The Americanization of family medicine: contradictions, challenges, and change, 1969-2000.
Family practice became the 20th medical specialty in 1969, identified by its leaders as a harbinger of health care reform, as well as practice excellence, and with expectations of continuing government support of its purpose and role. Since that time, the cultural and political environments have changed significantly in some ways, and not changed in others as initially expected, thus challenging the new specialty with pressures for reinvention with respect to its identity, function, and prestige. The most important impediment to a clear-cut role for family practice has been the lack of a formal administrative structure for primary care practice on a nationwide basis in the United States. Differentiation of the field from all other parts of medicine was also difficult because of the identification of family practice with the professional accoutrements of a specialty, parallel to other specialist fields. Family practice moved from an outsider role in medicine to a position of entrenchment in the medical establishment, including hospitals and academic medical centers. And, family practice became one of several overlapping and competing primary care fields. The role of family practice in US culture is now less clear than the potential role envisioned for it in 1969. Its multiple and not always well-defined roles in medicine may make it difficult to establish a clear identity for the specialty in the future. If it is to be successful, family practice must develop allies and work aggressively to establish its role in primary care. It must also work to institute primary care in the US medical system and act politically (as in the 1960s), taking advantage of current cultural trends, notably the information revolution and the growth of biomedical research.
Stevens
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Department of History and Sociology of Science, University of Pennsylvania, Philadelphia 19104-6304, USA. rstevens@sas.upenn.edu
D003469:Culture; D005194:Family Practice / Q000458:organization & administration / Q000639:trends*; D005544:Forecasting; D006801:Humans; D010819:Physician's Role; D010821:Physicians, Family; D011320:Primary Health Care / Q000458:organization & administration; D013038:Specialization; D014481:United States