Family Medicine residency training was established in 1975 as the rural residency program in the state of Tennessee. One purpose was to provide physicians who settled away from the major metropolitan centers. At that time family physicians were commonly assumed to be able to provide hospital and emergency care. State funding was provided with the assumption that private family practice offices would, in conjunction with hospital privileges, provide emergency care. But gradually family medicine changed, and ownership of emergency care frequently was done by contract to the hospital.