Family medicine needs a generation of dreamers.

Thomas L. Friedman addresses this question to societies such as the United States today and to corporations. We might ask the same question of family medicine. He follows the question with the observation, “When memories exceed dreams, the end is near.” The generation of pioneers that founded and established our specialty between 1965 and 1975 were definitely dreamers. They focused much more on a new specialty of family medicine than on the preservation of general practice. The first residency-trained generation of family physicians were also dreamers. They focused on making family medicine a legitimate academic specialty and one that was exciting for medical students and residents. Today, the pioneer generation is older and understandably nostalgic. The first residency-trained generation, to which I belong, also seems nostalgic and is wondering what happened to family medicine. Fewer than half the US medical students who chose the specialty a decade ago are doing so today. Family physicians are struggling to get through their work days and feel powerless to change their work environment. The future of family medicine rests with a new generation of family physicians, training now, during an era that has little contact and identification with the pioneers and first generation of residency-trained family physicians. They grew up during the dawn of the information age and the new globalization. If relationship-centered care and the commitment of being a comprehensive personal physician are to survive in family medicine, this new generation will have to invent a 21st-century application of these principles. Previously, I have described the redesign imperative in family medicine, an imperative because the complexity of the work in primary care and family medicine no longer fits the traditional brief visit care model. We are now expected to provide comprehensive prevention and the continuous management of chronic illness, along with treating whatever acute problems our patients may have. A review of our records or a survey of the populations we serve show that we do not do this well. It is not our fault; rather, our care model is faulty. We need a new model of care that matches our work requirements. This model should be rich in information management and provide “on demand” access to services. Who will come up with new models of family medicine and implement them in our education programs and clinical practice? Will the dreamers come from the medical directors who worry about the next month’s productivity report? Will they be the residency directors who prepare for the next Residency Review Committee accreditation visits and worry about how to keep the budget going? Will the dreamers be the experienced family physicians who have spent a career learning how to squeeze an hour of caring into 10 minutes of face-to-face time with patients? No, I don’t think it will be any of these. Just like the young pioneers of family medicine 30–40 years ago and the first generation they trained, the dreamers need to come from the young who readily see the limitations of how family medicine has been practiced and how it could and should be different. This new generation grew up with the Internet, handheld devices that store and present hundreds of hours of entertainment, and cell phones that allow connectivity from virtually anywhere. The Future of Family Medicine report has been written and is a start of the reform process. Like the prior Millis and Willard reports, the change generation may not read the report but will capture the need and vision for change in the new social context of information exchange, communication methods, and caring interactions. Family Medicine Needs a Generation of Dreamers