words buried surreptitiously in healthcare discussions: primary healthcare. And hovering at the fringes is the field of family and community medicine(FCM), the true speci8alists in outpatientcare.2
For outpatient care is a field of its own, a domain of specialty far removed from the epistemological glory attributed to traditional specialties—the specialties a Filipino will think of first if met with something as simple as a “sakit sa batok”, effectively bypassing primary care and a manifest failure of gatekeeping.3
For a family medicine physician is more. FCM is not encumbered by the blinders needed to excel in a single bodily system. We are not mere specialists. Weare the jack of all trades and better than just a master of one, the antidote to a culture of turfing, market excellence, andcompetition.4 We are generalists.
Doctors have difficulty admitting that our economic premise makes us treat poor patients and rich patients differently.5 Private hospitals value highly specialized care where latest technology is king and is subjugated by market-based forces where health is beholden to “maximizing shareholder value.”6,7 Incentive is high towards rare curative procedures while there is little profit in prevention, early consults, and screening.8
The result is skyrocketing costs and the walling-off of the private hospital like a gated subdivision designed to put others out.9 Yet the irony remains that worldclass health service is said to be available only in these hospitals, not in public hospitals, and certainly not in the community. It’s just your average Juan cannot avail it and is made to believe that he deserves less. “Bakit ‘kayo nag-private?” is a common phrase that epitomizes the ignorance of health workers—even doctors—to the crippling financialization of our private hospitals.9,10
For the public sphere—where the cracks of this brokenness are exposed—are perennially inundated. Public service is for the poor and, to some, where family and community medicine “should be.” Systemic inefficiencies serve to justify the lie that private sector services are inherently more efficient;11 yet only few private hospitals recognize family and community medicine within their ranks and even fewer are those who actively advocate its existence. Protecting practices remain to be the main interest and outpatient care is still in the domain of subspecialists, resulting to prohibitive costs in first-contactcare.12 Referral backs to primary care are virtually non-existent. Worse is that many private hospitals are centers of medical education, exposing medical students mostly to niche specialties and contributing to the prestige gap towards FCM.13
It is in the public sphere that this specialty in generalism has been making a mark, partly as additional manpower, and partly as a true recognition of primary care as key to resolving the self-inflicted issues of a market-driven healthcare system. FCM emphasizes values anathema to neoliberalism: the Patient-centered, Family-focused, and Community-oriented care matrix asks doctors to see the many-layered causes of disease, arming them with unique approaches in the science of physician ship and evidence-based medicine.14 It subtly behooves doctors to see healthcare as a socialized necessity that should be funded by progressive policies.
While it is lamentable that the Philippine system still treats generalism as a fringe service, international evidence15,16demonstrates that FCM is the most effective tool for curbing skyrocketing healthcare costs while ensuring better health outcomes for the population.17
Professional incentives in healthcare in the Philippines, however, remains to be concentrated hospitals and not in community clinics. Even some private FCM practitioners in big hospitals see these rights-based approach to health as a negative in UHC law.18
Outpatient care still lags in our country. A year since the passage of UHC Law, hospital care accounts for 50% of total health spending while primary care only accounts 4%.19 Poor preventive care remains to be the majority cause of excess deaths in the Philippines, with about 40% avoidable mortality in the country and notable deficiencies in the effective coverage of hypertension treatment.20
Non-communicable diseases such as hypertension, fatty liver disease, diabetes, and thyroid disease are never an exclusive domain of cardiology and endocrinology, for these are our competencies as a family physician.21
We can deal with depression and anxiety, recognize danger signs, and handle them with compassion that they need. 21
We can handle asthma and COPD exacerbations and ensure attacks no longer recur; we mastered the asthma action plan, motivational interviewing for behavioral change, and the 5As for smokingcessation.21
We can deal with some CKD patients and understand our role in preventing its progress. We handle HIV patients, treat gonorrhea and chlamydia, diagnose and manage syphilis, know the monitoring interval needed to ensure good response to treatment, and counsel high risk groups.21
We clean and suture wounds, conduct circumcisions, extract foreign bodies, perform normal spontaneous deliveries, repair lacerations, instruct breastfeeding, prescribe contraception, conduct family planning meetings, and do immunizations.21
We lean on diet and exercise advice and yet we are no stranger to giving GLP-1s and GIPs. We handle tuberculosis, pneumonia, dengue, scabies, impetigo, and a slew of childhood diseases and geriatric syndromes. We can also handle cancer screening and diagnosis and guide patients in navigating next steps, including palliative care and end-of-lifecare.21
We advocate for the empowerment of medical graduates to be better armed in managing primary care conditions and advocating for primary health care.22
Above all else, the FCM practitioner marvels in their role as a gatekeeper: to screen, to prevent, to cure, and to refer to our partner specialists when all means are exhausted.21
We do all this while bringing down costs of services, decreasing unnecessary testing, lower professional fees, decreasing risk of complications, and maximizing coverage for the people while maintaining good health outcomes. Weare the long-sidelined keystone to the future of our healthcare system.
So, when Rosario knocked on my outpatient clinic, desperately asking for help, I obliged. Six months later, she finished her regimen. She’s alive, well, and grateful to have found someone who was able to help her in a time of great need.
Yes, we’re the doctors who’ll see anyone who knocks on our door, and we’ll know exactly what to do.
References: 1. Kruk, M. E., et al (2018). High-quality health systems in the Sustainable Development Goals era: Time for a revolution. The Lancet Global Health, 2018; 6(11), e1196-e1252. https://doi.org/10.1016/S2214-109X(18)30386-3. 2. WONCA Europe. (2023). The European definition of general practice / family medicine. https://www.woncaeurope.org/page/definition-of-general-practice-family-medicine. 3. Dayrit, M. M., et al (2018). The Philippines health system review. Health Systems in Transition,8(2). World Health Organization Regional Office for South-EastAsia. https://iris.who.int/handle/10665/274579. 4. Hart, J. T. (1971). The inverse care law. The Lancet, 297(7696), 405–412. 5. Hipgrave, D. B., & Hort, K. (2014). Dual practice by doctors working in South and East Asia: A review of its origins, scope and impact, and the options for regulation. Health Policy and Planning, 29(6), 703–716. https://doi.org/10.1093/heapol/czt053. 6. Relman A. S. (1980). The new medical-industrial complex. The New England journal of Medicine, 303(17), 963–970. https://doi.org/10.1056/NEJM198010233031703. 7. Scheffler, R. M., & Alexander, L.(2022). The financialization of health care: Private equity’s role in the 21st century. Journal of Health Politics, Policy and Law, 47(5), 623–645. https://doi.org/10.1215/03616878-9977876. 8. Nisperos, G. A., & Ornos, E. D. B. (2022). The Philippine Universal Health Care Law: A differing view. Social Medicine, 15(2), 96-105. http://www.socialmedicine.info. 9. Council for Health and Development. (2022). Privatization of health in the Philippines: A fatal prescription [PowerPoint slides]. Approche Droits Rechtenbenadering. https://approchedroits-rechtenbenadering.be/wp-content/uploads/2022/01/4.-Kat-Berza.pdf. 10. Flaminiano, C. J. A., Puyat, V. A. R., Antonio, V. A. A., Uy, J., & Ulep, V. G. T. (2022, December). Spatiotemporal analysis of health service coverage in the Philippines (Discussion Paper Series No. 2022-42). Philippine Institute for Development Studies.https://pidswebs.pids.gov.ph/CDN/document/pidsdps2242.pdf. 11. Labong, J. A. M. (2021, July 1). A neoliberal perspective on the Rawlsian critique of different health care disparities and policies during the COVID-19 pandemic [Critique paper]. University of the Philippines. 12. Ulep, V. G. T., &Dela Cruz, N. A. O. (2015). Analysis of out-of-pocket expenditures in the Philippines. Philippine Journal of Development, 40(1–2), 93–125. https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidspjd13-oop_expenditures.pdf. 13. Nicodemus, L. A., et al. (2018). Medical students career choices and perceptions in family medicine and primary care. The Filipino Family Physician, 56(4), 175–181. 14. Leopando, Z. E., et al. (2019). The patient-centered, family-focused and community-oriented (PFC) matrix: A toolkit for biopsychosocial approach in primary care. The Filipino Family Physician, 57(1), 26–32. https://thepafp.org/journal/wp-content/uploads/2022/04/PAFP-Journal-2019-1-30-36.pdf. 15. College of Family Physicians of Canada. (2016). The patient’s medical home: A vision for family practice in Canada. https://pmh.cfpc.ca/. 16. Royal Australian College of General Practitioners. (2023). General practice: Health of the nation 2023. https://www.racgp.org.au/health-of-the-nation. 17. Gunja, M. Z., Gumas, E. D., & Williams II, R. D. (2024). Mirror, mirror 2024: A portrait of the state of primary care in the U.S. and nine other high-income countries. The Commonwealth Fund. https://doi.org/10.26099/v9n1-1123. 18. Estepa-Garcia, K., & Carpio, L. P. D. (2022). Attitudes and perceptions of Filipino family physicians toward the Universal Health Care Act., 60(2),254–259. 19. Department of Health. (2020). Philippine health facility development plan 2020-2040: Investing in resilient and sustainable health facilities towards Universal Health Care. Health Facility Development Bureau. https://bit.ly/PHFDP2020_2040. 20. Debebe, Z., et al.. (2026). A healthy future: Primary health care and the chronic disease epidemic in East Asia and Pacific. World Bank. https://doi.org/10.1596/978-1-4648-2284-1. 21. Philippine Academy of Family Physicians. (2016). FC instructional design with program outcomes 2016. https://thepafp.org/wp-content/uploads/2017/05/FC-instructional-design-with-program-outcomes-2016.pdf. 22. Espallardo, N. L., et al. (2024). Familyand community medicine in the context of universal health care: Introduction to recommendations for health policy development. The Filipino Family Physician, 62(2), 272–277. https://thepafp.org/journal/wp-content/uploads/2025/01/PAFP-62-2-76-82.pdf.
(Editor's note: this article appeared in the 1st issue of MIMS Doctor magazine, 2026, in partnership with the Philippine Academy of Family Physicians, Inc. [PAFP].)
When Rosario coughed blood while in office, she decided to do as any middle-class pinoy patient would: Go to the ER.
A doctor saw her after a grueling four hours. When he ordered the tests, he told her, “Why only now?” Rosario was taken aback, but she knew, growing up in the slums of Tondo, what the correct response was: meek submission.
For she hadn’t known where to go. A friend recommended her pulmonologist, but it seemed an overkill for a simple cough; the cost of an appointment would’ve eaten up her budget.
Faced with an expensive bill, she signed a “home against medical advice”. In a few days, her cough worsened, her breathing grew heavier, her appetite crashed.
The Philippine healthcare system frequently asks Filipinos an impossible choice: to be subjected to an inefficient, expensive hierarchy or a waiver signifying their “refusal” to avail healthcare. The two-tiered private and public sector is a framework that casts these inefficiencies in an economic light, albeit toosimplistically.1
At the epicenter of these efficiencies are these words buried surreptitiously in healthcare discussions: primary healthcare. And hovering at the fringes is the field of family and community medicine(FCM), the true speci8alists in outpatientcare.2
For outpatient care is a field of its own, a domain of specialty far removed from the epistemological glory attributed to traditional specialties—the specialties a Filipino will think of first if met with something as simple as a “sakit sa batok”, effectively bypassing primary care and a manifest failure of gatekeeping.3
For a family medicine physician is more. FCM is not encumbered by the blinders needed to excel in a single bodily system. We are not mere specialists. Weare the jack of all trades and better than just a master of one, the antidote to a culture of turfing, market excellence, andcompetition.4 We are generalists.
Doctors have difficulty admitting that our economic premise makes us treat poor patients and rich patients differently.5 Private hospitals value highly specialized care where latest technology is king and is subjugated by market-based forces where health is beholden to “maximizing shareholder value.”6,7 Incentive is high towards rare curative procedures while there is little profit in prevention, early consults, and screening.8
The result is skyrocketing costs and the walling-off of the private hospital like a gated subdivision designed to put others out.9 Yet the irony remains that worldclass health service is said to be available only in these hospitals, not in public hospitals, and certainly not in the community. It’s just your average Juan cannot avail it and is made to believe that he deserves less. “Bakit ‘kayo nag-private?” is a common phrase that epitomizes the ignorance of health workers—even doctors—to the crippling financialization of our private hospitals.9,10
For the public sphere—where the cracks of this brokenness are exposed—are perennially inundated. Public service is for the poor and, to some, where family and community medicine “should be.” Systemic inefficiencies serve to justify the lie that private sector services are inherently more efficient;11 yet only few private hospitals recognize family and community medicine within their ranks and even fewer are those who actively advocate its existence. Protecting practices remain to be the main interest and outpatient care is still in the domain of subspecialists, resulting to prohibitive costs in first-contactcare.12 Referral backs to primary care are virtually non-existent. Worse is that many private hospitals are centers of medical education, exposing medical students mostly to niche specialties and contributing to the prestige gap towards FCM.13
It is in the public sphere that this specialty in generalism has been making a mark, partly as additional manpower, and partly as a true recognition of primary care as key to resolving the self-inflicted issues of a market-driven healthcare system. FCM emphasizes values anathema to neoliberalism: the Patient-centered, Family-focused, and Community-oriented care matrix asks doctors to see the many-layered causes of disease, arming them with unique approaches in the science of physician ship and evidence-based medicine.14 It subtly behooves doctors to see healthcare as a socialized necessity that should be funded by progressive policies.
While it is lamentable that the Philippine system still treats generalism as a fringe service, international evidence15,16demonstrates that FCM is the most effective tool for curbing skyrocketing healthcare costs while ensuring better health outcomes for the population.17
Professional incentives in healthcare in the Philippines, however, remains to be concentrated hospitals and not in community clinics. Even some private FCM practitioners in big hospitals see these rights-based approach to health as a negative in UHC law.18
Outpatient care still lags in our country. A year since the passage of UHC Law, hospital care accounts for 50% of total health spending while primary care only accounts 4%.19 Poor preventive care remains to be the majority cause of excess deaths in the Philippines, with about 40% avoidable mortality in the country and notable deficiencies in the effective coverage of hypertension treatment.20
Non-communicable diseases such as hypertension, fatty liver disease, diabetes, and thyroid disease are never an exclusive domain of cardiology and endocrinology, for these are our competencies as a family physician.21
We can deal with depression and anxiety, recognize danger signs, and handle them with compassion that they need. 21
We can handle asthma and COPD exacerbations and ensure attacks no longer recur; we mastered the asthma action plan, motivational interviewing for behavioral change, and the 5As for smokingcessation.21
We can deal with some CKD patients and understand our role in preventing its progress. We handle HIV patients, treat gonorrhea and chlamydia, diagnose and manage syphilis, know the monitoring interval needed to ensure good response to treatment, and counsel high risk groups.21
We clean and suture wounds, conduct circumcisions, extract foreign bodies, perform normal spontaneous deliveries, repair lacerations, instruct breastfeeding, prescribe contraception, conduct family planning meetings, and do immunizations.21
We lean on diet and exercise advice and yet we are no stranger to giving GLP-1s and GIPs. We handle tuberculosis, pneumonia, dengue, scabies, impetigo, and a slew of childhood diseases and geriatric syndromes. We can also handle cancer screening and diagnosis and guide patients in navigating next steps, including palliative care and end-of-lifecare.21
We advocate for the empowerment of medical graduates to be better armed in managing primary care conditions and advocating for primary health care.22
Above all else, the FCM practitioner marvels in their role as a gatekeeper: to screen, to prevent, to cure, and to refer to our partner specialists when all means are exhausted.21
We do all this while bringing down costs of services, decreasing unnecessary testing, lower professional fees, decreasing risk of complications, and maximizing coverage for the people while maintaining good health outcomes. Weare the long-sidelined keystone to the future of our healthcare system.
So, when Rosario knocked on my outpatient clinic, desperately asking for help, I obliged. Six months later, she finished her regimen. She’s alive, well, and grateful to have found someone who was able to help her in a time of great need.
Yes, we’re the doctors who’ll see anyone who knocks on our door, and we’ll know exactly what to do.
References: 1. Kruk, M. E., et al (2018). High-quality health systems in the Sustainable Development Goals era: Time for a revolution. The Lancet Global Health, 2018; 6(11), e1196-e1252. https://doi.org/10.1016/S2214-109X(18)30386-3. 2. WONCA Europe. (2023). The European definition of general practice / family medicine. https://www.woncaeurope.org/page/definition-of-general-practice-family-medicine. 3. Dayrit, M. M., et al (2018). The Philippines health system review. Health Systems in Transition,8(2). World Health Organization Regional Office for South-EastAsia. https://iris.who.int/handle/10665/274579. 4. Hart, J. T. (1971). The inverse care law. The Lancet, 297(7696), 405–412. 5. Hipgrave, D. B., & Hort, K. (2014). Dual practice by doctors working in South and East Asia: A review of its origins, scope and impact, and the options for regulation. Health Policy and Planning, 29(6), 703–716. https://doi.org/10.1093/heapol/czt053. 6. Relman A. S. (1980). The new medical-industrial complex. The New England journal of Medicine, 303(17), 963–970. https://doi.org/10.1056/NEJM198010233031703. 7. Scheffler, R. M., & Alexander, L.(2022). The financialization of health care: Private equity’s role in the 21st century. Journal of Health Politics, Policy and Law, 47(5), 623–645. https://doi.org/10.1215/03616878-9977876. 8. Nisperos, G. A., & Ornos, E. D. B. (2022). The Philippine Universal Health Care Law: A differing view. Social Medicine, 15(2), 96-105. http://www.socialmedicine.info. 9. Council for Health and Development. (2022). Privatization of health in the Philippines: A fatal prescription [PowerPoint slides]. Approche Droits Rechtenbenadering. https://approchedroits-rechtenbenadering.be/wp-content/uploads/2022/01/4.-Kat-Berza.pdf. 10. Flaminiano, C. J. A., Puyat, V. A. R., Antonio, V. A. A., Uy, J., & Ulep, V. G. T. (2022, December). Spatiotemporal analysis of health service coverage in the Philippines (Discussion Paper Series No. 2022-42). Philippine Institute for Development Studies.https://pidswebs.pids.gov.ph/CDN/document/pidsdps2242.pdf. 11. Labong, J. A. M. (2021, July 1). A neoliberal perspective on the Rawlsian critique of different health care disparities and policies during the COVID-19 pandemic [Critique paper]. University of the Philippines. 12. Ulep, V. G. T., &Dela Cruz, N. A. O. (2015). Analysis of out-of-pocket expenditures in the Philippines. Philippine Journal of Development, 40(1–2), 93–125. https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidspjd13-oop_expenditures.pdf. 13. Nicodemus, L. A., et al. (2018). Medical students career choices and perceptions in family medicine and primary care. The Filipino Family Physician, 56(4), 175–181. 14. Leopando, Z. E., et al. (2019). The patient-centered, family-focused and community-oriented (PFC) matrix: A toolkit for biopsychosocial approach in primary care. The Filipino Family Physician, 57(1), 26–32. https://thepafp.org/journal/wp-content/uploads/2022/04/PAFP-Journal-2019-1-30-36.pdf. 15. College of Family Physicians of Canada. (2016). The patient’s medical home: A vision for family practice in Canada. https://pmh.cfpc.ca/. 16. Royal Australian College of General Practitioners. (2023). General practice: Health of the nation 2023. https://www.racgp.org.au/health-of-the-nation. 17. Gunja, M. Z., Gumas, E. D., & Williams II, R. D. (2024). Mirror, mirror 2024: A portrait of the state of primary care in the U.S. and nine other high-income countries. The Commonwealth Fund. https://doi.org/10.26099/v9n1-1123. 18. Estepa-Garcia, K., & Carpio, L. P. D. (2022). Attitudes and perceptions of Filipino family physicians toward the Universal Health Care Act., 60(2),254–259. 19. Department of Health. (2020). Philippine health facility development plan 2020-2040: Investing in resilient and sustainable health facilities towards Universal Health Care. Health Facility Development Bureau. https://bit.ly/PHFDP2020_2040. 20. Debebe, Z., et al.. (2026). A healthy future: Primary health care and the chronic disease epidemic in East Asia and Pacific. World Bank. https://doi.org/10.1596/978-1-4648-2284-1. 21. Philippine Academy of Family Physicians. (2016). FC instructional design with program outcomes 2016. https://thepafp.org/wp-content/uploads/2017/05/FC-instructional-design-with-program-outcomes-2016.pdf. 22. Espallardo, N. L., et al. (2024). Familyand community medicine in the context of universal health care: Introduction to recommendations for health policy development. The Filipino Family Physician, 62(2), 272–277. https://thepafp.org/journal/wp-content/uploads/2025/01/PAFP-62-2-76-82.pdf.