COMMENTARY
Richard A. Young, MD
Corresponding Author: Richard A. Young, MD; John Peter Smith Family Medicine Residency Program.
Email: ryoung01@jpshealth.org
DOI: 10.3122/jabfm.2025.250017R2
Keywords: Access to Care, Canada, Chronic Disease, Complexity Analysis, Continuity of Patient Care, Delivery of Health Care, Family Medicine, Health Care Costs, Health Care Systems, Health Policy, Health Surveys, Logistic Regression, Preventive Care, Primary Care Physicians, Primary Health Care, Resilience, Surveys and Questionnaires, Systems Analysis
Dates: Submitted: 01-14-2025; Revised: 06-05-2025; 10-15-2025; Accepted: 11-04-2025
Status: In production.
Family medicine care in the United States (U.S.) has been suppressed through structural impediments in the healthcare system, yet could provide more care and better health outcomes with appropriate changes. The role of General Practitioners in other developed countries provide insights on the value of primary care that could be better incorporated into U.S. healthcare. The fundamental value of family physicians’ care emerges from generalist thinking, i.e., the use of probabilistic reasoning that supports care variation when patient preferences, situations, and capabilities, as well as potential outcomes, are incorporated. Important strengths of family physicians include comfort with uncertainty, use of safety-netting, and listening to patient concerns and preferences, thereby providing balance in medical care decisions. These strengths occur through negotiating with patients to balance many concurrent considerations, reducing low value care, establishing reasonable expectations with patients, providing a comprehensive basket of services, and continuing to function as a reservoir of resilience for the overall healthcare system. Efforts to grow U.S. family medicine have been hampered by: a) current measures of value-based care, b) an over-emphasis on team-based care, and c) the “un-American” nature of some aspects of family medicine culture, such as not assuming more care is better care, using time as a diagnostic tool, being comfortable with death, and concurrently mindful of quaternary prevention. If family physicians communicate their value to patients and other stakeholders, and their unique strengths are better supported by stakeholders, patients will be better served, and future family physicians will have more joyful careers.