RE: Perhaps time for another eulogy, and another movement.

Everything that Kurt Stange writes is accurate; a great summary of how we got to the place we are and the factors that impede practicing the kind of personal care that family doctors want to provide for patients and their families. But if we are enabling the current system through our passivity in the face of forces committed to control rather than education, about stockholders, marketing and convenience rather than care and relationships, then we have to examine our own role in that process.

In 1964, Nicolas Pisacano, who became the first president of the ABFM wrote "General Practice: A Eulogy" which was published in GP Magazine with a forward by the editor saying, repeatedly, "he doesn't speak for us, he writes his own point of view". An apology by an editor BEFORE an article appears is unusual, as Dr. Stange and Dr. Richardson would attest. But the opening line likely struck a chord: "Most of us by now recognize that the species known as the general practitioner is all but extinct". Pisacano was advocating, five years before family medicine came into existence, for a rapid move to revise and restructure graduate education, not dwell in the past but move into the future, and take on the American Medical Association and, more importantly take on the doubters in the American Academy of General Practice. He and his colleagues knew the path would not be easy. But many family doctors around the country knew that not changing meant extinction. In fact, a published manuscript about general practice showed that, without radical modification in training that would attract students to family medicine, GP's, would disappear by 2010 (Fahs and Peterson Public Health Reports 1968).

Family Medicine has not disappeared but it is threatened once again. What might enable, in the positive sense, a thriving future for family medicine is another reinvention - one that would retain the principles of care that Dr. Stange outlines while engaging what Grumbach has called "Counterculture professionalism" and marching figuratively (and perhaps literally) with patients, communities, health professionals in a social movement to create primary care for all as a common good. It is time to get going.