• It Has Been an Honor to Serve

    When I ran for AAFP president-elect three years ago, I told our Congress of Delegates that we, as an Academy, were going through a turbulent time – a time of change, a storm. Little did I know then that we would now be reminiscing about 2018.

    Prince William Sound

    I know storms. We are going through a big one.

    My family and I have been sailing in Prince William Sound in Alaska for 26 years. It is an extraordinarily beautiful place where there are more whales and bears than people, and mountains and glaciers are reflected on the still ocean. Normally, sailing there is relaxing, but there are often storms of sudden power that come in from the Gulf of Alaska. We have learned to reef our sails early and rapidly, shortening them, not relying on wishful thinking. We know that we can always un-reef when the weather improves.

    Reefing the sails accomplishes several things. It makes my wife, Michelle, happy, for one. But it also allow us to stay on course, often with the same speed, despite howling winds and 10-foot waves.

    We as an Academy, and as individual family physicians, have been weathering a storm of unprecedented power and duration that has impacted all aspects of our society. And because we are family physicians, we have helped our patients through these difficult times despite our broken health care system. But we must never lose sight of our goal – to ensure health care coverage for everyone in the United States through a foundation of comprehensive and longitudinal primary care. Health care is a human right. We must continue our course to reach that goal despite the storm that confronts us.

    Because of our flexibility, broad knowledge and experience, family physicians have been able to fill gaps in a health care system that had already been cut to the bare minimum. The U.S. health care system had no provision for the surge in cases that we have encountered this year. Family physicians were covering L&D, ICUs and ERs; setting up testing programs; and following the ill in their homes, often without the protective equipment and the information that we had every reason and right to expect.

    I am deeply humbled and proud of the work you have done and for having this opportunity to lead this organization during this difficult time. You have put your lives and your health on the line to serve your patients.

    I am also filled with a deep and abiding anger for those in power who did less than they should have to protect us.

    We have not come through this unscathed. Family physician mortality due to COVID-19 was four times higher than any other specialty. Much of this was due to the diversion of personal protective equipment to specialties deemed higher risk and to hospital administrators who did not want to panic their clients, our patients, by allowing family physicians to wear masks. We have lost friends and colleagues, such as Angelo Patsalis, M.D. The past president of the Michigan AFP will be missed this week during our Congress of Delegates. We likely will lose more colleagues before this pandemic is over. They should not be forgotten.

    I also have been extremely proud of our Academy staff as we dealt with this crisis. Despite the unprecedented nature of the pandemic, and with our staff largely working from home, the productivity of the Academy increased. We’ve all experienced the rapid pace of COVID time. The Academy staff went into overdrive to get you the information you needed to protect yourselves and your patients and to have your backs with, for example, increased payment for telemedicine, preserving the increases in Medicare payment to primary care, and a program through which family physicians could buy PPE.

    During this time we transitioned to a new CEO, the first time we as an organization have had to do this in 20 years. Thank you, Doug Henley, M.D., for providing two decades of leadership. The Board and the selection committee had a difficult task in choosing his successor because we had so many truly excellent candidates. I want to welcome Shawn Martin as our new CEO and EVP. 

    As I said, we have had to reef our sails, which in an organization such as ours means making difficult decisions. Moving the Congress of Delegates to a virtual platform was one of those.

    The AAFP has never experienced a time such as this. A storm indeed. But this pandemic has come at a time when we have the technological resources to have a virtual congress, and our bylaws allowed a special meeting to be called. Our speaker and vice speaker have worked incredibly hard to allow this electronic gathering to happen. It is not the same as an in-person event, and I will miss seeing all of you in person, but it will do.

    The virtual COD offered my last opportunity to provide remarks to the congress as a member of the Board of Directors, and I would be remiss if I did not bring up comprehensive, full-spectrum family medicine and rural health care in this space, too.

    If we are to thrive in the next decade, our skill set will need to be as broad as possible, and new technology will help us. Sixty percent of family physicians started telemedicine for the first time in March, an amazing achievement. We have demonstrated the value of our broad-based training during the pandemic. Family physicians were used in every part of medicine, and no other specialty can do all that we do.

    Full-scope family physicians are also needed in rural communities, especially ones with largely minority populations. We are the answer to reduce the increasing rate of maternal and infant mortality in rural and underserved populations. I am extremely concerned because the situation was already dire before the pandemic, due to institutional racism, perverse economic incentives and neglect.

    We can reverse the development of maternity care deserts. Family physicians will need to provide maternity care and deliver babies again, and reclaim the title of true cradle-to-grave care. I know this will work. I have been fortunate to provide this kind of care. And there is nothing more satisfying than seeing the healthy babies you delivered grow up to be strong adults.

    My plan after the Congress of Delegates is to go back to being a full-time rural family physician. My partners, my wife and my community have been extremely patient during my six years on the Board of Directors.

    I thank you for having given me this opportunity. I have been truly honored to represent you. Sadly, the storm is not yet over. Please be careful. I am so proud of what you and this Academy have accomplished.

    We are living through a time of chaos and change. But let’s reframe this. We are living through an epic adventure, and family physicians are the heroes. In my experience, adventures are difficult, uncomfortable and push us to our limits. But, now, an organization like ours filled with confidence, resolve and clarity of purpose can chart not only our own course, but that of the country.

    This week John Cullen, M.D., is concluding his term as AAFP Board chair and six years on the Board of Directors.


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