home > office of medical history and archives > history of family medicine residency

A Specialty for Generalists (cont'd.)

Previous page 1 2 3 4 5

Thus farsighted physician-educators with ties to generalist medicine made several attempts during the 1960s to create the models for family medicine residencies despite signs of strong resistance within the profession. In 1964 a small group went so far as to incorporate the name "American Board of Family Practice" (ABFP) in anticipation of the time when the AMA and the Advisory Board for Medical Specialties would recognize it as the legitimate licensing board for the specialty. But, as has been noted already, opposition from the American Board of General Practice (hastily established in 1960 to forestall such an eventuality) was openly reinforced by opposition from many internists through the American College of Physicians. General internists believed that they, not dubious new specialists called "family practitioners," were the rightful heirs of the GP. The executive director of the AAMC, Ward Darley, was a behind-the-scenes supporter of Family Medicine, but in 1965 he wrote to Dr. Nicholas Pisacano, a GP at the new Kentucky medical school and the future Executive Director of the ABFP, that he feared it would be "a long road between now and the time when the medical schools will give significant help in training senior people to serve as the quarterback of the comprehensive medical care team."(29)

When political and social pressures did convince organized medicine to support an explicitly primary care specialty, the change was swift but focused on the newer, state-supported schools where family medicine was often imposed by legislative mandate. The Liaison Committee for Medical Specialties gave formal approval to the application of the ABFP on February 8, 1969, followed by approval by the full Advisory Board for Medical Specialties, the National Board of Medical Examiners, and the other residency boards whose cooperation was a necessity. Certification initially required competency in general internal medicine, some pediatrics and psychiatry, community medicine, and electives in uncomplicated obstetrics-gynecology, ambulatory surgery, or subspecialty fields. Over the next decade, the number of accredited residencies climbed. By 1975, 219 approved residencies were in operation with 70 percent of medical schools having some sort of "academic unit" devoted to family medicine. By 1978 approximately 22,000 doctors had become board certified in Family Medicine.(30)