“... you better start swimmin’ or you’ll sink like a stone, for the times they are a-changin’.”
These song lyrics, written by Bob Dylan in 1963, could have been written to describe US health care in 2014. In this issue, Randy Wexler, MD and colleagues summarize many of the changes that are creating upheaval and opportunity for family physicians. The 2010 Patient Protection and Affordable Care Act (ACA) has been a disruptive innovation in many ways, and like it or not, it appears there is no way to turn back the clock. The ACA was only the beginning of change at the federal level, followed rapidly by mandates many of us love to hate.
Family medicine, however, was a decade ahead of the health care reform curve. Family physician leaders met in 2000 at the Keystone III conference and declared that the health care system was due for a makeover.1 Findings of the Future of Family Medicine 1.0 initiative were published in 2004, making a number of important recommendations for family physicians to survive and thrive.2 After 10 years, the American Academy of Family Physicians has launched the Future of Family Medicine 2.0 initiative to reexamine the roles and opportunities for family physicians in the evolving health care system.
www.pcpcc.org) to read success stories for inspiration.This has not been an easy journey. Some of you have written to me about your struggles and your belief that health care in the United States is moving in the wrong direction. But many industrious and innovative family physicians are meeting the challenge by implementing new models, including the patient-centered medical home model and the direct primary care model (no insurance company invading the doctor-patient relationship).3 Go to the Patient-Centered Primary Care Collaborative Web site (
For the sake of our patients and the US health care system, I hope there are enough of you out there leading the way toward systems that deliver high-quality service, better health outcomes, and lower cost. Write and tell us about the changes you are making to have a positive impact on health care in your community.