Russell W. Kohl, MD, FAAFP

Family medicine has taught me that the most important decisions begin with relationships and context. Throughout my career, I've learned that people are never defined by a single problem. Every patient has a unique story with different challenges and diverse goals. As president-elect, I will approach our members with that same perspective: listening first, understanding the context in which they work and making sure that our Academy builds a future where each family physician can thrive in their unique circumstances, while strengthening the enduring values that define our specialty.

My career has allowed me to view family medicine from many different perspectives: rural practice, residency education, executive leadership, military service, quality improvement and caring for people experiencing homelessness. This has been my unique family medicine journey. Through it, I've learned that successful leadership is less about immediately having all the answers than it is about helping people navigate change without losing sight of their purpose—a skill which my time as a flight surgeon in Iraq and Afghanistan helped solidify. We are experiencing a time of tremendous transformation driven by technology, payment reform, workforce challenges and changing patient expectations. My time as vice speaker and speaker has allowed me to demonstrate my skill in helping family physicians navigate that type of complexity and finding consensus between those who may have differing views by focusing on our common goals. I lead with optimistic practicality. I believe our Academy can both embrace and guide innovation, while still remaining grounded in the principles that make family medicine exceptional. I think the breadth of my experiences will help me make sure that no family physician gets left behind, or feels alone, in those discussions.

I could just jump in and talk all about the AAFP’s legislative advocacy, physician wellness, education and resources that the AAFP provides to members, but I think it would be more important to start by listening and understanding why they aren’t a member.

I believe that too many times young family physicians transition from residency to practice, cross state lines to start their new professional lives, and find themselves disconnected from the chapter or infrastructure that was their AAFP home. As life and transitioning to a new work environment take over, seeking out and renewing membership may fall to the wayside. We must make that an easier process—and AAFP must better support our state chapters, who are often the front lines of our relationship with our members.

However, that doesn’t account for all non-member family physicians. There may be some who have dropped their membership over dues prices or over positions the AAFP has taken, or not taken, on political issues, or a myriad of other reasons. Additionally, I’ve heard from some employed physicians who see their employer as their representative—and who wonder what more the AAFP could do for them. I don’t think we, as an Academy, and each of us as leaders, should start from the place that “they’re bad for not joining;” I think we must start by better understanding what they want or need from the AAFP. We have the right answer for 58% of America’s family physicians, but I think that we have a responsibility to make that percentage of family physicians who are members even higher.

I’m reminded of the saying: “That which binds us together is far more important than that which divides us.” If you look at the family physicians who make up our Academy, you will see a full spectrum of different practice settings, communities, backgrounds and perspectives. But those differences are not a weakness to divide us—they’re a strength to find creative answers to overcome anything that can be thrown at our specialty. Unity doesn’t require uniformity.

Throughout my leadership experience, whether within AAFP, the National Guard, or leading multidisciplinary organizations, I have found that lasting consensus begins by identifying shared purpose rather than debating differences. Essentially every policy of the AAFP comes back to one belief: that everyone deserves accessible, evidence-informed care, personalized to their unique situation from a known, trusted and well-trained family physicians who should be able to provide it without unnecessary barriers. I believe my responsibility as president-elect would be to continually bring us back to that common purpose while fostering respectful dialogue and encouraging thoughtful action.

It’s comforting to believe that our actions today can decide where we’ll be in five years, but I don’t actually believe that’s true. Our actions today simply “nudge” the trajectory of the world that we will deal with tomorrow. And tomorrow we’ll make another “nudge.” And the day after. Those “nudges” are the small decisions that are true to the core of who we are as a specialty.

I was once told that the most powerful diagnostic tool a family physician has is a follow-up appointment—because your patient and their condition will be different tomorrow, regardless of what you do. Likewise, one of the last-remaining early pioneers of our specialty, Dr. G. Gayle Stephens was fond of saying, “You can fake most things in medicine, but you can’t fake being there when you were needed.” Our success as the AAFP will come from “being there when we’re needed” and following up day after day. Whether for our members, our patients or health care policy advocacy, there is no grand intervention, no silver bullet, nor magical incantation that will guarantee AAFP’s success in five years. Five years from now, people may think our success happened overnight from a moment of sheer brilliance, but it will have actually been the result of 1,825 days of showing up and making those small “nudges.”