Can Family Medicine Still Catalyze Social Change?


'Tis better to disrupt than be disrupted.

Fam Pract Manag. 2007 Feb;14(2):8.

The December 2006 issue of Harvard Business Review contains an article that should speak to family physicians. It's on what the authors call "catalytic innovation” – innovation that disrupts prevailing business models in the process of bringing about social change.1 For example, they say that turning a tertiary care hospital into a quaternary care center is simply an extension of the prevailing business model, while establishing retail health clinics on the Minute Clinic model may turn out to be catalytic innovation.

Catalytic innovations, they say, start small and effect change by growing or replicating the initial business unit; “they meet a need that is either overserved … or not served at all.” They offer simple, relatively inexpensive products and services that are not state of the art but rather “good enough” in the eyes of users. They make money or get volunteers or other resources “in ways that are initially unattractive to incumbent competitors,” and they are often disparaged by the incumbents, who find the new business model unworkable or unattractive for themselves.

Were this 1970, I wouldn't be surprised if the authors talked about family medicine as a catalytic innovation. Family physicians both care for the underserved and meet needs that are overserved by a health care system top-heavy with subspecialists, and they earn their income by offering services that are simple, relatively inexpensive and unattractive to limited specialists – especially procedural specialists. They are even lucky enough to be “disparaged by the incumbents.”

But it's not 1970, and family medicine doesn't feel as much like a catalyst of social change as it once did. It's less a movement than a disadvantaged part of the establishment – more subject to disruption by retail clinics than doing any disrupting of its own. True, exciting ideas are out there, whether they turn up in the work of TransforMed (, in movements such as Ideal Micro Practices (, in cash-only experiments, in retainer practices or in some corner of family medicine we haven't looked into yet. That's a comforting thought, at least, because we need the next big idea – and fast.

Robert Edsall, Editor-in-Chief


1. Christensen CM, Baumann H, Ruggles R, Sadtler TM. Disruptive innovation for social change. Harvard Business Review. 2006;84(12):94–101.


Copyright © 2007 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Mar-Apr 2018

Access the latest issue
of FPM journal

Read the Issue

FPM E-Newsletter

Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights."

Sign Up Now


Helping Your Adolescent and Young Adult Patients Get the Preventive Care and Services They Need

The Adolescent Health Consortium Project has clarified clinical preventive service recommendations for adolescents and young adults.

Making Sense of MACRA: Navigate Changes to the Quality Payment Program in 2018

Here's how to succeed in the four performance categories of the Merit-based Incentive Payment System.