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Appendix I: Chronology of the Evolution of Family Practice As a Specialty in the United States

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Appendix I: Chronology of the Evolution of Family Practice As a Specialty in the United States Appendix I: Chronology of the Evolution of Family Practice as a Specialty in the United States Robert B. Taylor Year Event Significance 1900 At least 80% of American physicians were General practice was the predominant model of general practitioners: one general practitioner medical care. for every 600 people. 1910 Publication of the Flexner Report by the Prompted changes in methods and quality of Carnegie Foundation with cooperation of the medical education: premedical education, American Medical Association (AMA). biomedical research, and postgraduate training. 1940 Generalists comprised 76% of private medical Decline of general ism paralleled the rise of specialty practitioners. practice. 1950-62% of practitioners were generalists 1960-45% of practitioners were generalists 1970-21 % of practitioners were generalists AMA petitioned to approve a general practice Request refused. specialty board. 1941 General Practice Certifying Board proposed at First call for a certifying board for general ists. AMA House of Delegates. 1946 Section on General Practice of the AMA An early organization of generalists with nationwide organized. representation. 1947 American Academy of General Practice (MGP) First major medical organization to require founded. continuing medical education as a condition of membership. 1950 First residency training programs in general Signified need for postgraduate generalist training practice established. beyond the internship year. Publication of journal GP. First scientific journal for generalists. 1958 Family Health Foundation of America Early funding for conferences on family medicine incorporated. education. 1154 Robert B. Taylor Year Event Significance 1960 American Board of General Practice formed. First effort to obtain general practice board status. 1964 19% of U.S. medical graduates entered general Continued decline in numbers of general practice. practitioners. American Board of Family Practice Advisory Developed objectives for the American Board of Group formed. Family Practice (1969). 1965 National Family Health Conference sponsored Studied unmet needs of American family for by Family Health Foundation of America. comprehensive health care, what practitioner can meet this need, and how he or she can best be trained. 1966 Report of Citizens' Commission on Graduate Identified fragmentation in health care and proposed Medical Education: The Graduate Education concept of a "primary physician." of Physicians (Millis Commission Report). Report of the Ad Hoc Committee on Education Recommended training of a "family physician." for Family Practice of the Council on Medical Education: Meeting the Challenge of Family Practice (Willard Commission Report). 1967 Formation of Society of Teachers of Family First organization of family medicine educators. Medicine (STFM). 1968 STFM published Family Medicine Teacher First publication (newsletter) for family medicine (FMT). educators. American Board of Family Practice (ABFP) Organized as official certifying board for the new founded. specialty. 1969 Recognition of family practice as a The 20th American medical specialty. specialty February 6, 1969, based on approval of the Liaison Committee for Specialty Boards. Fifteen approved family practice residencies Model graduate training programs established. in the U.S. 1970 First examination by ABFP. Successful candidates sitting for 1970 and 1971 examinations became charter diplomates. 1971 American Academy of General Practice changed The Academy recognized shift in emphasis to family its name to American Academy of Family practice. Physicians (AAFP). 1972 AAFP fellowships first awarded. Recognized "interest and participation in special educational programs designed to enhance professional competence and the quality of health care provided to the people of America." First meeting of North American Primary Care Forum for presentation of fami Iy practice research Research Group (NAPCRG). resu Its. 1973 Publication of Family Practice (Conn, Rakel, First major family practice textbook. Johnson editors). First National Conference of Family Practice First national meeting of family practice trainees. Residents and Student Members. Appendix I: Chronology of the Evolution of Family Practice as a Specialty in the United States 1155 Year Event Sign ificance 1974 Journal of Family Practice began publication. First family practice peer-reviewed journal. 1975 Residency Assistance Program (RAP) initiated. Family medicine educators develop guidelines and offer consultation to family practice residency training programs. 1976 First recertification examination by ABFP. First recertification examination by any medical specialty. Publication of the Virginia Study in the Journal First major report of doctor-patient contacts in of Family Practice. family practice. 1977 Doctors Ought to Care (DOC) founded. Championed positive health strategies for the clinic, classroom, and community. 1978 Publication of Family Medicine: Principles Second major family practice textbook. and Practice, 1st edition (Taylor, editor; Buckingham, Donatelle, Jacott, Rosen, associate editors). Practice eligible route to ABFP certification Candidates for the ABFP certification examination expired. subsequently must have satisfactorily completed a 3-year approved family practice residency. Association of Departments of Family Medicine First organization of family medicine academic established. units. 1979 End of first decade as a specialty. Continuing growth of the speciality. Residency training programs = 364 FP residents in training = 6,531 Members of AAFP = 43,956 Diplomates of ABFP = 22,246 1980 26% of active allopathic practitioners were Beginning upward trend in number of generalists. generalists. Graduate Medical Education National Advisory "Near balance" of general practitioners/family Committee (GMENAC) report published. physicians vs. need was predicted for 1990; no change recommended for family practice residencies. 1981 Family Medicine Teacher became Family Conversion of FMT newsletter to an academic Medicine. journal. Family Practice Research Journal began Third academic journal in family practice. publ ication. 1982 Report of the Study Group on Family Medicine Documented past achievements and current status; Research: Meeting the Challenge of Research indicated future directions in family medicine in Family Medicine. research. 1983 Publication of Family Medicine: Principles Principles and practice of discipline integrated as and Practice, 2nd edition (Taylor, editor; "Family Medicine Content." Buckingham, Donatelle, Jacott, Rosen, associate ed itors). 1984 Conjoint meeting of STFM and NAPCRG. First joint assembly of family medicine educators and researchers. 1156 Robert B. Taylor Year Event Sign ificance 1985 Liaison Committee on Medical Education Official recognition of need for medical schools to (LCME) report Functions and Structure of a present family medicine knowledge, skills, Medical School called for predoctoral training attitudes and behaviors. "necessary to enter graduate medical education programs in family medicine ...." 1986 Family Practice redefined by AAFP and ABFP. New definition affirms independence from other specialties. More than 20,000 physicians have been Record number of residency trained family graduated from 3-year family practice physicians. residenc ies. "Michigan lawsuit" won in United States Successful challenge of a Medicare statute that Supreme Court after 10-year battle. discriminated against family physicians on basis of different fees for the same procedure. 1987 First Leadership Skills Development Conference Emphasis on enhancing the skills of family physician held by the AAFP. leaders. 1988 Journal of the American Board of Family Practice Fourth U.S. academic journal in the specialty. begins publication. More than half of all MFP members are certified Predominant practitioner has become board-certified by ABFP (26,500 ABFP diplomates). family physician. First examination for Certificate of Added Joint venture of American Board of Family Practice Qualifications (CAQ) in Geriatric Medicine. and American Board of Internal Medicine. Publication of Family Medicine: Principles and Core problems and procedures in family medicine Practice, 3rd edition. (Taylor, editor; identified. Buckingham, Donatelle, Johnson, Scherger, associate editors). 1989 Anniversary of 20 years as a specialty: 384 Family medicine entered third decade as residency residency training programs, 7392 FP trained physicians began to assume leadership residents in training. roles. New active members of AAFP must be residency Affirmed the distinction between family physicians trained family physicians. and general practitioners and others. 1990 Association of Family Practice Residency First organization of directors of family practice Directors formed. residenc ies. President Bush signed into law Medicare Projected Medicare payment to be based on Physician Payment Reform based on Resource resource costs integral to providing a service. Based Relative Value Scale (RBRVS). AMA adopted policy that every U.S. medical Recognition of need for medical student exposure to school should have a family practice family medicine content and family physician role department. models. 33% of active allopathic physicians were Increasing trend toward general ist practice. general ists. 1991 AMA resolved "to develop recommendations for Evidence of AMA support of family practice and adequate reimbursement of primary care primary care. physicians, improved recruitment of medical
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