Fighting for Family Medicine for the Next 50 Years

Academy Takes Steps to Boost Resident Numbers, Revamp Health IT

February 07, 2019 03:46 pm Michael Devitt – Family physicians can look back with pride on all that they and their predecessors have achieved in the past half-century as the specialty of family medicine celebrates its 50th anniversary(www.aafpfoundation.org) on Feb. 8. And they can be emboldened knowing that the AAFP is marking the milestone with a focus on the future, redoubling its work to ensure that FPs -- today and 50 years down the line -- have the resources they need to continue giving patients the highest-quality health care.

The Dawn of Family Medicine

It's hard to believe it now, but there was a time when family medicine didn't have its own certifying board. What may be even harder to believe is that in the 1960s, a number of family physicians didn't even want a certifying board.

One only has to go back to 1962, when the AAFP was still known as the American Academy of General Practice, or AAGP. In June of that year, GP (the forerunner to American Family Physician) published an article, "An American Board of General Practice for Family Physicians,"(5 MB PDF) that contained a list of 10 points for -- and nine points against -- the creation of a board for general practitioners.

The following year, the AAGP Board of Directors adopted a resolution recommending that the Academy create a certifying board. Most members at that year's Congress of Delegates, on the other hand, opposed the idea. In 1964, the board took a cue from the delegates and issued a statement showing they also were unanimously opposed to the creation of a board of general practice.

In April 1965, however, the Congress of Delegates changed course and directed the Academy's leaders to proceed with the establishment of a certifying board. Nearly four years later -- after review by a litany of committees, commissions, councils, advisory boards and study groups; after the production of numerous reports, resolutions and recommendations; and even after some heated debate about what family physicians should call themselves -- the American Board of Medical Specialties approved an application submitted by the AAGP and the AMA Section on General Practice, and officially established the American Board of Family Practice (now the American Board of Family Medicine) on Feb. 8, 1969.

Back then, the specialty faced several obstacles. There was significant concern about declines in the number of practicing GPs. There was the growing specter of specialization, and the feeling that GPs would soon be considered "second-class" physicians by the public, and their peers, if their diplomates weren't certified. And there was worry that certification wouldn't do anything to guarantee GPs hospital privileges -- an issue that had been lingering since the end of World War II.(www.aafpfoundation.org)

Many of the issues that troubled family medicine in those early days have gone by the wayside, but they have been replaced by new challenges. Chief among them are the recruitment of medical students to help the specialty grow and increase its presence, and the use of health IT and its effect on how FPs practice.

The Academy is taking bold steps to address both of those concerns and ensure that family medicine is as strong 50 years from now as it is today.

Strength in Numbers: The 25 x 2030 Collaborative

The 25 x 2030 collaborative kicked off in August with an ambitious goal: By 2030, 25 percent of U.S. medical students will pursue family medicine careers, a leap from the current rate of 12.6 percent. This significant increase is necessary for family medicine to do its part in building the robust primary care workforce this nation so desperately needs.

The collaborative is truly a group effort, with the AAFP Foundation, the American Board of Family Medicine, the American College of Osteopathic Family Physicians, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group and the Society of Teachers of Family Medicine all working collectively to prioritize and execute initiatives most likely to create real change.

The collaborative is building on the progress made by Family Medicine for America's Health(fmahealth.org) in increasing medical students' choice of family medicine.

Just last month, the Family Medicine Working Party held a meeting to share ideas and shape the direction of the 25 x 2030 project. Each organization in the collaborative has designated staff and members (or diplomates) to a steering committee that will meet in March. As the collaborative establishes its priorities and begins work on different projects, other organizations -- including some from outside family medicine -- will be engaged for their input and collaboration.

According to Ashley Bentley, M.B.A., an AAFP student interest strategist and the program manager of 25 x 2030, achieving the collaborative's goal will take efforts in communities across the country.

"Over the last 50 years, family medicine has proven its dedication to primary care, making up the majority of the primary care physician workforce with family physicians distributed to mirror the U.S. population more than any other health profession workforce," Bentley told AAFP News.

"At a time when a shortage of more than 52,000 primary care physicians is predicted in the near future and experts call for 40 percent of the physician workforce to be in primary care -- up from a current rate of 32 percent -- family medicine is uniquely called to lead the charge," she continued. "Efforts of this collaborative will equip family physicians and family medicine allies in and outside of medicine who care about building a robust and diverse primary care workforce to inspire, support and encourage students and create and advocate for policies and standards that advance primary care."

And these physicians will be better able to care for their patients when they have better tools.

Making Health IT Work for Family Physicians

It wasn't too long ago that health information technology was being hailed as a savior of sorts(www.healthaffairs.org) for the typical family physician. It was believed that incorporating health IT into one's practice would help physicians more effectively diagnose patients, cut down on mistakes and provide better care, all while reducing costs.

As several recent studies have shown, that's often not the case. In some instances, electronic health records (EHRs), a critical component of health IT, may cause more harm than good. By requiring physicians to spend more time on administrative tasks and less time talking with and caring for patients, evidence has suggested that instead of reducing physician burnout, EHRs may actually contribute to the problem.

To really make health IT work, family physicians can't be bystanders; they have to drive the health IT conversation and take a more active role in the way EHRs and other elements of health IT are created. As a result, the AAFP is approaching health IT from multiple angles to shape the technology from inside as well as outside.

On Jan. 28, the AAFP sent a letter(8 page PDF) offering to work with the Office of the National Coordinator for Health IT (ONC) on policies that:

• reduce the time and effort required to record information in EHRs during care delivery;
  
• reduce the time and effort required to meet regulatory requirements for clinicians, hospitals and health care organizations; and
  
• improve the functionality and ease of use of EHRs.

Steven Waldren, M.D., M.S., an Academy vice president and the AAFP's chief medical informatics officer, followed up the letter with an in-person meeting on Jan. 30 with ONC staff, including the office's chief medical officer, Tom Mason, M.D. Waldren told AAFP News that the meeting went well, and that he was able to hear directly from the ONC about their efforts to reduce administrative burden.

Other AAFP efforts to improve the health IT landscape are taking place in-house. Waldren outlined many of those efforts in a Jan. 2 interview with AAFP News. 

Among other work, the Academy is in the process of creating an innovation laboratory to encourage developers to build more user-friendly health IT products that support family medicine practices, with direct input from FPs practicing in the field. Toward that end, the AAFP will fund a new challenge program for developers that will award the companies and innovators who deliver the best products and services to family physicians.

Watch AAFP News for ongoing updates on the Academy's efforts to shape the future of family medicine.