Confronting the millennium: family medicine in the late 20th century

American medicine approaches the end of the 20th century in disarray. Despite allocating an increasing proportion of our total national resources to the medical care enterprise, large segments of the population lack access to basic health services. We face a paradox where the rising investment in health services undermines our ability to deal with many of the fundamental causes of illness such as social disruption, poor educational systems, and poverty. Family medicine has a role to play in confronting this paradox. Family medicine is a discipline defined by its social role and must resist the temptation to become yet one more medical guild, profiting from rather than seeking to change the existing system. Specifically, we should periodically reevaluate the content of residency training, work collectively toward universal entitlement for health care, and resist reimbursement systems which create conflicts of interest between physician and patient. The family physician has both the opportunity and the responsibility to be the practical bridge between the public health and the curative medical system. By using this social role as an unwavering compass, family medicine can help transform an irrational and inequitable health care system.