50 Infrastructure and training. The American Academy of Family Physicians (AAFP) really did not care either, and the distinction between the two professions would be highlighted by their names. The advent of managed care would again bring another issue for ACOFP to surmount. In 1990, there were heated discussions about the organization’s name. The Health Care Finance Adminstration recognized family practice as a specialty and general practice as a group that had not become certified. As a result, the difference in reimbursement levels between family practitioners and general practitioners became considerable. Though many osteopathic general practitioners were indeed certified, others were not, and the distinction was difficult to establish by name alone. The profession needed a simple way to distinguish certified general practitioners from non-certified general practitioners, yet allow it to remain separate and distinct from the allopathic profession. A proposal to change the name of the college to the American College of Primary Care Physicians was brought to the Board of Governors. After careful consideration, it became clear that primary care could refer to several disciplines, such as internal medicine, pediatrics, and obstetrics and gynecology. To further complicate matters, non-physician health care providers such as nurse practitioners, physician assistants, and emergency medical technicians often used the primary care designation. The Board of Governors favored changing the name to American College of Family Physicians, or ACFP, with “osteopathic” in smaller letters under the name. This would keep the format of the original letterhead and be easier to change. There was a very strong grassroots movement to put “osteopathic” in the name on an equal billing with the other letters in ACFP. The historic vote took place in the spring of 1993 on the floor of the Congress of Delegates in the Peabody Hotel in Orlando, Florida. The vote determined the college would install a sign on the new home that would read, “The American College of Osteopathic Family Physicians.” In a pleasant twist of fate, Dr. N. Robert Brethouwer (the founder of the Alpha Society of ACOFP at Kansas City University in the late 1950s) would preside over the name change in 1993. THE LINE IN THE SAND The trend toward specialization and certification was a positive step for the organization, but stresses would be encountered in the process. Some ACOFP members, along with members of other primary care specialty colleges, wished to develop separate colleges and examinations for the subspecialties of general practice. This was true with emergency medicine, sports medicine, geriatric medicine, and adolescent medicine. Other emerging disciplines, such as addiction medicine and osteopathic manipulative medicine, also wished to become primary certifying organizations. The ACOFP leadership, as well as that of pediatrics, internal medicine, and physical medicine/rehabilitation, were faced with the N. Robert Brethouwer, DO, FACOFP
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