Future family physicians challenged to write health care's next chapter

P.J. Parmar, MD, could have treated the United States’ 250th birthday celebration as an opportunity to reflect on how far we have come as a country during his main stage speech at FUTURE 2026. But instead, he used it to shed light on how far we still have to go.

From the original 13 colonies to the diverse communities we see today, Parmar traced a direct line through American history to show that where people are born, what they earn, and how they are perceived have always played a part in shaping their health. Societal progress has expanded what’s possible, but its impacts haven’t reached every patient, family, and community equally.

For the future family physicians in attendance during the AAFP’s conference for students and residents, the takeaway was impossible to ignore: their work will help decide who gets included in the next chapter of health care evolution, and in turn, the story of our nation.

“‘We the people’ means we take care of all the needs of all our people,” Parmar said to a roar of applause.

Parmar spoke from a place of personal experience. As the founder of Mango House, a community hub with resources for refugees and immigrants in Aurora, Colo., the family physician has built his career by serving the patients who are most likely to be left behind by the traditional health care system.

As he’s learned, properly caring for those patients requires understanding what they carry with them into the exam room. On top of whatever health concerns they’re dealing with, they arrive facing gaps in insurance, food or housing instability, and additional cracks in support systems that make care harder to sustain.

"I can't provide full-scope medicine unless I know the full scope of the patient,” Parmar said. “I need to understand their insurance, their wealth, their access to food, their education, their housing, their language barriers, their cultural barriers … Some people have more, some people have less. That's how it's worked at any point in human history, right?”

One example he gave came during the COVID-19 pandemic, when Mango House was administering walk-in vaccines to cut down barriers for their usual patients. Eventually, wealthier individuals from outside communities began to drive in and fill up appointments. Parmar’s response was to limit availability to patients only from his zip code, which ensured that people in his community who needed support were the ones who received it.

In Parmar’s eyes, that’s the difference between equality and health equity, or what he calls “affirmative action in health care.” Treating everyone the same would’ve required allowing the patients with more time, access, and resources to squeeze out the people Mango House was built for, while an equitable approach meant the underserved were served.

“You may not know just how hard it is for a patient to come to see you,” Parmar said. “We have to design for the least among us.”

Putting that philosophy into practice starts with the choices physicians can control. That includes where they work, how their clinics are built, and whether patients with fewer resources are actually reached.

Parmar pushed FUTURE attendees to see these choices as part of the responsibility that comes with being a family physician. He implored them to see leadership not as a title they might earn for their resume, but as an obligation built into their role in the world.

“You chose a career that comes with a natural leadership role…you're making a difference, either one way or the other,” Parmar said. “Now that you've made it this far, you can't just blend in anymore.”

That message landed because it was grounded in something students and residents already understand: patients naturally turn to family physicians when they need someone to help them find a way forward.

“This is your community and your society,” Parmar said. “What better leaders have there ever been than the family doctors? Who is trusted more than the family doctor? Who is respected more than the family doctor? Who do the people look up to more than the family doctor?”

As a parting message, Parmar challenged attendees to think about the role they will play in forging the future of US health care. The next chapter, he argued, will be written by those who are willing to stand up for those who are too often left behind.

“Let's write a story about the next 250 years of America, where we the people mean all the people. Let's write a story where the family doctors are the trusted leaders that our communities need,” Parmar said.