Naturally, before we called this year’s FPM Reader Challenge “a search for big ideas,” we had to do some thinking about how one measures the size of an idea. We ended up deciding that a big idea is one that makes a big difference – in our context, a big difference for a family physician’s practice.

We also decided that big ideas aren’t necessarily new ones. The air swarms with ideas that don’t make any difference because we ignore them or brush them away like gnats. They don’t matter until someone sees one for what it is, seizes it out of the air and makes it real. Bringing an idea to life like that is rare enough to be worth celebrating.

Unity in variety

Given the creativity of family physicians, it’s not surprising that every one of the big ideas in this issue is unique. They range from a weight-loss program based on the simple question “Am I hungry?” to a mandatory interview for new patients and from a group-visit house call to a plan for helping the poor afford primary care. The practices that gave rise to the ideas range in size from one physician practicing out of a car to 42 family physicians scattered over several practice facilities. Some focus on making conventional practice more efficient or effective, while others involve highly unconventional practices. The range and variety are exciting.

At the same time, given our ground rules and the fact that we’re all breathing the same air and surrounded by the same clouds of ideas, it’s not surprising that this collection of big ideas includes a number that are in the air today. And certainly it’s no surprise that many are individual solutions to problems that bedevil thousands of family physicians. In fact, you’ll see several themes emerging from the ideas presented, including some that seem very much in tune with the times:

• The radical reduction of overhead through practice redesign;

• Various ways of disconnecting or insulating practice from the world of third-party payers;

• Creative uses of group visits;

• Ways of capitalizing on the power of the computer and the electronic medical record;

• Efforts to reverse the trend toward seeing more and more patients per day in shorter and shorter visits – to recapture the benefits of the 30-minute visit.

Movement toward a common future

Probably without knowing it, a number of the finalists have implemented aspects of the “new model of practice” advanced by the Future of Family Medicine (FFM) project.¹ According to the FFM Project Leadership Committee, the new-model practice is supposed to offer the patient a “personal medical home” without losing sight of the community context. It provides patient-centered, team-based care with a “whole-person orientation,” no barriers to access and a predictable range of services. It employs advanced information systems in innovative offices that emphasize quality and safety while enhancing practice finances.¹

Certainly this sounds like a tall order, but if you reread the previous sentence after reading the rest of this issue, you will recognize a piece of it in almost every one of the big ideas featured. While that may be coincidental, I suspect it’s more a sign of shared problems and a growing sense of the kinds of solutions that are needed.

Family medicine needs to slide out of the corner today’s system has pushed it into and find its way both back to what it is supposed to be and ahead to what it can be: patient centered, community oriented, safe, effective, efficient, integrated and all the rest. Most of the 18 finalists on display in this issue are trying in their different ways to move out of the corner and toward that vision. I hope that at least one of them will inspire you to follow suit.