June 10, 2022, 10:50 a.m. — On this day 75 years ago, our professional forerunners founded the specialty society that would become the AAFP. The American Academy of General Practice first met inside the (still standing) Claridge Hotel in Atlantic City, N.J., concurrent with an AMA gathering.
Today, I’m writing you to mark the beginning of our diamond jubilee year, a milestone anniversary made even more brilliant by the prospect of celebrating our unique, powerful history in person come September’s FMX.
There’s a lot to look back on. Our Academy’s formation and rapid growth coincided with the country’s postwar baby boom and prosperity, factors that in turn drove our specialty’s evolution from general practice to family medicine. Guiding and smoothing that progression was the Academy: its advocacy, its influence, its clinical authority.
When I reflect on all of this, I see a living history, an arc on which I proudly stand alongside my peers and within sight of my own ancestors.
My grandfather was a physician whose version of primary care included stints as a schoolteacher and then a principal, both preceding his time practicing medicine and working in public health. And my dad, who died in 1990, would have told you he was a “country doctor,” which meant he did everything from house calls to nursing home check-ins to sideline work at the high school to working as the local medical examiner. All of this in addition to his seeing patients in his busy office practice. In our own way, then, my family has lived the AAFP’s journey. We’ve practiced primary care over the very decades when family medicine became the country’s indispensable specialty.
My dad also was active in our state and local medical societies, where he advocated for his patients, his chosen profession and his peers. Being able to see the respect he was given by our community made the value of volunteer activism apparent to me at a young age and was a keystone of my childhood lessons. Because my parents thought I’d get something out of it, I worked as a page in the Virginia General Assembly when I was a kid. There, I was able to see how laws and policy were made, which is to say I learned that getting things done is often not pretty.
That lesson, too, still resonates with me, amplified by the force and constancy of the Academy’s advocacy, and by the fact that this advocacy isn’t a faceless monolith but is instead a vivid reflection of AAFP members. It’s you and it’s me. It’s all of us.
But I confess that it wasn’t always me, and that’s part of why I want to make a big deal out of this anniversary. My place on the AAFP’s historic arc has shifted over time, as I suspect yours has, too.
I joined the AAFP as a first-year medical student, in 1988, for one reason: the quality of American Family Physician articles. Throughout my four years in medical school and then three years in residency, this was my main interface with the Academy. I used its research every day in my clinical experience. I was not a person who went to meetings, and I wasn’t especially outspoken regarding policy matters. I was just trying to become the best family physician I could so I could serve my community.
When I was third-year chief resident, though, I went to a chief residents’ meeting and found myself invigorated. I met a lot of other family physicians in the same boat as me, people getting ready to face the big wide world and in need of networking experience as we learned to establish our practices. The Academy was there for us as we made this leap, illuminating the path.
Then I pivoted again in how I “used” the AAFP. I still valued the research, and I’d embraced the professional connectivity. Then came a phone call.
About five years into my practice, my local pharmacist phoned me to say that the insurance a patient of mine had wouldn’t accept a prescription I’d written. And this turned out not to be about prior authorization. He said, “They won’t fill it because you’re a family physician. They will only do it for a ‘specialist.’” The insurer wanted my patient to take another day off from work, drive two counties over and see a specialist, who would spend three minutes with the patient, look at my workup, write the prescription and send the patient on their way.
This was grossly unfair, and eventually I found myself writing a resolution for the Medical Society of Virginia House of Delegates, then standing in front of a reference committee and telling my story, and then hearing other people echo it with their own frustrations. My resolution was combined with another, passed several votes, then became policy. It took a couple of years, but the insurance company changed course because of this action.
As a lone physician, I hadn’t been able to clear systemic obstacles for my patients. As part of a group of like-minded physicians, though, I now understood that much more was possible. I got to know my state academy and realized the benefits of organized advocacy by family physicians to make our system better. Eventually I became the chapter’s president, then joined the AAFP’s Commission on Governmental Advocacy, the precursor to our Commission on Federal and State Policy, which cemented for me the intersection between my political engagement and my ability to improve care for my patients. I think about the maxim we attribute to Pericles: “Just because you do not take an interest in politics doesn't mean politics won't take an interest in you.” A greater truth might be that politics too often takes the wrong sort of interest in our patients.
It was during my third year on the commission that the Patient Protection and Affordable Care Act passed. The Academy of course championed that hugely pivotal legislation, and I’m proud of what we brought to the table during its construction, our continued advocacy for its improvement and our work to safeguard the law against the various challenges it has withstood. We’ve waged and won a lot of battles in our 75 years fighting for family medicine. Probably no victory has done more to benefit our patients than this one.
In fact, much of what in recent times has helped improve the quality of health care my patients are able to receive can be attributed to the AAFP — to its staunch advocacy and to its considerable clout on Capitol Hill and in statehouses nationwide. Outside audits have told us that our advocacy generates respect and results in Washington, D.C. And we keep upping our game, getting things done, bringing about the changes we seek. That’s the product of 75 years’ worth of our joined voices, our joint labor, our individual willingness to be active.
I know I’m hardly alone in thinking (and worrying) about a future in which some of our most experienced family physicians leave clinical practice or retire because our health care system burdens more than it elevates. This scenario would be sad for our patients, who would lose out on an enormous collective wisdom they bring, and alarming for a country full of underserved and rural areas already facing primary care shortages. We must do all we can to prevent that shortage from becoming truly severe, work that includes the Academy’s heightened emphasis on physician well-being as well as our robust advocacy toward fortifying the family physician pipeline.
Yet the long history of the AAFP demonstrates that our specialty will persevere — not least because family medicine is the Academy, and the Academy is family medicine. My own history, as I’ve described it here, shows the truth of this. It’s quite a paradox, but the more engaged I have become as an Academy member and an advocate for family medicine, the less in danger of burnout I’ve felt. Our personal and professional resources may be finite, but I have found my AAFP involvement to be not just renewing but energizing. Just last month, for instance, I left our Family Medicine Advocacy Summit electrified by the company of so many excited family physicians eager to improve public policy.
Facilitating these moments is what your Academy has done for 75 years. It’s the center of our mission: Family physicians satisfied in their practices and reinforced by a strong collective will take better care of their communities, benefiting every American.
I believe many of you feel the same way, and I encourage you to share your own AAFP histories as we commemorate our diamond jubilee in the comments under this post or on social media. As we celebrate the AAFP’s illustrious past, let’s also salute our busy, productive, fulfilling present and recognize one another as the core of our endlessly promising future.
Sterling Ransone, M.D., is the president of the AAFP.