Push back and push family medicine forward, new AAFP president urges

Last year at this time, we shared with you the AAFP’s strategic plan for the next three years. A reflection of your priorities and passions as reported through the member survey and Academy policy brought forward by our members and chapters, all serving as the foundation upon which all AAFP work builds.

There’s an AAFP activity that we all engage in and that touches all four of those pillars: Advocacy. 

At these most difficult of times, I am reminded of the tremendous amount of strength thriving within the AAFP—a community of family physicians who lift each other up, who inspire, and who advocate for one another and for our patients.

We share that community and invite others to join us through our mentorship of the next generation of students, residents and new physicians. A little more than a year ago I was privileged to mentor a phenomenal bilingual rising second-year medical student leading her peers running the Einstein Community Health Outreach Free Clinic: student doctor Yuliana Dominguez. 

Her name seemed a little familiar to me and about halfway into the year, one of my patients of more than a decade, an older Dominican man, a bit crotchety at times and well known to me and the clinic staff, came in with a big smile across his face. It turned out that his daughter—Yuliana—was our new Free Clinic Project director. Since that time, she has joined us for his visits in the office, reviewed and learned from the complexities of her father’s medical history, and was set up as a proxy on his patient portal. They both said they would be honored to share their story with you. Earlier this year she started her clinical rotations and recently shared how she is enjoying every rotation, but most enjoys the passion and work done in primary care as she considers a career in family medicine. 

Primary care is the only care that improves life expectancy and reduces disparities, with research showing adding primary care physicians to a community actually results in measurable increase in lifespan and more equitable health outcomes—which is even further improved by culturally concordant medical care with clinicians whose backgrounds align with the communities they serve. Yuliana, like so many of our future family physicians, will serve as a bridge between our medical community and the Bronx community: strengthening the diversity of the AAFP and the health of her community of origin.

I am grateful to each of you who, too, answer the call welcoming students and residents in your offices and sharing with them the joy, innovation and inspiration that defines family medicine.  

Direct patient care and mentoring students are two things that bring me joy, but I wear another hat at work. Through my informatics lens, I see that much inspiration and opportunity for advocacy may be realized through innovation. As chief medical information officer for my own organization, I have been a voice for primary care EHR-focused development, and consideration of independent FQHC networks like my own and solo and small independent offices not integrated into large systems. Now the next generation of transformative technology is upon us: artificial intelligence.

Family physicians are sharing that generative AI note documentation can be life changing and joy renewing for the work we do. We are using evidence-based AI resources to inform our care, and are ready to engage, prioritize and define the direction of artificial intelligence. Your AAFP is there. Together, we are reimagining how we care for our patients, how we support each other and how we advance our profession. Innovation will not simply be about technology, but must be affordable, collaborative and equitably applied, paired with our willingness to challenge the status quo.

A willingness to challenge the status quo must be coupled with the ability to respond to a quickly changing environment.

Let me share with you another example of the community of family medicine rallying, advocating and prevailing. At a time when our nation is grappling with unacceptably high levels of maternal mortality and severe morbidity, we have seen a pattern of hospital obstetrics departments moving to exclude family medicine from the labor and delivery floors. When one such program was a risk last fall, the tremendous on-the-ground and community advocacy, in collaboration with state and national AFP—made possible through your membership—returned the program back to a place of negotiation and renewed investment in the collaborative care model, placing family physicians in a position to care for birthing patients.

These fights are mounting throughout our country, increasing in frequency, frequently revisited. They are even more critical in our rural communities and small towns where family medicine is often the only clinician provisioning care.

Many of the challenges we are facing are daunting.

So why do we do it? 

We are strongly connected to the work that we do and slightly defiant about the way that it is happening in our world.

Let me acknowledge that the work you do is deeply important, tremendously meaningful, and moving us toward a greater good amid the noise and chaos. That’s because we come together as members of the American Academy of Family Physicians; we are able to not just push back against injustice, misinformation and harm, but push forward with evidence and science advocating for the more equitable health care system, focused around primary care, bringing joy, innovation and inspiration to practice, patients and the next family medicine generation. 

And that is what I hope you hear today and see in the coming year—that we not only push back, but that together we push forward.

Together, we will shape the future of family medicine—and the future of health care itself. We will advocate boldly for policies that prioritize primary care, protect our patients and invest in the health of every community. Whether it’s advancing payment reform, defending the patient-physician relationship in the determination of appropriate care or expanding access in rural and under-resourced areas, our voice will be heard.

Thank you for your trustworthy partnership with your patients, your service to your communities and our country, and your unwavering commitment to values, aspirations and the actualization of family medicine.

I am Sarah Nosal, and I am proud to be a family physician and I’m proud to be your president of the American Academy of Family Physicians.

Thank you.