‘We can do anything:’ family medicine as a vector for change
Aug. 13, 2025, Matt LaMar — Over the FUTURE 2025 weekend that wrapped up early this month, there was palpable excitement about the future of family medicine. Thousands of attendees roamed the ballrooms and hallways of the Kansas City Convention Center as they made connections with their peers and prepared themselves for the next steps in their journey.
That journey is changing. The federal administration had made sweeping funding and policy changes, while new technologies like AI are disrupting everything from how students study to how physicians treat patients. Taking a step back to pause and think about the state of family medicine is naturally also a part of FUTURE.
For Kate Tian, MD, a key experience in her first FUTURE—at the time branded as National Conference—sticks out as a seminal moment. Anita Ravi, MD, MPH, FAAFP, had been presenting a workshop about her PurpLE Clinic, a groundbreaking clinic in New York City for victims of gender-based violence.
“I remember just getting my mind blown sitting in the seat and it was like, oh my God, this is what family doctors can do,” Tian said. “We can do anything.”
It was neat full circle moment for Tian this year, as Ravi presented in the Friday afternoon keynote live podcast recording with Tian in attendance as the FUTURE 2025 resident chair. Tian wrapped up her residency at the University of Vermont Medical Center this year and steps into her first full-time position as a board-certified family physician in September.
But if family physicians can do anything, what should they do? How should they do it? Core to the answer, for Tian, is that family medicine is a fantastic avenue for change. “We are the ones who are seeing the people who need help,” Tian said. “Family doctors are the ones who step up.”
Importantly, that change isn’t just change in general. It is targeted change to achieve better outcomes for those who need it. It is, in other words, political change. Tian is sensitive to those who may want to sidestep some of those conversations. In her experience as a resident, though, those thoughts have come around.
“I think I’ve always avoided the question, ‘Should physicians be political?’,” Tian said. “You never know what the other person sitting in front of you is going to think. But what I’ve learned is that medicine is political because what we do every day is affected by the policies, by the environments, by philosophies, by how we treat people.”
In other words, as Tian says, “If you are talking about achieving social justice, no other specialty does it better than family medicine.”
Of course, it can be hard to spend time advocating, especially in residency, which can be a grueling environment where you’re pulled in different directions. That didn’t stop Tian from trying to recruit her peers to participate. “When I was in residency, I always tried to tell my colleagues just to be passionate about the same things I was doing,” Tian said, smiling. “But sometimes they’re like, ‘Well, I’m tired, I just want to sleep.’”
Any med student cramming for a test or resident who just finished their shift can relate. Burnout is a common topic both for training physicians, new physicians and established physicians alike. Tian, though, recommends a helpful reframing of the situation in her position as resident chair.
“Sometimes people think advocacy is just another task they have to do that will contribute to burnout,” Tian says. “What I'm trying to show a lot of people is what I learned from a lot of leaders in AAFP is that, going to these conferences is actually how I address my burnout because I am changing things from the system level. And every time I leave a conference, I left energized. I never regret going to any conferences.”
Changing things on a system level is certainly rewarding, but it can take a long time. For Tian, the best approach is focusing on what you can do. Sometimes that’s a small thing, and that’s ok. “I do think about making small changes one at a time,” Tian said. “Those are all very big projects—being able to affect big change in our community and in our patients. However, our work really is sometimes one patient at a time.”
One of her favorite ways of thinking about “one patient at a time” is to make sure she’s providing quality to care to the marginalized in the community as the focus of work and branching out from there. She thanks her experience working with the large immigrant population in Burlington, Vermont to help her to think this way.
And though other medical specialties are certainly needed, Tian is adamant about the value of family medicine. “In other specialties, your scope goes narrower and narrower; you specialize and specialize,” she says.
We are trained to cover everything. And I think it's just the idea of being able to provide care for everyone walking through the door is the idea that excites me.”