July 14, 2022, 2:35 p.m. — The AAFP marked its 75th anniversary in June. With the National Conference of Family Medicine Residents and Medical Students approaching July 28-30 in Kansas City, Mo., AAFP News sat down with the Academy’s student, resident and new physician members of the Board of Directors to discuss their vision of the specialty’s future.
AAFP News: What do you hope to accomplish in your career, and why was family medicine the specialty that best aligned with your goals?
Amy Hoffman, M.D., student member of the Board, first-year resident at Lancaster General Hospital Family Medicine Residency: It’s exciting that there are so many opportunities and different paths that I can see myself taking in family medicine. Something I love is that it is such a values-driven specialty, which is what drew me to it. People bond and connect over values and love for their community and patients. I hope to embed myself in a community and be known as someone who provides compassionate, excellent care. I also want to pursue leadership to promote our specialty and advocate for health justice and equity.
Amanda Stisher, M.D., resident member of the Board, recent graduate of the University of Alabama Medical Center-Huntsville Program: As a medical student, I was torn about what I wanted to do. I loved everything I experienced: pediatrics, obstetrics, surgery, internal medicine, our hospitalist rotation. That led me to family medicine. I hope to practice full-scope family medicine with obstetrics. I want to take care of multiple generations of families, including taking care of mom, delivering her baby, taking care of that baby and eventually her babies.
I took that question a little bit differently than Amy, but I like her answer as well.
Samuel Mathis, M.D., new physician member of the Board, Galveston, Texas: My answer is also different, and I think that highlights the uniqueness of family medicine. Family physicians are so unique in what we practice, who we see and how we do things. That’s what drew me to the specialty, the fact that I get to practice in a way that is unique to me and not have to fit into some sort of mold.
I want to see systems changes that enhance the quality of care that we provide and find a way to expand that state- and nationwide to the patients we serve. I believe family medicine has a unique role in that we are one of the few specialties that is health care focused rather than sick-care focused. When we enter communities, we improve the health of the entire community. We make people live longer as opposed to just fixing problems as they arise.
AAFP News: What makes you most excited about your future and family medicine?
Hoffman: As a new family physician, I am excited for all the clinical variety. Some of my clinical interests now include addiction medicine, gender-affirming care and reproductive health care. I am also looking forward to more obstetrical training, which is what drew me to my program, Lancaster General. Like so many family physicians, I want to provide care for the whole family tree in that longitudinal “birth-to-earth” fashion. I’m excited how my career can change and adapt to the needs of my community. There are so many ways I can branch off and explore leadership and research and different clinical corners of the world.
Mathis: I’m in academics, so I get to teach the next generation of family physicians. I love that.
Stisher: That’s what I was going to say. I’m excited about teaching our future generation because family medicine is the future of health care.
AAFP News: What is the Academy doing well for members now, and what do you see as the biggest challenges?
Hoffman: Family medicine’s scope is so extremely broad, and I see the work of the AAFP mirroring that. There’s a broad scope of advocacy and legislative work on Capitol Hill, to talking about clinical guidelines, residency requirements and education and practice enhancement. It’s incredible how the AAFP touches so many different corners of health care. Trying to encompass the values and what’s important to family physicians is something that the AAFP is doing well. I’m also so grateful for the opportunities they provide to students and residents. Our voice really is valued.
Mathis: I think the biggest thing we’re doing well for members is our effectiveness in advocacy. Our scope and membership is so large and so diverse, and we do a good job of maintaining a balance in advocating for population health and the betterment of our specialty as a whole. This is why the Academy is listed as one of the most trusted lobbying groups in Congress right now, because our focus is so singularly devoted to the betterment of our patient population.
Although family physicians certainly face challenges, the Academy continues to find and create opportunities to address those issues. For example, we need more GME funding to meet the demand and the need for primary care physicians that’s going to continue to grow over the next 15 to 25 years. Thanks to the AAFP’s advocacy, Congress recently created 1,000 new Medicare GME slots, and CMS adopted our recommendations for how to target to areas with the greatest need.
We’ve got to continue to work to find ways to improve the quality of health care while decreasing the costs, which is why the AAFP is focused on accelerating the transition from fee-for-service to value-based care while ensuring that family physicians have the financial and technical support we need to be successful. The AAFP also helps provide grants to physicians looking at doing research on ways to improve the quality of care we provide.
Finally, our patients must have affordable, timely access to comprehensive health care. This is why the Academy continues to advocate to close the Medicaid expansion coverage gap, expand Medicaid coverage for 12 months postpartum (we got a partial win on this in the American Rescue Plan), ensure that primary care services are covered pre-deductible and without cost-sharing, protect access to evidence-based reproductive health care, and enforce mental health coverage parity laws.
We have so much that we still can do better, but even in a politically divisive and fiscally constrained environment, the AAFP is making significant headway on issues that matter to family physicians and our patients.
Stisher: I’m super excited about some of the advances in education and the special projects that have recently been approved. Advancing AAFP Education is a new educational approach based on the needs and wants of our members. We hope to deliver an extensive amount of educational training by expanding our on-demand didactics, workbooks and tools, and incorporating case-based simulation exercises, demonstration videos and advanced gamification. I anticipate it will help strengthen the pathway to family medicine, ensure that we can practice comprehensively and to the full spectrum of our training while helping to develop and diversify family medicine leadership.
Mathis: The Academy is really focusing on the educational projects and the products that we’re putting forward to make sure that we’re meeting needs of members all across the learning spectrum to ensure that they get high-quality education that is relevant to their needs.
AAFP News: In what way do you hope family medicine will change during your careers?
Hoffman: I hope family medicine continues to grow in academics and our departments continue to grow and make an impact on their greater medical systems. We need to educate the public about the value of family medicine and the huge value that we can bring to the health care system and the communities we serve. I would love to see family medicine grow in reputation, size and funding. Every single medical school across the country should have a strong family medicine department.
Mathis: We’ve got to change to meet the needs and demands of our patients as well as our members. That’s the beauty of family medicine, it adapts.
AAFP News: In 25 years, people will be talking about the AAFP’s 100th anniversary. What does family medicine look like a generation from now?
Mathis: The next generation of family medicine is going to look different. With the changes in health care, we’re going to see a shift to more focused, team-based care. The next generation of family physicians is going to be much more involved in the social determinants of health and how the exam room is an extension of what’s going on in the patient’s living room. We have to make that shift to really make sure that we are meeting patients where they’re at with their current situation in their home, work and community.
Hoffman: Evidenced by what the residents and students talk about and the actions of the resident and student Congresses, I think we are seeing a generation of people coming through family medicine who are values-driven, committed to social justice and see family medicine as their path to fulfill their values, interests and commitment to the community.
AAFP News: There are deadlines approaching this month for some AAFP student and resident leadership positions. Why did you get involved in family medicine leadership? What have you gotten out of it, and do you encourage others to get involved?
Stisher: I would highly recommend anybody interested in family medicine get involved either at the state or national level. The AAFP plays a crucial role in helping maintain our scope of practice and also allows us to better serve our patients. That’s why I originally got involved in the Academy. I’ve made lifelong friendships and found mentors throughout my journey.
When you come to National Conference you see friends and mentors who are doing what you plan to do. When I was a student wanting to do obstetrics in family medicine, I had several people in med school telling me I couldn’t do that. They were wrong. So it was a breath of fresh air being surrounded by so many people who are so passionate about family medicine and making the health care system better for our patients and for us as physicians, as well.
Hoffman: My work with the Pennsylvania AFP and AAFP has connected me back to my purpose and calling to medicine. In medical school you get stuck in this cycle of memorizing information and standardized tests. The science of medicine is so important, but the AAFP allowed me to take a step back and feel like I was doing something important in this field by advocating for my patients. I have found a voice and purpose through AAFP, and it has really augmented my medical education and provided me some fuel to get through the challenges of medical school and prepared me for residency. Getting involved provided me so much meaning and connected me to incredible people across the country.
Mathis: I got involved in the Academy as a student, stayed involved as a resident and have continued as a new physician. I was involved on the state level as a student and resident but got the opportunity to represent the Academy to outside organizations, which led me to jump in and be a part of the decisions being made at the national level.
The Academy is a fantastic opportunity for young physicians, including students, residents, fellows and those who were in their first few years of practice, to really gain leadership experience and education in how to speak up for our profession and our patients. That’s what I’ve gotten out of the Academy. That’s what I tell people they can get out of the Academy. I am always encouraging students, residents and new physicians, as well as those who have been in practice for a while, to engage with the Academy. Every physician has a voice and every physician has a different view, so it’s important that we hear all of those different viewpoints to make sure that the Academy reflects the membership.
The Academy is increasing the number of opportunities for new physicians to get engaged, especially on the commission level, in order to ensure that their voice is heard.
AAFP News: What advice do you have for students considering family medicine?
Hoffman: Find your people. Family medicine is incredibly broad. Whether your passions are sports medicine, ultrasound, obstetrics, research, health policy, integrative medicine or osteopathic manipulation, or any other field you can think of, there is a group in family medicine for you. That is obviously a strength of family medicine, but it’s something that is hard for medical students to understand. If you are exposed to one family physician, you’ve only seen one family physician.
There are diverse groups of people within this awesome specialty, so National Conference is a great way to find people who share your passions in family medicine, and you can envision your future career through connecting with these folks.
Stisher: Attend National Conference!
AAFP News: Amanda, you have served as chair of that event, so why don’t you tell us why?
Stisher: Well, it’s the first in-person National Conference that we’ve had in three years, so everybody is going to be super excited to meet face to face. We have special workshops for both students and residents this year that you will not want to miss.
For students, we have a huge expo hall where you can meet the majority of the residency programs from across the country, so you can compare and see what they have to offer. If there’s something specific that you are looking for in a program, you can see which programs align with your goals. And you get to meet residents and faculty from those programs to see where you might fit best.
Also, getting involved in the Congresses, which was my favorite part, is a way to advocate for change, whether it’s for family medicine or for our patients.
Being around people who are so excited about family medicine and are just as passionate as you is one of the best feelings I’ve ever experienced. As a student, this is when I knew I had found my people.
AAFP News: Samuel, what do you tell your students?
Mathis: If you’re considering family medicine, you have to think about the style and focus of what you want to do. Family medicine is so malleable, you can make your practice into whatever you want, from working in rural areas and practicing full-scope to being in urban areas, or doing direct primary care. So figuring out the type of practice you want and the kind of patients you want to work with and see is important. If you go into residency with an idea of what you want to do, it will help you get the most out of residency and ensure that you learn everything that you need to be successful.
AAFP News: Did family medicine interest groups influence your specialty choice or did you already know what you wanted to do?
Mathis: For me, it was my family medicine rotation in my third year. I had a family medicine doc who was involved in advocacy, and working with those family medicine doctors during my rotation I realized I did not want to give up medicine to practice a specialty. That’s what really worked for me.
For students who are coming into family medicine now at my institution, the FMIG plays a huge role in their decision to do family medicine because that is the initial point of contact for first and second years where they’re able to learn about the breadth and the depth that family medicine offers. If you want to know more about family medicine, you should definitely get involved with the FMIG at your institution.
Hoffman: I love FMIGs because they’re student driven. The students decide what speakers to bring and what training opportunities to have. I was involved with my FMIG early on and was able to pursue a lot of meaningful projects, from opioid education to ultrasound skills. I also connected with classmates who shared my values and interests. You don’t have to get involved nationally to explore family medicine; you can look within your own department and discover a lot of diversity within the field.
AAFP News: What do you wish more students understood about family medicine?
Stisher: I heard someone describe this perfectly. They said family medicine is like a pluripotent stem cell, a cell that you can do anything with. You learn everything, and then you can do with it what you want. If you want a career in rural practice, like (former AAFP President) John Cullen in Alaska, you can do appendectomies, deliver babies and everything in between; or you can be a hospitalist; you can focus on outpatient medicine if you want; you can provide full-spectrum care; there are so many possibilities. There are family physicians doing endoscopy and all kinds of things. You can become whatever you want to be with family medicine training because of the breadth of knowledge we obtain.
Mathis: Family med docs are uniquely situated to take leadership roles within their universities or employment situations because of the fact that our training is so broad. We’re able to connect with both our clinical and surgical colleagues, and our job is such that we’re natural collaborators. We make fantastic leaders because we’re able to see the whole picture of an organization, as opposed to just a part.
Hoffman: The numbers of family physicians in academic leadership has grown, and that goes right along with your point, Sam. We’re poised to be leaders in academics and our health care systems. Students need to understand that the future of family medicine is truly bright. You will have autonomy to decide where you practice and what kind of care you provide.
Regarding payment for primary care, we’re seeing a slow but sure change toward more of a primary care-focused health care system. Family physicians are really going to thrive in that environment.
AAFP News: Any final thoughts?
Hoffman: I’m so incredibly grateful for the AAFP. They have played such a pivotal role in my medical education, and I can’t envision my future in my family medicine career without the AAFP. This is where I found my home, purpose and voice within a specialty.
Mathis: Family medicine has never been a specialty that fit in a box or mold. We have always driven to break out of any constraints that have been put on us. The future of family medicine is dependent on us continuing to stretch the bounds and push against anything that would constrain us to just doing one thing. The beauty of family medicine is we’re rule breakers. We make the rules of the game we want to play. And that’s how we’re going to continue to be successful, by continuing to support our members who are redefining what it means to be a family physician.