What opportunities have we missed, and what bad deals have we made?

In addition to its many accomplishments, family medicine has inevitably mad e some choices that have not worked out as well. Respectful consideration o f where we may have done so can help inform future decision making. This pa per suggests some decisions that in retrospect appear to be bad deals, good deals gone bad, or missed opportunities. Bad deals include the limiting ef fects of our speciality's name and of our go-it-alone philosophy. Good deal s gone bad include our affinity for a permanent counter-culture role, our p ersistent belief that big is better, and limited evolution of our residency family practice centers. We have missed opportunities to lead development of a new model of patient-responsive health care, to charge the system of p ayment for care, to maximize the strength of out discipline by links betwee n university and community family physicians, and to build a powerful progr am of family medicine research.