What does family practice need to do next? A cross-generational view.

BACKGROUND AND OBJECTIVES

This paper presents a 60-year view of family practice, including its first 30 years and best projections for its next 30 years as a discipline and field of practice.

METHODS

An objective cross-generational approach was taken based on available evidence.

RESULTS

Five lessons are drawn from the past 30 years: (1) Neither medical education, medical practice, nor the health care system have been reformed by family medicine. (2) Family practice remains but one of several options for primary care. (3) The generalist-specialist ratio has shifted farther to specialists since 1970. (4) The United States is unique among Western industrialized nations in having multiple generalist specialties. (5) The three primary care specialties are on parallel but separate courses. The health care system is now very different from that of 1970, as a result of managed care; increased burden of chronic illness in an aging population; de-emphasis of hospital care; proliferation of primary care providers; increased emphasis on shared decision making with patients, cost-effectiveness, and value of health care services; and advances in information and communication technology.

CONCLUSIONS

The following course changes are recommended for family practice: (1) Embrace new paradigms of care (eg, evidence-based medicine, population-based care, chronic disease management). (2) Modify practice style and redesign systems of care. (3) Embrace further differentiation within family practice. (4) Reassess and revise educational programs at all levels. (5) Increase emphasis on practice-based research and expansion of clinical electronic databases. (6) Explore feasibility of a unified generalist discipline through new alliances with other primary care specialties. (7) Build organizational and political strength through alliances in advocating for structural change of the health care system to include universal coverage and a generalist primary care physician for all Americans.