Few of us today realize that only a quarter of a century ago, the family physician seemed about to fade out of the American medical scene. The earlier quarters of the 20th century had seen a burgeoning of scientific medicine, a proliferation of specialties and rapid refinement of medical technologies. These developments were accompanied by a notable decline of the family physician’s function. In the mid-1960s, a growing popular disenchantment with the profession’s response to the people’s need for continuing medical care was reflected by articles then appearing in such publications as Time, Life, the Saturday Review, The Wall Street Journal, Science, The New York Times Magazine, the New Republic and Harpers Monthly. The articles noted, with varying degrees of regret, resignation or approval, the approaching demise of the general practitioner.

Between April 1965 and February 1967, the Family Health Foundation of America (FHFA)–a study and development arm of AAFP’s antecedent organization, the American Academy of General Practice–sponsored with the Association of American Medical Colleges a series of conferences devoted to family practice. The conferences focused on defining family practice, developing its core curriculum and formulating plans to stimulate the establishment of family practice departments, residencies and, ultimately, a certification procedure in the specialty of family practice.

Simultaneously, three other major studies were under way: one by a national commission chaired by the late Marion Folsom, former Secretary of the then department of Health Education and Welfare; another by a citizens’ commission led by the late Dr. John Millis, president of Western Reserve, and the third by the American Medical Association’s Council on Medical Education. The reports of these three bodies converged upon the theme that individuals should have personal physicians who are the central point for integration and continuity of all medical and medically related services to their patients; recognition and status equivalent to other medical specialties should be given to family practice, and there should be a specialty board, certification examinations and diplomate status for physicians highly qualified in comprehensive care.

All these studies, and the conferences sponsored concurrently by the FHFA, were based on the recognition that in the pride of its scientific accomplishments, American medicine seemed to have lost sight of its essential objective: to provide continuing comprehensive care to the whole patient. Indeed, the Millis commission pointed out that precisely because “the science and art of medicine devoted to understanding and treating individual organs and systems have outrun the science and art of understanding and treating the whole man, specialty practice has become more necessary and more attractive.” But Sir Theodore Fox, writing in The Medical Post in 1965, suggested that the very growth of scientific medicine makes it all the more imperative that the investigator and specialist “be balanced by someone who is concerned with people rather than things.”

In a specialty commissioned report on the situation confronting family practice in the mid-1960s, I wrote: “What confronts us in medicine today is a societal monstrosity, a profession standing on its head. Its management function–its coordinator–lies at the bottom of the heap and is rapidly being ground out of existence by the pure weight and commotion of the proliferating mass of uncoordinated specialists milling about above it.”

The pyramid still stands precariously on its apex. But the specialty of family practice is gaining daily in numbers, in prestige, in popular acceptance and appreciation. Many other primary care physicians, especially general internists, are practicing what is essentially family medicine.

Bringing these revelations to present-day significance, the resource-based relative-value scale (RBRVS) study, produced under congressional mandate by William C. Hsiao, Ph.D., and colleagues at the Harvard School of Public Health, recently became the hottest topic in medical economics, stimulating a profession-wide debate.

In the midst of this debate, American Medical News reports that “the positions of the contending medical groups largely coincide with [their] financial interests.” The same source reports that each of the score or more specialists groups has retained a consultant to help it present its case.

The RBRVS formula will inevitably be revised, and special concerns, where reasonable and clear, will be accommodated. But some of the reported reactions raise the specter of a confusion of counsel or Babel of tongues such as might lead highly stressed politicians to look for a more simplistic plan for Medicare reimbursements.

The RBRVS proposal essentially offers these advantages or attractions to a free American medical profession: (1) It would seek to relate compensation to relevant factors in the costs of providing medical services. (2) It would appropriately adjust compensation for the elemental professional skills of patient care. (3) It would greatly strengthen the profession’s hand in resisting growing public pressures for federalized medicine. (4) It would render the economic practices of the profession more reasonable and logical to the people.