In August 2025, leaders from family medicine organizations and representative patient stakeholders met for discussions regarding the evolution of the clinical model for family medicine. Performance improvement (PI), long a part of the continuing board certification process, was among the topics discussed. Pockets of concern or confusion remain about the relevance, importance, practicality, and administrative burden of PI for practicing family physicians. This discussion paper summarizes concerns about PI as commonly currently operationalized and outlines the rationale for inclusion of PI in the clinical model of family medicine. It outlines opportunities for the progression of PI to become less single-disease metric focused to practically focus on team-based care, complexity, and patient-centered outcomes, while accounting for the variety of contexts in which family physicians practice.