In 1988, when I became editor of American Family Physician (AFP), lots of people advised me not to tamper with this well-liked publication. So much so that my incoming editorial was entitled, “If It Ain't Broke, Don't Fix It.”1 But, I promptly set about fixing things. It's hard to imagine now, but at the time AFP's articles did not routinely include reference bibliographies. They didn't routinely undergo peer review. And its editorials were either unsigned or written by a pseudonymous Uncle Wilfred, as in “Uncle Wilfred wonders why….” (I kid you not).
At the end of this month, I'll be stepping down as editor but staying on to support the incoming editor-in-chief, who I hope promptly starts “fixing” things according to her own unique vision. In the meantime, I'll try to paint a picture of my journey with this great publication.
Early on, AFP consisted mainly of review articles that were well-illustrated (a hallmark of AFP from its beginning) and Tips from Other Journals (a popular department that ran brief summaries of articles from other journals). Of course, a lot has changed in the past 30 years. I was the first family physician on the editorial team during AFP's first 30 years of publication (I started as an assistant editor in 1981). I brought on an all-family-physician crew and set about developing what I called the “journalization” of AFP, turning it from a somewhat folksy magazine to a more scholarly, but practical, resource for family physician readers. AFP's mission became providing its readers with clinical information they could use to take better care of their patients.
AFP By Topic collections
AFP Community Blog
AFP Journal Club (ended)
AFP YouTube channel
BMJ's Clinical Evidence Handbook (ended)
Choosing Wisely tables and searchable database
Clinical Pharmacology (ended)
Close-Ups: A Patient's Perspective
Cochrane for Clinicians
Controversies in Family Medicine
Diary from a Week in Practice (ended)
Digital apps (AFP digital edition, AFP By Topic, Photo Quiz)
Evidence-Based Medicine Toolkit
Family Practice International (ended)
FPIN's Clinical Inquiries
FPIN's Help Desk Answers
Graham Center Policy One-Pagers
Healthcare Bluebook: Costs of Tests and Procedures (starting in 2018)
Implementing AHRQ Health Care Reviews
MDCalc collaboration (starting in 2018)
Medicine and Society (ended)
Medicine by the Numbers
Patient Information Handouts
Putting Prevention into Practice
Radiologic Decision-Making (ended)
Resident and Student Voice (ended)
Right Care Alliance collaboration (starting in 2018)
SPARC: New Diagnostic Test Reviews (starting in 2018)
STEPS: New Drug Reviews
What's New tables
In response to the evidence-based medicine (EBM) movement in the 1990s, Dr. Mark Ebell, deputy editor for evidence-based medicine, led a team of editors of family medicine journals to develop a Strength of Recommendation Taxonomy that we all now use.4 We also built an EBM Toolkit.5 With digital publishing, we went from mailing paper copies of manuscripts, to mailing CDs, to sending e-mail attachments, to using our online manuscript submission and peer review program, Editorial Manager.6 To help shape AFP and develop future medical editors, I created a one-year medical editing/faculty development fellowship. I was fortunate to have 15 outstanding fellows over the years, all of whom worked on AFP afterward, some for many years, including three of our current medical editors.2
Starting in 1998, AFP Online has played a vital role not only for all American Academy of Family Physicians (AAFP) members, but also for tens of thousands of other primary care physicians, as well as the tens of millions of people who access our website each year.7 Dr. Kenny Lin, associate deputy editor for AFP Online, has been terrific in overseeing our online resources, including our social media outreach via Twitter8 and Facebook,9 the AFP Community Blog,10 our primary care–oriented Choosing Wisely recommendations,11 AFP digital apps,12 the “Related Content” links that appear for each piece of content, and the popular AFP By Topic collections.13 We instituted a commenting feature so that readers can express their viewpoints about our published content. Readers can sign up for e-mail alerts to our Table of Contents14 and create links to their “Favorite” content.15 Because of limited space in print, we created our first online-only department, Medicine by the Numbers, in collaboration with The NNT Group.16 With leadership from Dr. Steven Brown at the University of Arizona College of Medicine–Phoenix Family Medicine Residency, we now have a highly popular AFP Podcast,17 with more than half a million episode downloads, that is sometimes the number 1 medical podcast on iTunes. We're in the process of adding new clinical videos about medical procedures and examination techniques to our YouTube channel.18 And in the coming months, we'll be launching some new features, including reviews of new diagnostic tests (which ones are worth using?), and content based on collaborations with MDCalc and the Right Care Alliance.
We try to ensure that our 20 years of online content links older articles with newer ones so readers can find the most current version of an article. An important area of growth for AFP would be for us to continuously update our online content, providing the most current evidence and recommendations whenever readers search AFP Online.
AFP wouldn't be the best-read journal in primary care if it weren't for its outstanding team of medical and professional editors, most of whom have worked for AFP for many years.19 In fact, our medical editors have 200 cumulative years with AFP, and more than 300 years of medical editor experience, including seven editor-in-chief positions. Our professional editors have 125 cumulative years with AFP and play a central role in making the journal look great and read as amazingly well as it does.
For the past three decades, I have enjoyed wonderful support from the Academy, and I appreciate the editorial independence that necessarily exists between AFP and the AAFP. I'm thankful to scores of those who have helped me in my role as editor over the years, but in particular: Executive Vice Presidents Robert Graham and Doug Henley; Publishers Clayton Hasser, Joetta Melton, and Stephanie Hanaway; Managing and Executive Editors Mary Knickerbocker, Sharon Scott Morey, Janis Wright, and Joyce Merriman; Editorial Assistants and Coordinators Cathy Bell, Taiya Olayinka, Lindsey Clark, Mindy Saraco, Sarah Johnson Katz, Marselle Bredemeyer, Holly Messerschmidt, Jennifer Wilkes, Ashley Langone, and Chris Brower; Production Graphics Manager Stacey Herrmann (AFP wouldn't look as good without her skills); Senior Editor and AFP Online Administrator Matthew Neff (check out the Featured Content on our website); AFP's medical editor executive committee (Drs. Mark Ebell, Kenny Lin, Sumi Sexton, and Caroline Wellbery); Art Coordinator Dave Klemm, who, following his predecessor Peter Stone at Georgetown University's Digital Imaging, Illustration, and Graphics department, coordinates all of AFP's cover art and medical illustrations for articles; and John Molluso and Mickey Cotter (the Jersey Boys—my home state!) who sell the ads that bring in the money that supports this publication. Finally, my utmost thanks to my wife Linda, who supported my lucubrating (look it up—great word) for so many years.
These are just some of the many people behind the scenes dedicated to bringing you this great medical journal. As you can see, it takes a village of multitalented people to put AFP together. In fact, I often feel like Tom Sawyer, needing to paint a very large fence, the canvas of AFP: at first it looks incredibly daunting, but then hundreds of authors, reviewers, and fellow editors line up, all asking for a chance to pitch in and get the job done.
Thank you all for your untiring help over the years, your dedication to excellence, and your highly skilled service in the name of three of the nicest words in the English language: American Family Physician.