Half-century of progress and community keeps this leader coming to COD

Cora L. E. Christian, MD, MPH, FAAFP, attended her first Congress of Delegates 50 years ago, before her native U.S. Virgin Islands had an official AAFP chapter.

When Dr. Christian, the COD’s sergeant-at arms for more than 20 years and a longtime chapter delegate, attends the AAFP’s annual policy-making event Oct. 19-21 in Nashville, Tennessee, it will little resemble that first Academy event she attended in 1976. But the sense of community and passion to improve health care that she felt 50 years ago will still permeate the COD and the FMX that it leads into.

AAFP recently talked with Dr. Christian about the changes she has seen in family medicine leadership and representation.

What keeps you coming back to COD?

Dr. Christian: What keeps me traveling across the miles year after year to the COD is the vitality of grassroots democracy. The Congress of Delegates is the beating heart and moral conscience of family medicine. It is where policy is forged from the ground up, where a tiny chapter like the U.S. Virgin Islands has an equal, resounding voice, and where resolutions presented and debated by family physicians can influence national health care policy.

For example, a resolution I sponsored at COD regarding the Federal Medical Assistance Percentage—the rate at which the federal government matches state or territory spending for joint health and social programs like Medicaid—was adopted in 2014. While a member of the Commission on Governmental Advocacy, I was able to get Academy policy to oppose capping federal financial participation in state Medicaid programs imposed upon the commonwealths and territories. The AAFP later expanded this foundational policy beyond Medicaid to encompass all federal health programs affecting the territories.

I was told it was impossible and that Congress would never approve it, but it passed in 2017. Many people helped, including family physician and USVI Rep. Donna Christian-Christensen, MD, (my friend and fellow resident in training) but having support from a respected organization like the AAFP was extremely helpful and provided national credibility.

Many members come to events like COD and FMX to build community with other family physicians. How have you seen that over the years?

Dr. Christian: Dr. Sylvester McDonald, longtime St. Thomas, USVI, physician and community health pillar, began participating in AAFP circles in the 1970s. “Dr. Mac” was my family doctor. He was the kindest man you would ever meet. His wife was one of my mom’s best friends. So, I was protected and watched over.

I was assistant commissioner of health and secretary of the Virgin Islands Medical Society. With my interest in organized medicine, he invited me to my first COD.

The U.S. Virgin Islands was not yet an official chapter of the AAFP, so we were not voting delegates. Rather, we were guest representatives and persistent advocates, building relationships, forming and attending the minority caucuses, and laying the groundwork for our territory’s eventual charter and floor delegation in 1987.

What change have you seen from the networking that happens at AAFP events?

Dr. Christian: During the late 1970s, the handful of African American, African-born, Caribbean, and International Medical Graduates (IMGs) attending COD and Scientific Assemblies (now FMX) found each other organically in hotel lobbies and quiet corners. Banding together as an informal Minority Caucus gave everyone critical mass. When others saw the power of our collective voice, women, LGBTQ+ colleagues, physicians with disabilities, and new physicians found a home with us. We welcomed them all without hesitation, living out the true AAFP ethos—that family medicine embraces everyone.

This group had no official charter, no budget, and no line item on the AAFP agenda. It operated by word of mouth from one annual meeting to the next, coordinating talking points for reference committee hearings and lobbying friendly state delegates to sponsor resolutions on our behalf. It took more than a decade of those persistent, unsanctioned caucus meetings by that small nucleus of African, African American, Caribbean, and IMG physicians to pave the way for the creation of the the special constituencies structure.

I was one of those persistent antagonists.

Is there a personal moment that stands out?

Dr. Christian: Receiving the AAFP Humanitarian Award at the 2013 COD was overwhelming and deeply humbling. The award honors extraordinary, selfless commitment to human life, recognizing physicians who dedicate their careers to serving underserved populations and addressing the deep social disparities that compromise health. To be selected out of a national body representing more than 130,000 members—who collectively care for hundreds of millions of patients—felt surreal.

Coming from the U.S. Virgin Islands, a small territory with a population under 100,000 that often feels invisible in national discussions, standing before that immense assembly of peers was profoundly validating. When you practice and lead public health initiatives on a group of small islands, you are on the frontline every day with limited resources, fragile supply chains and unique geographic isolation. You do the work not for accolades, but because your community depends on it. For our national Academy to look across the water, see the daily struggles and resilience of our tiny territory, and say, “We see you, we value what you are doing, and your patients matter to us,” was not just an honor for me personally—it was a triumph for the U.S. Virgin Islands, for our patient population and for every physician practicing under challenging conditions.

Another enduring highlight has been mentoring young physicians, medical students, and residents from across the country, showing them that family medicine is not just an office visit, but a profound commitment to the well-being of the individual or family, the public health, community leadership and civil rights.

Standing on that floor year after year, carrying the voice of our island home into the national arena, will always be the defining privilege of my professional life.

In 50 years, how many CODs have you been to?

Dr. Christian: My recollection is, most. Dr. Harry Metcalf, who served as AAFP president in 1987–88, noticed my absence one year, and the next year he came to speak to me. He made it clear that I had an obligation to the AAFP and to myself. He had seen the way I conducted myself at reference committees and other assignments I was given and said I was the right person for each responsibility, including sergeant-at-arms.

What made me reconsider my yearly pilgrimage to the AAFP were the responsibilities I had at home with multiple jobs and my own babies to raise. My husband was an ambassador from his native St. Kitts and Nevis to the Caribbean Community (CARICOM) and traveled a lot. I took my children everywhere, but it was exhausting, and I wondered whether I was being a good mother. I went to my dad in tears, thinking I might be neglecting my most important responsibilities.

He ignored my tears and said, “Children learn by example.” He was right.

In addition to serving as a chapter delegate, you are one of the COD’s sergeant-at-arms, responsible for preserving decorum, managing credentials, seating guests and more. Why do you enjoy that role?

Dr. Christian: To witness delegates debate with fierce intellect, mutual respect, and shared purpose—and to serve on that floor maintaining order and tradition as sergeant-at-arms—renews my spirit. You cannot get that fellowship or democratic energy from a textbook or a webinar; you have to be in the room where family physicians stand together for our patients and each other.

Escorting newly elected officers to the dais is a deeply moving experience. When election results are announced, the hall erupts in applause, but as sergeant-at-arms, you are right beside them in that transformative moment. To be the first colleague to look into their eyes, embrace them, and offer that initial word of congratulations before they ascend the stage is an extraordinary privilege. You feel the weight of history and the collective trust of more than 120,000 members resting on their shoulders. You feel their joy, but you also see the tears of those who did not make it. And so, a pat on the back or a handshake at times is all that is needed to say, “Job well done,” despite the disappointment.

I have watched brilliant, dedicated leaders step into those roles over decades, and I have never been disappointed. The depth of talent, compassion, and intellect in our Academy is staggering. My only regret in any election year is that there are always more exceptional candidates than available seats. However, that abundance of leadership keeps the AAFP strong and resilient.

Why would you encourage AAFP members to get involved in leadership?

Dr. Christian: Through involvement in the AAFP—whether serving on the COD floor, stepping up in chapter leadership, serving on national commissions, or taking on any assigned task—one moves from personal victory to a shared hope.

In clinical practice, our triumphs are personal: You make the elusive diagnosis, you guide a family through a crisis, or you keep your independent doors open for another month. Those moments are precious, but when you go home at night, you realize that the systemic barriers harming our communities—fragmented care, administrative burdens, health disparities and physician burnout—cannot be solved within the four walls of an exam room or by the bedside of a patient. One doctor cannot heal a fractured system in isolation.

When you step into chapter leadership or take your seat as a delegate, your frontline clinical frustrations become formal resolutions, legislative testimony and national advocacy. You discover that a dedicated physician from any corner of this country—even a tiny island—can alter the trajectory of American medicine.

Active involvement joins you with kindred spirits who share your ethical compass, understand your exhaustion, and reignite your reverence for the calling of medicine.

If family physicians do not actively defend our patients and our autonomy, outside entities who have never truly held a patient's hand will dictate the terms of care for us.

Stepping into leadership pulls you out of the silo of daily survival and links you with a devoted community of colleagues and the AAFP and chapter staff, who are our indispensable foot soldiers working tirelessly behind the scenes. It turns solitary struggle into collective strength, and personal victory into an enduring, shared hope for the future of health care.