AAFP President Michael Fleming, M.D., of Shreveport, La., is leading the Academy at an exciting time for the specialty. Health issues are the subject of hot debate in presidential campaigns and in the halls of Congress. Organizations in "the family of family medicine" are examining the very nature of the specialty. In this interview, Fleming discusses student interest in the specialty, the Future of Family Medicine project, the new Americans in Motion initiative, and advocacy for and by family physicians and their patients.
Q: We've had six straight years of declining numbers of people coming into family medicine residencies. How can the Academy attract more students to the specialty?
A: Since this specialty began, medical students have been told -- whether they're at small state medical schools or large urban medical centers -- "You're too smart to go into family medicine." Family medicine is belittled within the academic community, from top to bottom.
I intend to work with the academic folks to try to bring them into the real world. In my world -- the private practice world -- my relationship with my subspecialty colleagues is excellent. In polls for the Future of Family Medicine project, other specialists and subspecialists said clearly, "We must have family physicians in order for us to do our work."
Q: How does the National Conference of Family Medicine Residents and Medical Students factor into this?
A: Students who come to the conference get turned on to the specialty in a major way. I have given a number of scholarships to students. Now, I don't know what our rate of capture is for those students -- getting them to go into family medicine -- but I would suggest to you that it is very high. I plan to encourage our family medicine departments to provide more scholarships to next year's conference (July 28 - 31 in Kansas City, Mo.).
Q. What progress has been made in the Future of Family Medicine project?
A. Reports from the project task forces have gone to the seven organizations participating in the project, and the project Web site (http://www.futurefamilymed.org/x13525.html) has research results.
The project's task forces have considered the research results and framed recommendations. It's now the collective job of the governing boards of the seven organizations to decide which of the recommendations they want to begin to address, and to prioritize the recommendations. In late January, the project leadership committee will meet and wrestle with responses from the governing boards.
Every family physician in the country is watching our leadership to see what comes from this project. So stay tuned!
Q: You're taking an active role in the Academy's new Americans in Motion program, vowing to lose weight and get more physically fit over the next year. What's drawn you to this program?
A: I always remember the story my grandfather told me about the doctor who told him to quit smoking while blowing smoke in his face. We family physicians have to walk the talk, or we won't be credible with our patients. I have a personal issue, a health problem -- and I have four grandchildren, and I want to be around for them.
Americans in Motion gives me an opportunity to respond to a serious challenge. I have changed my diet. I wear a pedometer and aim to walk 10,000 steps each day; I use a personal scale to monitor my body mass index; and I've enrolled in the Active Lifestyle Program, a program of the U.S. President's Council on Physical Fitness and Sports that urges people to take part in at least 30 minutes of physical activity five days a week for six consecutive weeks. By this time next year, I want to see a major difference. So far, I have lost 20 pounds. I encourage other family physicians to check out our Web site (http://www.aafp.org/flemingchallenge.xml) and join with me in the Americans in Motion program!
Q: You have said, "We are not the old AAFP. There's a new attitude. We are advocates for members and patients, and we are asking our members to be advocates as well." What does that mean?
A: We can't just expect a few to go out and be advocates for the whole specialty. It's time for everybody to be involved.
Take the Academy's Patient Voices in Washington program (at http://www.aafp.org/ptvoices.xml). In my office, our Patient Voices program has allowed our physicians to mobilize patients by giving them information on key issues that affect them and showing them how they can be involved in the political process. I haven't been able to keep the Patient Voices brochure holders full. I have not heard back from my legislators yet, but I know from past experience that legislators do listen to their constituencies when their voices are strong.
Q: How do we go about establishing the AAFP as the medical organization legislators turn to?
A: We're going to have to let people know that our opinion matters. And, topic after topic, our message has to be, "Here's what's best for our patients." Family physicians have about 100 million self-identified patients, who make 210 million patient visits a year. We have got to make that known. Family docs tend to be nice people. We don't get in anyone's face. I think it's time to get in some faces.
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