Table 1.

Themes from the Early Future of Family Medicine Online Discussion*

* An earlier version of this table was posted in TRACK on April 26, 2004. The author is grateful to the many discussants who provided helpful feedback for its revision.
References1 Hashim MJ. Future trends in primary care: lessons for family medicine [eletter]., 20 April 2004. 
 2 Franklin TL. A truly new approach to family medicine [eletter]., 20 April 2004. 
 3 Starfield B. Whither family medicine [eletter]?, 6 April 2004. 
 4 Lamberts H. Complexity and benificence [eletter]., 6 April 2004.
Times are changing1
Change and the current health care reality is causing great frustrationAmong family physicians, patients, others
Loss of relationships, system fragmentation
Financial crisis, malpractice crisis
Pain from being part of a dysfunctional system
Distress is an impetus for calls for retrenchment or further change
Some feel isolated from the report and its proponent organizations; some are energized
A sense that the reports, and therefore the organizations, in trying to see beyond the current frustration, are not adequately acknowledging the current reality
The call is about something larger, a crusade about which family medicine is only a partRestructuring and greater equity in health care financing and reimbursement
Health care for all
A medical home for high-quality, integrated medical care
Diverse strategies are emergingLocal practice and system innovation
Appreciative medicine2
A viable economic model can provide “breathing space” to pursue innovation, but with current financing, this can involve sacrificing access for all to primary care
Concierge practice
Safety-net projects
National advocacy and partnerships for health care, financial and tort reform
Frameworks for understanding and fostering changeReturn to old values and approaches
Retain some core values and develop new approaches
Take the offensive based on the unique and valuable generalist role3
A complexity science perspective4
Anticipate nonlinear results and unintended consequences
Well-planned social interaction can result in a partial agreement
Initial conditions and evolving relationships are key
Challenges for individuals and organizationsAdapting to (and thus enabling) a dysfunctional system while working to change the system
Engaging and activating traditional and new partners
Being true to core ideals AND open to new ideas
Getting enough margin to make proactive changes
Costs (eg, electronic health record) of transition to any new model
To be effective in fostering the big changes their members need, organizations need to engage outside groups that are not sympathetic to the financial concerns of doctors, while not losing the support of their members
Managing the short term, in which things might have to get worse before they get better