Most family physicians would agree that there has been a professional lethargy in our specialty over the past decade, compounded by a broken, inefficient national health care system. The issues behind this problem are complex and intertwined: the decline of professional prestige and practice reimbursements, waning student interest, an increase in physician frustration, toxic environments for family medicine in many academic health centers, quantification of our discipline’s impact on the health of our country, and more than 40 million uninsured patients. Medical students increasingly are choosing other career specialties based on perceived prestige, applied technology, and lifestyle issues.
To combat these problems, the Future of Family Medicine (FFM) project was developed. Its mission is to devise a strategy to transform and renew the discipline of family medicine to meet the needs of patients in a changing health care environment. After extensive planning and considerable expense, the FFM report1 was published in March 2004 in the Annals of Family Medicine.
Family physicians are relying on the FFM project to identify strategic directions that resonate across the discipline. The project was designed to serve as a compass to point us in the right direction rather than an exact blueprint filled with details.
The FFM project initially was designed around five task forces. Task Force One considered core attributes and values of family medicine and proposed ideas for reforming family medicine to meet the needs and expectations of patients. Task Force Two determined the training needs of family physicians to deliver these core attributes and system services. Task Force Three explored ways to ensure that family physicians deliver core attributes and system services throughout their careers. Task Force Four determined strategies for communicating the role of family physicians to purchasers and consumers. Task Force Five determined family medicine’s leadership role in shaping the health care delivery system.
The groups distilled 41 implementation tactics into 10 major project recommendations covering the following issues: (1) a new model of family medicine, (2) electronic health records, (3) family medicine education, (4) lifelong learning for each family physician, (5) enhancing the science of family medicine, (6) quality of care, (7) the role of family medicine in academic health centers, (8) promoting a sufficient family medicine workforce, (9) a unified communications strategy, and (10) leadership and advocacy.
Early in the project it became evident that, without significant changes in reimbursement and financing, the work of the five task forces would be in vain. Therefore, a sixth task force was created specifically to make concrete recommendations for improving practice finances to make the new model an economic reality. Its report2 has been published as a supplement to the November/December 2004 issue of the Annals of Family Medicine. The group is composed of family physicians with practice management expertise and representatives from major payers and consumers, including the Centers for Medicare and Medicaid Services, Families USA, AARP, BlueCross BlueShield Association, Aetna Inc., WellPoint Health Networks Inc., and Kaiser Permanente Inc.
Task Force Six created economic models that demonstrate that implementation of the new model significantly increases family physicians’ incomes, in both the current fee-for-service environment and future pay-for-quality reimbursements. The results should serve as a stimulus for widespread adoption of the new model for practicing family physicians. Every family physician should read the entire FFM report to realize fully the opportunities that lie before us.
Another major goal of Task Force Six is the development of a national resource center to allow family physicians access to a centralized organization that can help them implement the new model and its components.
The FFM report has been a featured topic at national and state chapter meetings. It has been received with cautious optimism by many physicians and with a sense of cynicism from others, who realize that without a revision of our health care system, the potential of these recommendations will not be realized.
The FFM report offers a credible model to address many interrelated issues. Numerous studies have shown that a primary care–based health care system provides cost savings and better clinical outcomes. The FFM project focuses on a medical home for all Americans—one that is best provided by primary care physicians. To date, no other specialty has addressed the way its issues tie in with an efficient health care model for America’s patients.
We are currently in the communication phase of the FFM project. AAFP members are encouraged to read the report online athttp://www.annfammed.org/cgi/content/full/2/suppl_1/s3. As a discipline, we cannot afford to sit passively on the sidelines. We must actively advocate for our profession and patients and embrace the adage of the American “philosopher” Yogi Berra: “The future ain’t what it used to be.”