I firmly believe that family medicine is rooted in communities. It is the only way the physician can develop an understanding of the local culture, industry, and lifestyle to “get it” from the patient’s perspective.
Live, work and serve in the community was a principle articulated by Ian McWhinney in his Introduction to Family Medicine in 1981. Cost shifting, that is using your revenue from paying patients to care for those who could not afford care, was a time-tested method of paying for healthcare for decades. This was a tacit understanding between paying patient and physician which exists no longer. Although it is not a direct part of the physician-patient relationship, it has always been part of the landscape and responsibility that a physician embedded in a community would be expected to live up to. It is also part of the responsibility of a community in taking care of their own.