Comprehensiveness has long been a defining principle of family medicine (FM), and a reason that primary care delivers better outcomes at lower cost with greater equity. Yet rising patient complexity, narrower scopes of practice, workforce strain, and misaligned payment and credentialing systems have made sustaining traditional “full-basket” care increasingly difficult. In 2025, the Family Medicine Leadership Consortium convened a national dialogue to examine whether and how the discipline should reaffirm comprehensiveness as its core organizing principle. Participants agreed it remains essential to family medicine’s identity and public value but emphasized the need to redefine it for modern realities, balancing breadth and depth of care, recognizing limits on individual physicians, and shifting accountability toward interprofessional teams and broader care ecosystems. The envisioned next-generation model situates comprehensiveness across the clinician, team, practice, and community levels, supported by longitudinal relationships, team-based care, and enabling technologies such as artificial intelligence (AI). This reconceptualization offers a framework for training, workforce strategy, measurement, and payment that preserves family medicine’s generalist identity while advancing access, quality, equity, and sustainability.