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History of Family Medicine

Although not officially recognized as such, family medicine is arguably the oldest medical specialty. For thousands of years, physicians were true “generalists,” providing care for men and women, children and adults through the entire spectrum of life.

General Practice

According to John Stanard in Caring for America: The Story of Family Practice (Donning Company Publishers, 1997), “[In the early 1900s], most graduates of America’s medical schools went into general practice, providing their enhanced skills in surgery, maternity care, care of children and other fields to people throughout the nation. They delivered most of the babies, and maternal and infant mortality rates dropped sharply as care improved. Through dedication to their patients’ continuing care every day, these general practitioners (GPs) established a public image that remains symbolic of what people expect from their physicians. And people could reasonably expect to get this kind of care: In 1930, about 80% of American physicians were GPs; only 20% were specialists.”

The trend toward specialization started around World War II with the advent of new medical technologies and Congressional approval of military exemptions for medical students after graduation for those who went into residencies. There were no residencies in general practice at that time.

Specialty of Family Medicine

The American Academy of General Practice (AAGP) was established in 1947 to give voice to the decreasing number of generalists. A series of events after that paved the way for family medicine to become an accredited, board-certified, professional specialty. In 1966, three landmark reports were released by commissions that had been appointed to study the problem of declining generalists:

  • The Folsom Report concluded that “every American should have a personal physician to ensure the integration and continuity of all medical services.” It also stressed the importance of preventive medicine, the use of community resources and the importance of caring for the patient as a whole.
  • The Millis Report focused on graduate medical education and determined that family medicine needed to be a board-certified specialty.
  • The Willard Report recommended residency training programs for family medicine and specified the establishment of a board to oversee certification. The American Board of Family Practice was established three years later in 1969.


More recently, family medicine has taken concrete steps to ensure that the specialty remains dynamic and strong. In October 2000, family medicine leaders held an historic conference called Keystone III (which followed Keystone I in 1984 and II in 1988) to “examine the soul of the discipline of family medicine.” Family physicians from three generations came together to discuss key issues facing the specialty and to consider its status after 30 years of development. Soon after, the Future of Family Medicine (FFM) Project was conceived with the charge to “develop a strategy to transform and renew the specialty of family practice to meet the needs of people and society in a changing environment.” The project, a collaborative effort of the family medicine community, resulted in a series of recommendations, which included a proposal for a new model of care.

Family medicine’s history indicates that Americans have wanted and continue to seek a physician who is attentive to their needs and skilled at addressing them, and with whom they can establish a life-long relationship.

Stanard also writes, “Today’s family physicians provide comprehensive, high-quality care in any medical environment, whether it’s a health maintenance organization, a rural practice or anything in between. They share a unique and personal relationship with their patients that’s built on trust, and they serve as their patients’ advocate and guide in the nation’s evolving health care system.”


The Role of a Professional Association

The formation of a professional association to set education and practice standards is one of the hallmarks of a true profession. The American Academy of Family Physicians (AAFP), known as the AAGP prior to 1971, was founded to serve a number of purposes:

  • To provide responsible advocacy for and education of patients and the public in all health-related matters;
  • To preserve and promote quality cost-effective health care; 
  • To promote the science and art of family medicine and to ensure an optimal supply of well-trained family physicians; 
  • To promote and maintain high standards among physicians who practice family medicine; 
  • To preserve the right of family physicians to engage in medical and surgical procedures for which they are qualified by training and experience; 
  • To provide advocacy, representation and leadership for the specialty of family medicine; 
  • To maintain and provide an organization with high standards to fulfill the above purposes and to represent the needs of its members.


Membership in the AAFP has grown from an initial 10,000 members to more than 94,000 members in 2009, representing one of the largest national medical associations. Becoming a member of an organization such as the AAFP affords you the opportunity to participate in numerous leadership opportunities, expands your understanding of organized medicine and allows you to engage in strategic action. Advocacy, practice enhancement, education, communication and outreach are ways to make membership matter and impact the discipline.

Other Family Medicine Resources

Several organizations fall within “the family” of family medicine and can be useful resources for understanding the evolution of family medicine and all parts of the discipline. Each of these organizations offers a unique perspective on the issues facing family physicians and the specialty of family medicine today.