Waking Up in 2021

My dream began at dawn with me standing in an open field witnessing the launch of a hot air balloon rally. There among hundreds of decorated balloons – glowing as they each rose into the crisp, blue morning sky – was a stunningly beautiful one hoisting a wicker basket full of passengers. The balloon’s massive envelope was suspended in midair by what appeared to be a canopy created by hundreds of individual helium inflatables. Each was uniquely shaped to form a diverse array of balloon houses. It reminded me of the Pixar movie Up.

As I craned my neck to marvel at the detailed artistry of the sight, the blue sky was suddenly replaced by a dark storm that violently cast the balloon and its riders across the sky. I watched in terror knowing that the great balloon was doomed to come falling to the earth.

As I feared, it crashed. But almost immediately, from out of the shadows rushed a cast of familiar faces. They were family physicians from every corner of the county. They had come to rescue the passengers.

I woke up from my odd dream contemplating what message my subconscious spirit was attempting to convey to my conscious mind. The reality is that 2020 was an odd inflection point in time that has continued. We have become accustomed to waking up to unfamiliar life events.

Later that morning I shared the details of my dream with members of the AAFP Board during our December virtual meeting. My message was that family physicians cannot afford to stand by as helpless spectators held down by the gravity of unanticipated life events. Instead, we are the specialty of medicine best equipped to rescue a nation attempting to navigate through this storm.

A year ago, the AAFP arrived at the brink of a new decade certain that our 20/20 vision of the future would allow us to clearly focus on certain strategic member priorities. We began the year by focusing our legislative mission on

• lessening administrative complexity,
• increasing funding of teaching health centers,
• advocating for a primary care benefit in high-deductible health care plans and
• getting increased payments for Medicare evaluation and management services authorized.

But the COVID-19 pandemic quickly amended both patients’ and family physicians’ agendas to include previously unimaginable social precautions, like wearing a face covering, keeping our distance from others, washing our hands properly and learning how to do everything virtually.

The pandemic brought with it a loss of jobs, personal income and more than 350,000 American lives. The word “unprecedented” became a prominent fixture in our vocabulary. In contrast, we avoided uttering the phrase, “Well, it can’t get any worse” for fear of storms that might rage even more violently and blow our lives further off course.

With the arrival of the pandemic came a social awakening as people recognized the structural inequities in our social support and health systems. The winds of reality ripped away our ability to unconsciously deny the injustice and inequalities among us; but in the chaos it also affirmed our capacity as a nation to provide untethered human kindness to others.

We emerged from 2020 with a rekindled ability to nimbly adjust our focus. With our core strategic objectives in mind – reduce administrative complexity, support comprehensive family medicine, improve individual and population health, and grow a diverse workforce – we sent the incoming administration and the 117th Congress a bold message of priorities needed to save our nation’s health care system:  

• Health care for all – COVID-19 has underscored the importance of all Americans having access to high-quality, affordable health care.
• Strengthening the primary care workforce – The United States will need 52,000 more primary care physicians by 2025.
  
• Health equity – The pandemic highlighted the gaps in our nation’s health care system and the health impact of systemic racism in our society.
  
• Value-based payment reform – Payment reform needs to re-emphasize the importance of primary care and prevention.
  
• Telehealth – COVID-19 has demonstrated the adaptability of serving patients outside of traditional in-person visits through thoughtful integration of telehealth into established physician-patient health care systems.

The past year also taught our nation and the world many important lessons. In this crisis we demonstrated the essential role our specialty plays in the public health of our country. Even as we begin this new year, we are engaging with our nation’s public health administration to strategically coordinate how best to distribute the much-anticipated COVID-19 vaccines on the final mile to the recipients. You can go to our COVID-19 resource page to learn more about our efforts.

Family physicians are the secret sauce in the recipe for change in our health care system. It is imperative that our members are assured that they belong as a valued component of America’s system. We must resist any temptation to default to merely existing within the chaos of an ineffective health care system. To passively do so would only hasten the deterioration of physician well-being.

Now more than ever, this is our opportunity to effect serious change in how medicine is structured and valued. Our advocacy message did not take a holiday. The past year ended with the AAFP continuing to fight for you 24/7. During the closing weeks of the year your AAFP staff aggressively lobbied to keep intact our many months of careful work to preserve the payment policies included in the 2021 Medicare physician fee schedule. This was threatened during an 11th-hour crafting of the $900 billion stimulus package passed by the 116th Congress just prior to adjournment. The final package resulted in

• no impact to 2021 E/M payment increases;
• adding $3 billion to the fee conversion factor, which helps family medicine;
• temporarily freezing the Advanced Alternative Payment Model bonus thresholds, which will help ensure that family medicine practices participating in AAPMs can remain eligible for the bonus.

We have faced an unparalleled number of unimagined and unforeseen challenges. But we know that change is a reliable constant we must navigate together. The AAFP’s pledge is to keep our members informed of the threatening clouds of change accumulating on the horizon as we emerge from this national health emergency. Social carnage has challenged us to reimagine America’s health care system. As a nation, we can ill afford to passively return to supporting the system of illness that existed prior to the arrival of a pandemic that forced us from our tethered comfort zone. It must instead be a system anchored on a solid foundation of family medicine principles.

The specialty of family medicine emerged intact after dramatic social change. We have become the emblematic flame needed to lift our nation’s health care system to loftier heights. In this relaunched system of health, it is more than just an odd little dream to lift the lives of all people by the courageous efforts of family physicians – it is a necessity. In times of great need, we are the ones who will always rush to our nation’s rescue during ordinary and historical times of need. It is our nature to make a difference in the lives of others by always being in the right place just in the nick of time. It is time for us to wake up refreshed by the lessons we have learned so we can boldly prepare for the 21st century’s roaring 20s.

Happy New Year! It is 2021. Let’s get some serious stuff done.

Gary LeRoy, M.D., is Board chair of the AAFP.