Johanna Shapiro, PhD
In recent years much has been written about the evolving nature of family medicine as it seeks to come of age in a time of great societal demands and shrinking fiscal resources. The paradigm shift in the world of medicine (away from exclusive focus on subspecialty medicine and toward a biopsychosocial understanding of the patient as a whole person) that created the specialty has given way to other paradigm shifts. One current trend emphasizes academic rigor, scholarly productivity, and the development of scientifically sound research directions. Reflecting a completely different emphasis, another paradigm shift has occurred toward “gatekeeper economics.” These developments pose formidable challenges to family physicians, and the changing face of family medicine has profound implications for behavioral scientists as well.