• Let People Taste Family Medicine and They'll See Our Value

    What do North American lobsters, chitlins and the specialty of family medicine have in common? Practically nothing, but don't hit the back button just yet. All three do share histories of being undervalued. Potential consumers of these items have too often relied on unverified social lore or visceral perceptions to construct stereotypical notions of each item's value.  

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    Lobsters were once so plentiful in the waters off the Northeastern United States that they were commonly used as garden fertilizer. The lobster's appearance garnered it the moniker "cockroach of the sea." It was a food often reserved for servants, slaves and prisoners. Advances in food canning and rail transportation of fresh food across the nation eventually led to the high price we see for a lobster dinner at restaurants today.

    In contrast, chitlins were believed to be a food "invented" in the Southern United States by slaves who were forced to eat the putrid-smelling pig intestines that were of no monetary value. Initial sensory and emotional perceptions can be deceiving. Culinary history reveals that both lobster and chitlins were considered a delicacy in parts of Europe and West Africa prior to the 19th century. Over time, both of these foods significantly increased in value in the United States.

    This historical case study of perceived value can also be applied to the specialty of family medicine.

    The American Academy of General Practice was founded in 1947 to promote and maintain high-quality standards for generalist physicians, who were being devalued by the increasing number of medical specialists. And to ensure those physicians stayed current on medical advances and emerging technologies, the AAGP became the first U.S. medical association to require completion of CME as a condition of membership. In 1969, family medicine was established as the 20th recognized medical specialty. Through the years, our intrinsic value to the health care system has continued to evolve -- not diminish.

    This is the 50th anniversary of our specialty. We should use the occasion to both celebrate our valued history and embrace the reason why we must consistently refer to ourselves as "physicians" or "family medicine specialists." We have earned this honor, having fulfilled all the rites of passage to become a medical specialist. I make it a point to never diminish my specialty status by referring to myself as a "provider." Even when I sign a document prelabeled with the term "provider" on the signature line, I replace that "P" word with another -- "physician" -- to erase any doubts about my value as a medical specialist.

    With the strength of 134,600 members, the AAFP has a diverse collection of voices clamoring to be heard. Although the average family physician salary has increased by about $80,000 during the past decade, this is of limited consolation in certain geographic areas of our country, where the administrative costs of doing business as a solo physician or independent practice group continue to outpace increases in net revenue.

    The 71% of members who report that they are employed by a hospital network or a professional group are demanding to be seen as more than just hired hands performing basic medical tasks. These members want to be recognized by, and appropriately compensated for the value they bring to, the institutions to which they belong.

    Our independent and solo family physician members are also raising their collective voices for relief from crushing administrative burdens combined with limited financial incentives to provide medical services for our country's expanding health care professional shortage areas.

    Joining the chorus are our dedicated rural physician members practicing miles away from tertiary medical care centers. They are crying out for more funding to supply critically needed point-of-care resources in their respective communities.

    Each of these valuable groups contributes to the totality of family medicine specialists who provide roughly 193,000,000 office visits each year.

    As I visit our constituent chapters in every corner of our country, it is not uncommon to hear from a member who shares his or her story of feeling a loss of professional autonomy and value. Many no doubt feel like the lobster plunged headfirst into a pot of boiling water. Although each member has passed the prerequisite sniff tests to become a certified family medicine specialist, many are outraged when they are treated like an undesirable batch of chitlins about to be cast out by unwitting employers who do not recognize their relevance or value.

    News flash: This is not a concern isolated to family physicians. Increasingly, I hear similar concerns expressed by our physician colleagues in other specialties.

    When a member tells me that the AAFP "has done nothing" to convince them to renew their membership, I ask them what the Academy can do better to assist them. Their answer usually results in me directing them to a member benefit the AAFP is already providing. Increased real-time member awareness of the benefits of AAFP membership is essential. The Academy represents far more than just great journals and CME. And with the anticipated launch of our new website in the spring of 2020, the AAFP will use machine learning technologies to direct members to the webpages and resources we need.

    The genesis of many member concerns can be traced back to the demands placed on them by employers. In September, the AAFP authorized the formation of our 20th member interest group, this one focused on employed physicians.

    The take-home message is there is an even greater need for the collective voice of family medicine to be heard. We have launched a public relations project to raise awareness about and elevate the perception of family medicine in the minds of American consumers. We've been working on building the program since early 2019, and it really started gaining traction this summer. This project is leveraging several of our own members as media ambassadors, resulting in numerous articles in national publications on topics such as mental health and immunizations, as well as television news appearances.

    Ultimately, when it's flu season and the morning television shows need to consult an expert about how to fight influenza, we think that expert should be a family physician -- not some other specialist who doesn't regularly vaccinate against and treat the flu. It will take some time to make our way as far onto the national stage as we deserve to be, but early results have been solid.

    In early October, I participated in a two-day series of media briefings in New York with The Wall Street Journal; Kaiser Health News; the Associated Press; O, The Oprah Magazine; and Time. My primary mission was to clearly define the specialty of family medicine for each reporter. We can no longer allow others to define us based on a distorted perception of who we are. They certainly cannot do so accurately without first getting a taste of what we do every day for our communities.

    Silence and retreat are not solutions. Since my installation as AAFP president, I have been sending 10 handwritten cards weekly to randomly selected Academy members who have contacted the AAFP with positive, neutral or negative comments. This serves two purposes: It provides me with a weekly reality check on what our members are talking about in real time, and it lets these selected members know that they have been heard by their elected leadership. None of them receives a form letter. Each letter is written with the very pen I used to write the draft of this post.

    The charge of the AAFP is not to advance the treasure of the few; it is to enrich the health of the multitudes we serve as physicians. Much like the preventive care we provide, it is impossible to precisely measure the social value of our specialty. The same applies to frustrated members who complain that the AAFP is doing nothing to fix the numerous external problems invading their professional lives. With all the noise created by employers, insurance companies, social mandates and government-imposed regulations, it is understandable why some of us feel as if we are in a battle for our professional survival.

    Despite their increased contemporary culinary value, I still will not eat scary-looking lobster or smelly chitlins. However, my appetite for the specialty of family medicine remains insatiable. Even if some have not noticed, our value continues to rise.

    Gary LeRoy, M.D., is the president of the AAFP.  


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