FIFTY YEARS OF FAMILY MEDICINE

Fifty years ago, a revolution was occurring in American health care. Patients were becoming aware of the implications of the increasing subspecialization of medicine. Leaders were organizing to create the new specialty of family practice to largely replace the general practitioner. Pioneer physicians were leaving their practices, entering the world of academic medicine and beginning to create the very first family practice residency programs. Medical students began seeking a specialty that allowed them to serve their patients in the context of their communities. An awareness of the needs of our nation’s underserved was emerging and our youngest physicians began to rise to meet these needs.

Family practice programs sprang up around the country led by those we now recognize as the founders of our discipline: Lynn Carmichael, Roger Lienke, Gene Farley, G. Gayle Stephens, and many others. Finally, in 1968, the “Special Requirements for Residency Training in Family Practice” were approved by the Liaison Committee for specialty Boards, the Advisory Board for Medical Specialties, and the American Medical Association (AMA) Council on Medical Education.

As approved by the House of Delegates of the AMA at its Clinical Convention in December 1968:

Residencies in family practice should be specifically designed to meet the needs of graduates intending to become family physicians. The family physician is defined as one who: 1) serves as the physicians of first contact with the patient and provides a means of entry into the health care system; 2) evaluates the patient’s total health needs, provides personal medical care within one or more fields of medicine, and refers the patient when indicated to appropriate sources of care while preserving the continuity of his care; 3) develops a responsibility for the patient’s comprehensive and continuous health care and when needed acts as a coordinator of the patient’s health care services; and 4) accepts responsibility for the total health care, including the use of consultants, within the context of his environment, including the community and the family or comparable social unit. In short, family physicians must be prepared to fill a unique and specific functional role in the delivery of modern comprehensive health services.

Using those requirements, 15 family practice programs received provisional approval in 1968. These pioneer programs offered a 3-year curriculum of “essentials” in family medicine, internal medicine, pediatrics, psychiatry, obstetrics and gynecology, surgery, community medicine, and research. Key to the training was the family medicine practice, offering residents experience with their own patients in an environment similar to their eventual practice. Often, these practices evolved from the program director’s own patient panel that they brought to newly developing programs.

Residents treated all ages and sexes of patients across care settings alongside faculty that included physicians, behavioral health providers, nutritionists, social workers, and others. Despite having minimal or no training in either management or educational theory and design, program directors took on the roles of both faculty manager and resident educator.

By May 30, 1969, 20 residency programs were accredited in Family Practice. By 1975, 3,720 family practice residents had joined 250 programs.

It would be more than 10 years before program directors came together to form the Association of Family Practice Residency Directors (AFPRD) in 1990, led Dr Richard L. Layton, MD as the first President.

Why did family practice residency programs become so popular? Perhaps medical students, patients, hospital administrators and communities recognized what Gayle Stephens postulated in The Intellectual Basis of Family Practice:

Family physicians know their patients, know their patients’ families, know their practices, and know themselves. Their role in the health care process permits them to know these things in a special way denied to all those who do not fulfill this role. The true foundation of family medicine lies in the formalization and transmission of this knowledge.

What all this means is that the family physician’s role has some constants and some variables; there is no homogeneity nor complete interchangeability among all family physicians… medical educators must look carefully at the role requirements for physicians serving the health needs of a particular area, design a program to meet the obvious components of that role, and allow enough flexibility for special circumstances.

We continue to strive as program directors to help our residents learn their patients, patients’ families, practices, themselves and the communities that they serve. Our programs owe a debt of gratitude to these early pioneers, many of whom continue to train residents today as one of the more than 500 accredited family medicine residency programs.

• © 2017 Annals of Family Medicine, Inc.