We’ve Been
Here Before
Prepared for REACH Leaders and Chairs Meeting
Rebecca Etz
Professor, VCU Department of Family Medicine and Population Health
Co-director, Larry A. Green Center
June 4, 2026
Every turning point for 50+ years
https://aspe.hhs.gov/reports/hhs-roadmap-behavioral-health-integration
First – we name it
Say out loud what the system is failing to do.
Next – we convene
And the field follows
Bring the discipline together around a shared vision.
Because the hunger is already there, waiting.
Generalists, experts, primary in care.
Millis
REPORT · 1966
The “primary physician,” continuing, comprehensive care.
Willard
REPORT · 1966
Residency-trained family physician and a certifying board.
Folsom
REPORT · 1966
“Communities of solution”, health as a shared, community project.
Stephens named it: a competing epistemology, anti-reductionist; �coherence of the social and scientific; relationship is knowledge, �not sentiment.
Governed by dissent, conscience and coherence.
Family medicine was a reform movement and medicine “a moral vocation.”
Counterculture.
Photo credit: https://obits.al.com/us/obituaries/birmingham/name/george-stephens-obituary?id=11151101c
McWhinney named it: commitment to the person, not the disease; the relationship itself is the means of healing; presence not detachment
Governed by values, attitudes and methods.
Practitioners are distinguished “not by bodies of knowledge and theories, but by what they do.” Tacit knowledge and knowing that is not reduceable.
Relationship.
Photo credit: https://www.cfp.ca/content/58/11/1298.1
Starfield named it: whole people, across all problems and over �their life course, grounded in accumulated knowledge of them �as people.
Person-focused.
Governed by evidence, equity, and longitudinality.
Make it personal, narrow disparities, and growing knowledge through and over time.
Photo credit: https://publichealth.jhu.edu/2011/starfield
Convene and lead — rinse and repeat.
1966
2004
Future of Family Medicine
2014
Family Medicine for America’s Health
2021
Implementing High Quality Primary Care
ABFM 1969
NAPCRG 1972
ADFM 1978
Education, training, and research.
Education
Redesigning residencies. Latest is the Starfield Summit. Additional steps before it, like the P4 project.
Naming the ontology.
Research
Creating a national agenda. An ADFM-led strategic plan. Additional steps before it, like Building Research Capacity. Naming the epistemology.
Quiet, graceful, micro leadership during the pandemic.
https://pantareiapproach.com/challenges-bringing-us-closer-really/
We also saw what happens when we lose our voice.
Graphic @ photos.com
Policymakers �were blind to us
Voice correction – www.newprimarycareparadigm.org
The microphone is waiting.
The challenge is here.
Your learners are watching.
They will become the kind of physician they see.
1966 · 2004 · 2014 · 2020 · ____
Sources