Excellence means to surpass in accomplishment or achievement -- to go beyond a limit. In his book, “Outliers: The Story of Success,” Malcolm Gladwell examined the factors that contribute to high levels of success in various fields. This word “outlier” means an observation that is markedly different in value from others of the sample. Family medicine has a deep history of sharing the same qualities as “outliers” as the values that we bring and we share are different from other specialties.

In 1982, Gayle Stephens noted in his book, “The Intellectual Basis of Family Practice,” that family medicine provides a unique vision to medicine because we have a different perspective on science. We have a history of being on the side of change in American life, we have identified ourselves with certain minorities and minority positions, and we take great pride in identifying ourselves as part of a counterculture in medicine. Dr. Stephens, one of the first academic leaders of the discipline, was known as the “poet laureate” of family medicine as his voice best articulated the heart and philosophical foundation of the specialty of family medicine.

Today we might occupy outlier status still because we believe that the biopsychosocial approach is fundamental to great patient care; that the dream of generalism is real and attainable; that the difference between disease and illness is critical to caring for patients; that relationships are fundamental to excellent diagnostic and healing skills; that social determinants of health must always be considered when caring for communities and patients; that family physicians are team players and that the whole is greater than the sum of its parts. And we have not bought into the idea that the academic medical center is the ‘sine qua non’ or ideal place for the best health care for the majority of Americans.

While the family medicine vision for the future continues to evolve, there are other facets of development that we must not fail to examine. In addition to projecting the number of family physicians that will be needed to provide care for the nation, we must make quality our utmost concern. We must train residents to have the knowledge, skills and attitudes to be effective family physicians. We have sought to belong rather than to lead in medical schools and we have failed to adapt a real business model of practice, but this is changing. We have valued teaching over developing a sense of inquiry and research in our discipline.

Malcolm Gladwell notes in his book that 10,000 hours of experience, practice, diligence--whatever one may call it--are required to become excellent in anything. In addition, he debunks the idea that IQ is the essence of ultimate success. Instead, knowing the characteristics of a successful future family physician is crucial to the success of our profession. Health Care Reform and the implementation of the Patient-centered Medical Home are crucial to our patients, our health system and family medicine. We are poised to play a significant role in the future regarding these changes because of the family physician’s multifaceted capabilities and the understanding of the patient in the context of the family, community and larger populations. As we renew our focus on strengthening the primary care infrastructure, family medicine is prepared to lead the national effort to improve health care for everyone better than any other discipline.

As I reflect on the writings of Dr. Stephens, I might say things in a different way, “The time is right. The idea is right and there is an aura of serendipity about it all. There is a sense that we are participating in something that is a great deal bigger than just us but that we can play a preeminent role in making health care work better for everyone.” Family medicine is an outlier and a story of success when one examines our history. Excellence even as an outlier is a phenomenon of continual pursuit. Oliver Wendell Holmes made this comment which is prudent and appropriate for family medicine: “Greatness is not in where we stand, but in what direction we are moving.”