Future of Family Medicine Recommendations Confirm Need for Increased Research from Family Physicians

Members of NAPCRG and others might scan the Future of Family Medicine (FFM) report¹ and conclude that research has been neglected, with only 1 of 10 recommendations clearly focused on the science of family medicine. They would, however, be wrong. This family medicine report is laced with research that predated its beginning, continued through the current ignition point, and will continue on into the foreseeable future.

FFM spent most of its money on research and based its deliberations and conclusions on research results from all over the world. As a set of compass headings, compared with an exact blueprint, the FFM report declares that further research is a necessity to guide a serious revision of family medicine. The report calls early and often for various types of research, especially effectiveness research, because, “These ideas need to be tested in practice.”

Among 5 key challenges facing family medicine, 2 particularly call out for NAPCRG’s assistance: (1) addressing the public’s perception that family medicine is not solidly grounded in science and technology, and (2) winning respect in academic circles. Indeed, just as the report concludes that “the problems afflicting family medicine do not include irrelevance or obsolescence,” the same can be safely concluded for the research enterprise so dear to NAPCRG.

The basket of services expected of all family physicians includes quality improvement and practice-based research. The new model of practice is contrasted with the old model in that the old model consumed knowledge, but the new model will both consume and produce knowledge. The report calls for further development of practice-based research networks and sentinel practice systems and, with remarkable clarity, a reconciliation between family medicine and academic health centers. Even the identity statement formulated for family physicians acknowledges the role of science in family medicine.

Family medicine residency training of the future is expected in this report to require a “culture of innovation and experimentation. The educational process must train family physicians who can function optimally in the New Model practice … who actively measure outcomes … involved in the creation of relevant new knowledge.” And repeatedly, the report reminds everyone that future family physicians will be expected to implement reliably evidence-based practice, enabled by robust information management capacities.

Among the declared strategic priorities is “advancing research that supports the clinical decision making of family physicians and other primary care clinicians,” to place family medicine on equal (or better) footing with the rest of medicine. And, indeed, recommendation 5 is explicit about research, calling again to increase dramatically funding for the Agency for Healthcare Research and Quality and for a national entity to lead and fund research, not about an organ or a disease, but about the health and health care of the whole person.

Taken in its totality, this report further validates NAPCRG as an organization. The report indirectly recognizes the wisdom of NAPCRG’s name and traditions of inclusiveness and cooperation across disciplines by acknowledging the interdependence of family medicine, a medical specialty, and primary care, a functional foundation of successful, sustainable health care systems. Also, the report rests in part on ideas and principles persistently advanced by NAPCRG, eg, the development of primary care classification, practice-based research networks, participatory research, behavioral science in frontline practice, and building research capacity.

A careful reading of this report suggests that NAPCRG has been working on the right stuff for quite some time, but that much, much more is needed now from NAPCRG, all the family medicine organizations, and others who support transforming frontline medical practice. NAPCRG is creating a task force to help us suggest proactively strategies on how the recommendations will be accomplished. We’re going to need participation far beyond the Board to help accomplish these changes. Watch for future NAPCRG correspondence for ways you can get involved.

Let the games begin!

• © 2004 Annals of Family Medicine, Inc.