The Robert Graham Center at 25: Breaking Ground and Making a Difference

That imperative applies to much of the wide-ranging research the RGC has issued over the past 25 years — work that has girded the Academy’s advocacy, informed AAFP members and educated health care stakeholders. Jabbarpour shared her thoughts about the center’s history of “look at this” moment with AAFP News this month to mark the RGC’s silver anniversary.

The two primary care scorecards extend the RGC’s landmark 2012 projection of workforce needs and a 2015 paper estimating how much residencies needed to expand. What other, perhaps less widely discussed papers do you think showcase the RGC and its unique focus?

I can break it down into the categories we typically study.

Looking at workforce, besides what you mentioned we have done a lot of work around the importance of a diverse physician workforce to meeting the needs of all patients, including those from minoritized communities. I would point to our work on patient-physician racial concordance.

We lead a workforce diversity series with the American Board of Family Medicine, with many articles looking at the contribution of racial- or ethnic-minority family physicians to the care of patients nationwide.

Also, we have taken a look at the female family medicine workforce and their needs in multiple papers and projects, under the heading Sustaining Women in Medicine. Of particular interest is the work we did around gender differences in how family physicians address their burnout.

On training, I am proud of the work we do for U.S. News and World Report in revising its medical school rankings for primary care. Previously, this measure did not take into account the actual production of primary care physicians by each medical school. We changed that so that the methodology really reflects which schools are training the primary care workforce of the future. We also have done studies on the factors that influence medical student choice — most recently looking at the impact of the U.S. Supreme Court’s Dobbs decision.

Studying primary care payment and delivery, we broke ground on defining and measuring primary care spend. And we’ve documented the contribution of primary care to delivering behavioral health services, vaccinations and women’s health.

One recent workforce-related publication that stands out is “Reflections From Family Medicine Residents on Training During the COVID-19 Pandemic.” What kind of ripples do you think we’ll continue to see from the pandemic, especially as the AAFP pushes to broaden students' interest in family medicine?

I think the pandemic heightened the level of burnout in family docs — from increasing mistrust in medicine to breaking down physician-patient relationships to increasing our workload without much recognition from our health systems that we were essential. I think this resulted in early retirements and people leaving full-time work. I imagine we will continue to see workforce shortages persist for a while because of this.

I also think the pandemic really showcased how under-resourced practices were. Many were on such a thin margin that they had to shut their doors when patients stopped coming because of stay-at-home orders, and many did not have access to PPE. Medical students witnessed this and perhaps changed their minds about wanting to work in environments that were overburdened but under-resourced.

On the positive side, it brought us all closer to telehealth, which continues to be utilized today and is here to stay. This can be really good for equity issues, particularly for patients who lack transportation or child care.

You just marked your own second anniversary leading the RGC. When you started, you said you looked forward to bringing, as its first female director, “a different perspective” to the work. Can you point to where that perspective is showing so far and preview what you’re excited about for the coming months?

I really wanted to take a more equity-focused lens to our work. I think a lot of the work I just described, including racial concordance and the female family physician–specific work, showcases that. We have a grant from the Robert Wood Johnson Foundation to visualize structural racism’s impact on the physician workforce. That is being led by HealthLandscape.

We also just acquired Medicaid data. Traditionally the RGC has only had access to Medicare data. I hope this new data source will allow us to focus on a population where family physicians have a huge impact and where I believe family medicine physicians shine — namely, bringing high-quality care to underserved communities. We are using the data to examine the impact of physician-patient continuity on outcomes — including, eventually, maternal health outcomes.

The RGC has looked at the impact of family physicians to mitigate maternity care deserts. How are you continuing to study the maternity care crisis?

What we know is that the family physicians who do maternity care also do reproductive care more generally. So our next area of inquiry is around whether state policies that restrict reproductive care are going to impact the number of family physicians who choose to work in those states, which also happen to be the states with the largest maternity care deserts. We have a grant in to get funding to do this.