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As the US health care delivery system undergoes rapid transformation, there is an urgent need to define a comprehensive, evidence-based role for the family physician. A Role Definition Group made up of members of seven family medicine organizations developed a statement defining the family physician's role in meeting the needs of individuals, the health care system, and the country. The Role Definition Group surveyed more than 50 years of foundational manuscripts including published works from the Future of Family Medicine project and Keystone III conference, external reviews, and a recent Accreditation Council on Graduate Medical Education Family Medicine Milestones definition. They developed candidate definitions and a "foil" definition of what family medicine could become without change. The following definition was selected: "Family physicians are personal doctors for people of all ages and health conditions. They are a reliable first contact for health concerns and directly address most health care needs. Through enduring partnerships, family physicians help patients prevent, understand, and manage illness, navigate the health system and set health goals. Family physicians and their staff adapt their care to the unique needs of their patients and communities. They use data to monitor and manage their patient population, and use best science to prioritize services most likely to benefit health. They are ideal leaders of health care systems and partners for public health." This definition will guide the second Future of Family Medicine project and provide direction as family physicians, academicians, clinical networks, and policy-makers negotiate roles in the evolving health system. INTRODUCTIONA t the turn of the century, family medicine leaders organized the Keystone III Conference to "examine the soul of the discipline of family medicine, and to take stock of the present and grapple with the future of family practice." 1 This conference inspired the major family medicine organizations to organize the Future of Family Medicine Project (FFM) charged to " [d]evelop a strategy to transform and renew the specialty of family practice to meet the needs of people and society in a changing environment." Many successes were born out of FFM, but the decade that followed saw erosion of primary care training, a decline in student and resident interest, and a widening of the physician income gap. Currently, while family medicine and primary care are fighting pressures from insurers and purchasers, they are enjoying a renaissance thanks to considerable forces for health reform, including the Affordable Care Act. The major family medicine organizations have launched the FFM 2.0 Project to offer leadership in how family medicine responds to these opportunities.Despite at least 1 attempt to characterize the family physician's role a decade ago, 3 family medicine's lack of a role definition hampered its ability to prioritize and strategize its advocacy:The role of family practice in US culture is now less clear than...

Objectives Despite the promise of expanded health insurance coverage for children in the United States, a usual source of care (USC) may have a bigger impact on a child’s receipt of preventive health counseling. We examined the effects of insurance versus USC on receipt of education and counseling regarding prevention of childhood injuries and disease. Methods We conducted secondary analyses of 2002-2006 data from a nationally-representative sample of child participants (≤17 years) in the Medical Expenditure Panel Survey (n=49,947). Results. Children with both insurance and a USC had the lowest rates of missed counseling, and children with neither one had the highest rates. Children with only insurance were more likely than those with only a USC to have never received preventive health counseling from a health care provider regarding healthy eating (aRR 1.21, 95% CI 1.12-1.31); regular exercise (aRR 1.06, 95% CI 1.01-1.12), use of car safety devices (aRR 1.10, 95% CI 1.03-1.17), use of bicycle helmets (aRR 1.11, 95% CI 1.05-1.18), and risks of second hand smoke exposure (aRR 1.12, 95% CI 1.04-1.20). Conclusions A USC may play an equally or more important role than insurance in improving access to health education and counseling for children. To better meet preventive counseling needs of children, a robust primary care workforce and improved delivery of care in medical homes must accompany expansions in insurance coverage.

Introduction Recent health reforms will expand US children’s insurance coverage. Yet, disparities persist in access to pediatric care, even among the insured. We investigated the separate and combined effects of having health insurance and a usual source of care (USC) on children’s receipt of health care services. Methods We conducted secondary analysis of the nationally-representative 2002-2007 Medical Expenditure Panel Survey data from children (aged ≤18 years) who had at least one health care visit and needed any additional care, tests, or treatment in the preceding year (n=20,817). Results Approximately 88.1% of the study population had both a USC and insurance; 1.1% had neither one; 7.6% had a USC only, and 3.2% had insurance only. Children with both insurance and a USC had the fewest unmet needs. Among insured children, those with no USC had higher rates of unmet needs than those with a USC. Discussion Expansions in health insurance are essential; however, it is also important for every child to have a USC. New models of practice could help to concurrently achieve these goals.

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