The Joy Is in the Gray-The Problems Family Medicine Leaders Should Be Talking About

Family medicine care in the United States has been suppressed through structural impediments in the healthcare system, yet could provide more care and better health outcomes with appropriate changes. The role of general practitioners in other developed countries provide insights on the value of primary care that could be better incorporated into US healthcare. The fundamental value of family physicians' care emerges from generalist thinking, particularly the use of probabilistic reasoning that supports care variation when patient preferences, situations, capabilities, as well as potential outcomes, are incorporated. Important strengths of family physicians include comfort with uncertainty, use of safety-netting, and listening to patient concerns and preferences, thereby providing balance in medical care decisions. These strengths occur through negotiating with patients to balance many concurrent considerations, reducing low-value care, establishing reasonable expectations with patients, providing a comprehensive basket of services, and continuing to function as a reservoir of resilience for the overall healthcare system. Efforts to grow US family medicine have been hampered by: (a) current measures of value-based care, (b) an over-emphasis on team-based care, and (c) some "un-American" aspects of family medicine culture, such as the belief that more care is not necessarily better care, that time can be used as a diagnostic tool, that it's important to be comfortable with mortality and end-of-life care, and being mindful of quaternary prevention. If family physicians communicate their value to patients and other stakeholders, and their unique strengths are better supported by stakeholders, patients will be better served, and future family physicians will have more joyful careers.