National Conference Q&A: ‘The Milieu Makes a Difference’
July 8, 2024, David Mitchell — With the 50th anniversary approaching for the National Conference of Family Medicine Residents and Medical Students approaching, coming to Kansas City, Mo., Aug. 1-3, AAFP News gathered six past student and resident chairs whose experiences span the event’s half-century.
In this four-part series, these family medicine leaders share their thoughts on the beginnings, evolution and growth of National Conference; the event’s vital role in helping students choose the specialty, find residency programs, connect with mentors and become future leaders of the specialty; and the future of the specialty itself.
In its first year, the event was a modest meeting of 35 residents who were gathered to give the AAFP input from this small but important membership segment. In 2024, National Conference drew more 4,800 attendees, including more than 1,400 students and more than 1,300 residents.
In between that first conference and 2023, the meeting added one of the nation’s largest residency fairs; congresses for student and resident elections and policy debates; clinical skills workshops and an expanded slate of speakers.
In this second installment, our panel discusses why National Conference attendance makes a difference.
Did attending National Conference influence or affirm from your specialty choice?
Douglas Henley, M.D., (back right) stands with resident leaders during the 1979 National Conference of Family Practice Residents in Kansas City, Mo. Henley was elected resident chair for the 1980 conference. Also pictured are STFM Board representative Cynda Johnson, M.D., (back left); and delegates Bob Urata, M.D., and Phyllis Hollenbeck, M.D. (seated right).
Douglas Henley, M.D., FAAFP, resident chair 1980: I already knew I wanted to be a family physician. I grew up in a small town in North Carolina. Our next door neighbor was a general practitioner. The other general practitioner in town lived right down the street. The general practitioner office was across the street from my dad’s drugstore. It was the culture I grew up in. Medical school reaffirmed that, despite the hidden curriculum of everyone trying to get me to go into something else. The rotations confirmed that, plus a couple of great preceptorships that I did while in medical school. National Conference, attending it the first time, reaffirmed that early decision in a positive and exciting way.
Marla Tobin, M.D., FAAFP, student chair 1980, resident chair 1982 and 1983: I, like Doug, had grown up in a rural town and had a lot of role models. I worked as a candy striper and a nurse’s aide at the hospital. The local docs would take me in the OR or let me help with deliveries when I was in high school. That was impactful in terms of thinking about a community to serve. None of them were family docs because they didn’t have family medicine yet at that point, but at the same time I knew that was what I wanted to do. I actually joined the Academy my first day of medical school because Mickey Shafer (later an AAFP vice president) was our state chapter executive in Missouri at that time. She came to our university and had a booth there and said, “Sign up for free meals, and come to the family medicine interest group and learn about family medicine.” I did and ended up being chair of that group. I loved the acceptance, the support and the energy I found in the group.
Beulette Hooks, M.D., FAAFP, student chair 1993, resident chair 1996: I, too, grew up in a small town, but there were no family physicians. There were just generalists, and I went to the doctor twice, maybe, that I remember growing up, so it wasn’t like I knew a lot of physicians or even went to the doctor that often. I remember in high school saying, “I want to be a pediatrician.” But that was just because it was out there. Nobody said anything about family medicine. So, fast forward. I go to Mercer Medical School, and they were talking about putting family physicians in rural areas in Georgia, and so that was my first hearing of family medicine. Going to the conference reaffirmed that, yes, family medicine is what I wanted to do and could do. There were just so many like-minded people talking about tobacco, decreasing use and all of that. Those were things that were close to my heart, also. So, yes, going to my first conference between my first and second year of medical school affirmed what I wanted to do.
Daniel Lewis, M.D., FAAFP, resident chair 2006, current chair of the National Conference Planning Subcommittee: I grew up in a small town. I was a first-generation college student. I didn’t have a lot of exposure to physicians. I had a physician growing up who was the GP who saw everybody. He wasn’t family medicine-trained, but that’s what I thought a doctor was, somebody who saw anyone who walked in the door because he saw adults, he saw kids, he saw my mom, and he saw me and my dad. I went to a medical school with a strong primary care base and expected to do family medicine.
When I arrived to my first National Conference in the summer of 2001, I knew I had met my tribe. I met a lot of individuals who I still connect with today. It just really locked me in to the point that I wouldn’t look at anything else.
Julia Wang, M.D., student chair 2020: I think I came in understanding that primary care was what I wanted to do. But med school is really cutthroat. Folks are fighting really hard because that’s what you have to do in order to survive in medical school, unfortunately. Coming to National Conference and realizing the ethos of the people — really warm and caring toward each other and really fierce advocates for our patients — it was the right combination of kindness and gentleness, and also really fierce-heartedness that felt right.
What role did National Conference play in helping you find your residency?
Lewis: I did meet my residency program at National Conference. At the time, the Internet was certainly present but not as popular. We had the Strolling Through the Match book. There was a website directory of all the residency programs, so I looked at that before I went and kind of looked in the Southeast and actually in the Pennsylvania area because there are several really strong programs there. I did go my first year and, of course, first year I was just a rising second year, so pretty broad base at that point. But third year and fourth year I did talk to my program, talked to the programs in the area around that and I did meet individuals there that recalled me when I came to interview and applied for a sub-I at the residency program. They remembered they met me in Kansas City.
Tobin: Strolling Through the Match and The Jungle Out There for the new physicians were two of the projects that came out of resident-student activity groups.
Lewis: Thank you very much.
Wang: That booklet was so critical because there’s like 500 programs that have exhibition booths. I actually sat down with one of my advisors with the list of programs, and we made a game plan for how to use time appropriately because it was impossible to get to all of them. It sounds like things have changed astronomically. I think it was really vital in the sense that most programs have a bullet list on their websites about their curriculum. But understanding what are the priorities of the faculty at a program and what are the struggles that residents face at a program? Those are things that are impossible to glean off of websites, so talking to people face to face was really critical to helping me decide where I wanted to apply.
Aside from your program, did you meet mentors at National Conference who you might not have met otherwise?
Henley: Oh, absolutely. After the second year, you had the Board of Directors there. The Academy got residents and students involved in commissions early, by probably 1975. You met so many people, students and residents who were reporting to commissions and committees. The Academy had a lot more commissions and committees at that time. You had nine commissions and probably 20 committees, and most of them had residents or students, often both. You met so many other members of the Academy, as well as fellow residents and students at the Clusters (commission meetings). There are a lot of ways to develop those mentor-mentee relationships.
Meet the Panel
Alan David, M.D.
Then: Resident chair from the University of Missouri Family Medicine Residency in 1974 and 1975
Now: Retired chair of the Department of Family Medicine and an associate dean at the Medical College of Wisconsin; Granville, Ohio
Other notable roles: Former president of STFM (1991); Also served on the boards of the Association of Departments of Family Medicine and the ABFM
Douglas Henley, M.D., FAAFP
Then: Resident chair from the University of North Carolina Family Medicine Residency in 1980
Now: President, Henley Health Care Consulting; Loch Lloyd, Mo.
Other notable roles: North Carolina AFP president (1987-1989); AAFP president (1995-96); AAFP Board chair (1994-95, 1996-97); AAFP executive vice president/CEO (2000-2020); chair of the Patient Centered Primary Care Collaborative (2015-17)
Marla Tobin, M.D., FAAFP
Then: Student chair from University of Missouri in 1980; resident chair from Duke University Family Medicine Residency in 1982 and 1983
Now: Retired Aetna Inc. regional senior medical director, who previously practiced full-scope family medicine in rural Missouri, Warrensburg, Mo.
Other notable roles: Inaugural convener of the National Conference of Women, Minority, and New Physicians (now the National Conference of Constituency Leaders) in 1990; Missouri AFP president (1993-94)
Beulette Hooks, M.D., FAAFP
Then: Student chair from the Mercer University School of Medicine in 1993; resident chair from Atrium Health Navicent /Mercer University School of Medicine Family Medicine Residency in 1996
Now: Medical director for the Family Medicine Clinic at Martin Army Community Hospital, Fort Moore, Ga.
Other notable roles: President of the Georgia AFP (2011-2012); convener of the National Conference of Special Constituencies (now the National Conference of Constituency Leaders) in 2006
Daniel Lewis, M.D., FAAFP
Then: Resident chair from Self Regional Health Care Family Medicine Residency in 2006
Now: VP and CMO of Southern Market for Ballad Health/Wellmont Health Systems, Greeneville Tenn.
Other notable roles: Member of the Commission on Education and chair of the National Conference Planning Subcommittee; president of the Tennessee AFP (2020-21); resident member of the AAFP Board of Directors (2007-08)
Julia Wang, M.D.
Then: Student chair from Keck School of Medicine in 2020
Now: Reproductive Health and Advocacy Fellow, Tufts Cambridge Health Alliance; Family medicine attending, Cambridge Health Alliance Primary Care, Malden, Mass.
Other notable roles: Student delegate to the AAFP Congress of Delegates; student member of the AAFP Commission on Education
Hooks: Dr. Henley was on the Board, and he had to fly through Atlanta and I had to fly through Atlanta. And whenever he saw me he would say, “Do you want a ride?” So, I always had a ride with him and Mrs. Henley. And to this day, I’m hugging Mrs. Henley as much as I hug him.
All of the speakers (of the Congress of Delegates) have been great. They were great to all the student leaders, especially the student chairs and the resident chairs because they helped us learn to run our meetings. There were just so many people that I met through being involved in National Conference and still know to this day and consider mentors and friends.
Lewis: Two of mine are on this call, Doug and Beulette. I think I met Beulette at National Conference. It may have been a commission, but they were there early.
Rich Roberts (speaker 1996-1999 and AAFP president 2000-2001) and Michael Fleming (speaker 1999-2002 and AAFP president 2003-2004) as speakers helped us run things. There are multiple individuals that I still appreciate the friendships today.
Tobin: I would chime in that Sam Nixon was a Board director and president (1980-1981) that was hugely supportive of my work and residents and students in the early days. Doug Henley is on my list, of course, like all of yours. Nancy Dickey, who went on to the AMA presidency (1998-1999), was involved then. Jack Stelmach, who was another president of the Academy (1978-1979) and was from my home state, was a supportive leader for me. Joe Scherger (STFM president 1986, former AAFP and ABFM Board member); Bruce Bagley (AAFP president 1999-2000); Ross Black (former Ohio AFP president and AAFP Board member); Alan David (STFM president 1991, ADFM and ABFM Board member); and Bill Coleman (AAFP president 1993-1994) were all resident leaders ahead of me and certainly were people I worshipped, watched and followed a lot.
Henley: Great list, Marla.
Wang: The ability to interact with so many folks who have been around in medicine for so long really helps to give a perspective to the younger generations of what it’s taken to get here. No one teaches us in medical school that fighting for the title of family medicine physician was a thing that happened, and I wouldn’t have known that history had it not been for the AAFP leadership. In medical school they teach you how to be a doctor, but the AAFP really taught me how to be a professional in this setting while still fiercely advocating for things I’m passionate about. In particular, Dr. Christina Kelly (past convener of the AAFP’s National Conference of Constituency Leaders and current faculty for the AAFP Foundation’s Emerging Leader Institute) is the person who really exemplifies that for me. It’s just been such a phenomenal experience.
What is a key memory from your first National Conference? What stands out as far as speakers, workshops or connections?
Hooks: I remember being with all these people who wanted to do family medicine. At my first meeting, I had not firmly established that I wanted to do family medicine, but the Georgia AFP said, “OK, we can take this many students,” so I volunteered to come. Since that time I’ve been drinking the Kool-Aid, and I’m trying to get other people to drink the Kool-Aid.
Lewis: I remember two things I was just thinking about from my first conference. I was walking into a meeting for the FMIG Network. Michael King (longtime program director in Kentucky and Florida) from the University of Kentucky grabbed me and said, “Hey, where are you from? What are you interested in?” And that kind of got me connected to the FMIG Network. The other part I remember was being a small-town boy from Tennessee, the first time I rode the escalator to the Exhibit Hall, getting up there and gawking and riding immediately back down because it scared me to death because it’s so huge. It took me two trips before I made my way over to a program and looked at anything.
Wang: I was a third-year med student the first time I went to National Conference, and I remember Anita Ravi was talking about the Purple Clinic that she was running. And in the spirit, similar to what you're saying, Dr. Henley, about the counter-cultural, social justice roots of what being a family medicine doctor actually means, taking care of every single patient. It was the first time I had heard someone in a suit talking my language in a way that felt really genuine and in a way that I wanted to practice medicine. The idea that family medicine can act as a champion of social justice, and really take evidence in science and marry it to how we take care of patients, is a beautiful idea, and I’m really grateful for it being so prominent during my first National Conference.
People say you have to see family medicine to understand it or appreciate it. What role can National Conference play in helping students understand family medicine?
Lewis: The exposure to individuals from across the country who apply family medicine training in different ways. It’s hard to highlight all the different areas family medicine touches in the conference programming. Some of the subjects that would be considered counter-culture now are the gender identity workshops and other issues that we do related to that. We try to be mindful of including not only what some would call bread-and-butter medicine, like diabetes and hypertension, but also branching out to pediatrics and obstetrics and issues like social justice. Well-being and mindfulness have been a huge part of the programming for the last few years and will continue to be. It’s truly an opportunity to see where all the tendrils of family medicine go and that there are multiple avenues to explore.
Tobin: I think there’s been a strong history of really wonderful storytellers and speakers. I haven’t been to as many conferences as Doug, but I’ve been to a couple of them, and I read a lot about the articles about what’s going on at the meetings. There’s always good people telling stories about the various worlds of family medicine, international and national, rural, urban, special interests and all of the special groups of patients you serve. Many students don’t get that broader perspective of family medicine anywhere else, and they never get a chance to do that kind of networking.
When we talk about National Conference, the obvious things that come up are the networking, workshops, the congresses, the residency fair. Are there things students get out of National Conference that maybe they don’t expect?
Hooks: Parliamentary procedure. That’s something you don’t learn anywhere else. Also, the connections you make with students from other places who you may get to know and make life-long friendships. Those are some of the intangible things that happen in the congresses.
Henley: We know it has an impact. If you take the descriptions that Danny and Marla and Beulette have made about the impact of the National Conference, that simply validates the study the University of South Dakota did about seven years ago that showed a direct correlation between attendance at National Conference and increased choice of family medicine as a career. South Dakota was experiencing a drop in students going into family medicine. They made the intention at the university to send more students to the National Conference. Guess what happened? They completely reversed the trend.
Alan David, M.D., resident chair 1974-75: There are so many students who have not only come back from National Conference convinced that this is what they wanted to do, but also motivated to participate and get a longitudinal experience with a family physician while they’re in medical school.
Henley: Who knows what’s going to get an individual student excited about family medicine because they come to that conference? It’s probably a mixture of several things that we’ve already heard, but it’s the milieu that makes a difference.
Lewis: We know academic medical centers aren’t always family medicine-friendly, so it’s easy in your medical curriculum to get discouraged if you are planning for family medicine. It really is an opportunity to recharge your batteries, meet your tribe and get with the individuals that are like-minded. It can provide a buffer against that negativity that you may experience in academic medical centers.
Wang: All of the individual pieces you mentioned — exhibitions, speakers, workshops — helped me solidify the idea of what I was passionate about. I remember interviewing for med school. I had all the stock answers of “why medicine?” And they flew out the window once you start getting into the daily grind of going to lectures, having to memorize everything, studying for tests. National Conference served as this pivotal moment where I got to see so many different people with varying reasons for why they were passionate about medicine, and it helped me figure out what it is that I want to get out of a career, which is invaluable. And to be able to do that in just a weekend? What a deal!
Tobin: Recharging your passion is wonderful. I would echo what Beulette said about life-long friendships. I think that’s something you can never get enough of, the connections with residencies in different places in the country that you never thought about. People grow up and live and go to school in a certain area, and I wanted to go to another part of the country to do my residency because I felt like there were things I could learn after encountering people at the conference who were different than me.
What do you want students to know about family medicine that maybe they don’t?
David: Even though I’ve retired and moved to Ohio where we have family, I’m doing some precepting for two residency programs. The residents are nice folks, and generally they are very good. But, and I’ve heard this observation with some of the other community-based preceptors, if I ask a resident, “Who is this patient? What do they do for a living? Who do they live with? If they’re retired, what did they do?” They don’t know. Now they’re in a hurry because everything is being measured. They are focused on, “Am I competent to diagnose the problem, order the right tests and order whatever therapy might be necessary?”
What I would hope that we could impress upon them is that you can see a lot of people with high blood pressure, depression, diabetes, episodic problems, and that is the context of much of your family medicine and primary care. The process is seeing people over time. It’s developing an ongoing trusting relationship with those people, and how does that benefit the patient and your ability to help take care of them and help them take care of themselves? That involves putting yourself out there sometimes, sharing a little bit of your history. I’ve had back surgery. When I see somebody with a resident who’s had back surgery, whether they’re having problems or not, I can relate to that. I’ve got two rods and four screws in my back. When somebody has another problem, not necessarily the one I have, I can say, “I’ve seen lots of people with what you have.” It’s difficult, trying to get residents to connect to patients on a process level over time. I think they will. That, to me is what separates family medicine from the content of medicine elsewhere. We have to be good at what we do content-wise, but the process of what we do is what makes us excellent physicians.
Hooks: What I like about family medicine is the fact that it’s not one part or one person in the family. I’m taking care of the whole family.
Tobin: I’d say it’s the connection with the patients that we have and such a deep, multi-generational relationship. I had five-generation families all the time in my practice, and the satisfaction that you get from being a family doctor and being part of that family and community is something that nobody tells you. They tell you how hard you work and how many hours you’re going to be on call, but they don’t tell you the satisfaction and what it’s going to do for your soul.
One of the things that we need to showcase is how to make the lifestyle work for you because there’s a lot of worry in this generation, and in all generations, about how do you get the lifestyle you want out of family medicine? There’s no two family docs who are alike, so showing the diversity of the specialty and helping people find how they’re going to fit into that is important.
The other thing that I think that National Conference has done well is showing the diversity of family docs across the country and internationally. I never considered international medicine, but friends of mine have, like Marc Rivo (former editor of WONCA News) who was a leader who got involved in a lot of international stuff. Even now when I go to the Emerging Leader Institute presentations, there are people who are doing international projects for their leadership year with the ELI program, and I’m blown away by residents and students getting involved at that level that quickly and doing those kinds of impactful things.