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I met Beth-Ann, a sixty-one-year-old female, during my first clinic as an intern. She was newly insured and looking for treatment for persistent heart palpitations and bright red blood in her stool. Her medical chart was peppered with poorly controlled chronic diseases, including diabetes, hypertension, and fibromyalgia. BI'm in need of a tune-up,^she said. Sucking in my breath, I tried to hide how overwhelmed I felt as our visit began.Ask any primary care resident how they chose their specialty and chances are that longitudinal relationships with patients are their central motivation. In surprising contrast, primary care residencies follow an inpatient-centric model of training, with residents spending less than 20 % of training in the outpatient setting where these relationships are fostered. 1 Consequently, residents lack both the number and frequency of hours in clinic to develop the skills to provide continuous care for a panel of patients. 1 Moreover, the meager time spent in outpatient training is frequently of poor quality. Insufficient funding combined with the infrequent and irregular clinic presence of residents severely cripples the provision of well-coordinated outpatient care. This training model deprives residents of the personal fulfillment that comes from providing high quality longitudinal primary care, and it deflates expectations of what is achievable in the clinic setting. 1 As a second-year Family Medicine resident at Group Health Cooperative (GHC) in Seattle, I am part of an experiment in resident education that seeks to change the prevailing model of primary care training. Our hypothesis is that to best equip and engage future primary care physicians, the first priority in training must be to provide continuous care for a panel of patients in a highly functional outpatient setting. To pursue this goal, we completely redesigned our curriculum. We refer to the transformed curriculum as our 'Clinic First' model of family medicine residency training. Before discussing the curriculum changes, it is important to recognize that our residency clinic lies within an integrated delivery system centered on an advanced primary care model. GHC's primary care clinics are National Committee for Quality Assurance (NCQA) level III patient-centered medical homes, and NCQA performance measures are tracked electronically and used to improve preventive screening and chronic disease management through targeted outreach. 2,3 Clinical work is shared such that team members work to their highest level of training. Virtual medicine is emphasized and over 70 % of all physician-patient encounters occur via telephone or secure message. 3 This advanced model of care delivery creates an ideal learning environment, allowing residents to experience first hand the essential elements of highfunctioning primary care.At my first visit with Beth-Ann, we created a care plan and organized a team to address her needs. I shared the plan with our nurse who assists in the management of hypertension and diabetes, virtually consulted w...

The Keystone IV Conference was a touchstone moment for multigenerational conversations regarding our health care system and an opportunity to reconnect with the values of personal doctoring as a vocation. It inspired participants to renew commitments to relationships, healthy communities, and social change. Keystone IV was also a stark reminder of the need to rekindle family medicine's counterculture flame in today's tumultuous health care environment and reclaim the role of personal doctors in American society. Reimagining and reigniting the fire of personal relationship is today's counterculture movement for primary care. Personal doctors must heed the call for immediate action, which requires defining when relationships matter most in health care and understanding how to harness paradigm shifts in information technology, team-based care, and population health to strengthen, rather than undermine, personal doctoring. Simultaneously, we must also invent a new notion of personal doctoring that creates partnerships with patients and families to drive forward a social movement demanding health care focused on the whole person in the context of his or her community. Change will occur when patients insist on a personal doctoring approach as an essential priority for what they expect from the health care system-that anything less is unacceptable. (J Am Board Fam Med 2016;29:S64 -S68.)Guest editors' note: This article was prepared after the G. Gayle Stephens Keystone IV Conference by attendees who were compelled by their participation in the conference to formulate recommendations for action to enable personal physicians to make and honor their commitments to patients and their communities. It constitutes a Keystone IV "call to arms" from a multigenerational set of authors. In a famous article that described family medicine as counterculture, Gayle Stephens 1 recognized how family medicine was able to take advantage of the social movements of the 1960s to affirm a model of the personal doctor grounded in strong relationships with patients. He described how family medicine, itself a counterculture, aligned with reforms This article was externally peer reviewed.