As early as 1941, an AMA delegate recommended that the AMA consider developing standards and a means by which certification might be given in general practice. An AMA reference committee commented, "This resolution carries the certification idea a bit too far."
The stage thus was set for a prolonged battle between general practice as it then existed and the forces pushing for a generalist specialty, complete with certification. But the battle had an "up" side.
Family Practice: Creation of a Specialty, published by the AAFP in 1980, records this comment of Nicholas Pisacano, MD, leader of the GPs seeking certification: "Things born out of turmoil and conflict very often become the strongest. If they can survive the blast furnace heat, they're like tempered steel."
Dr. Pisacano, a founder of the American Board of Family Practice (ABFP) in Lexington, KY, in 1969 and its executive director and secretary until his death in 1990, was repeatedly lambasted for proposing certification to the AAGP Congress.
In 1957, the AAGP Board appointed a committee to set standards GPs must meet to be eligible for AAGP membership. The committee went further in its 1958 report: It said the lack of a certifying board hampered development of training programs and discouraged graduates from entering general practice residencies. The committee used the terms "family physicians" and "family practice."
In December 1959, some physicians favoring the shift to a specialty quietly obtained corporation status in Maryland for the American Board of General Practice. The 1960 AAGP Congress adopted an AAGP Board report saying, "We repudiate the creation of an `American Board of General Practice' without the knowledge, consent, or approval of the only national society of general practitioners in America."
Establishing a certifying board required the participation of the AAGP and of the AMA general practice section, a preliminary application process, and negotiations to win approval from groups including the Liaison Board for Medical Specialties. Obtaining AAGP's consent took years.
"The big fear was that this specialty would set the outer boundaries of general practice and do nothing but limit people," said Roger Tusken of Kansas City, MO, who is quoted in Family Practice: Creation of a Specialty. Mr. Tusken, who died in 1994, served on the Academy's staff from 1957 to 1984 and became its chief executive in 1971. He also noted that a funny thing happened when opponents of the specialty idea were elected to the AAGP Board: "Within six months or a year, back in their constituencies, people would say they had been brainwashed--because they would begin to perceive the depths of the problem."
The AAGP Congress in 1963 failed to adopt two resolutions for and two resolutions against a certifying board. In 1964, the Congress opposed a certifying board. Then in 1965, the Congress voted to proceed with establishing a "certifying mechanism."
The Liaison Committee for Specialty Boards approved the application for the American Board of Family Practice in February 1969, and the legal process to establish a corporate structure was completed in April 1969.
The specialty was born.
New name, new energy
In 1971, the AAGP changed its name to the American Academy of Family Physicians.
The interests and needs of family physicians led to expanded programs as well as continued action on problems that led to AAGP's formation in the first place. For example, the AAFP has continued to assist physicians in obtaining privileges. About 1,000 FPs each year now contact the AAFP for support in gaining hospital privileges or resolving other scope-of-practice issues, many recently concerning HMOs.
As other articles in this 50th anniversary issue indicate, GPs-turned-FPs established family practice residencies, became certified, and attracted enthusiastic students to the nation's 20th specialty.
Recent advances
By 1996, the total number of family practice residents exceeded 10,000. Other records reached last year The specialty now has 3,494 first-year residents and 454 residencies.
The Academy, which opened a Washington office in the early '70s, has successfully lobbied for federal funding for family practice training and primary care research. The Academy campaigned both for the Agency for Health Care Policy and Research and for AHCPR's Center for Primary Care Research. In addition, within the last five years, the Academy has promoted primary care research that is outcomes-based and conducted by individuals or networks of FPs in their offices.
Changes in the health care system have given impetus to new AAFP services, including managed care programming at Assemblies, a yearlong course training FPs for entry-level management positions in MCOs, and the "Family Practice 2000" monographs on managed care topics. A new series, "Vital Signs," helps FPs measure patient satisfaction, improve their preventive care systems, streamline their medical record documentation, and employ cost-effective innovations. With membership growth and expanded services, AAFP's financial worth has increased. From AAGP's net worth of about $74,000 in May 1948, the Academy has become a multimillion-dollar organization. In 1996, the AAFP spent about $34 million providing services, programs, and publications for its more than 82,000 members, including about 46,000 active members.