The December 2006 issue of Harvard Business Review contains an article that should speak to family physicians. It's on what the authors call "catalytic innovation” – innovation that disrupts prevailing business models in the process of bringing about social change.¹ For example, they say that turning a tertiary care hospital into a quaternary care center is simply an extension of the prevailing business model, while establishing retail health clinics on the Minute Clinic model may turn out to be catalytic innovation.

Catalytic innovations, they say, start small and effect change by growing or replicating the initial business unit; “they meet a need that is either overserved … or not served at all.” They offer simple, relatively inexpensive products and services that are not state of the art but rather “good enough” in the eyes of users. They make money or get volunteers or other resources “in ways that are initially unattractive to incumbent competitors,” and they are often disparaged by the incumbents, who find the new business model unworkable or unattractive for themselves.

Were this 1970, I wouldn't be surprised if the authors talked about family medicine as a catalytic innovation. Family physicians both care for the underserved and meet needs that are overserved by a health care system top-heavy with subspecialists, and they earn their income by offering services that are simple, relatively inexpensive and unattractive to limited specialists – especially procedural specialists. They are even lucky enough to be “disparaged by the incumbents.”

But it's not 1970, and family medicine doesn't feel as much like a catalyst of social change as it once did. It's less a movement than a disadvantaged part of the establishment – more subject to disruption by retail clinics than doing any disrupting of its own. True, exciting ideas are out there, whether they turn up in the work of TransforMed (http://www.transformed.com), in movements such as Ideal Micro Practices (http://www.idealmicropractice.com), in cash-only experiments, in retainer practices or in some corner of family medicine we haven't looked into yet. That's a comforting thought, at least, because we need the next big idea – and fast.