What I Want Family Medicine to Look Like in 2026

This blog post is a finalist in the STFM Blog Competition.

unnamed

Stephen Carek, MD

It is the year 2026, “Triple Aim Hits the Bullseye: Health Care System Rises in Access and Quality While Lowering Costs” flashes across the screen of a daily new show. In this moment of reflection, I take the time to remember where the American health care system was 10 years prior and view the current landscape of healthcare with optimism. It had been a long, arduous battle, but after years of reform, cooperation, and evolution, the United States health care mega-complex had undergone such tremendous reform that the world no longer viewed the US as a model of big spending and inefficiencies, but as a model of reform and innovation.

But why? What had become of the system fraud with inequities, corruption, overspending, and compromised patient care? It was no more, thanks to an established network of primary care physicians who took a corrupt model of healthcare, flipped it upside down and created a system that no longer served the interests of insurance companies, hospital systems, pharmaceutical companies, and bureaucracies.  

Family medicine changed everything. The collective momentum of insightful minds who put the system in a new perspective and created a model of healthcare where patients’ interests and well-being were prioritized through a system of primary care physicians and preventive care models that promoted well-being.

Why Family medicine? Why was this the specialty that pushed itself to the forefront in a sea of confusion and uncertainty?

Because we offer a perspective unlike any other, caring for all patients, regardless of age, gender, ethnicity, income, or education.

Because our relationships with patients are like no other. Just as much as we may impact our patient’s lives, they impact ours.  

Because we introduced the model of shared decision making, allowing patients a vested interest in their own care, simplifying communication and tailoring decisions on the wants and needs of our patients.

Because we created quality metrics that were meaningful and improved outcomes, allowing for a greater understanding of our community at an individual level and in the frame of an entire population.

Because we expanded the concept of the ‘end of life’ discussion with our patients and their families in our clinical environment, building on a relationship of trust and care to prevent pain and uncertainty for the patient and their family, creating peace and closure when the time comes.

Because we continued to improve medical education, training world-class students and residents to pursue the challenge of healthcare reform to serve as advocates for our patients and the needs of all physicians.

Because we built a system that utilized novel technologies through virtual care, internet based communications and social media to connect with patients in ways that had never been seen. Increasing access and strengthening relationships.

Because we provided clarity and leadership in the age of ‘alphabet soup’ of healthcare reform, the age of the ACA, ACO, HMO, and MACRA, and created modern models for delivery of care that put the patient first.

Because we reached out to those who needed care the most, giving everyone in this country a chance to pursue their American dream and live a happy, healthy life.

Family medicine became the foundation for healthcare innovation and improvement in the 21st century. Not only did we revolutionize healthcare, but together, we saved it.

Innovating Connections in Family Medicine

brian-picture

Brian Champagne, MD

This blog post is a finalist in the STFM Blog Competition.

Two years ago I chose family medicine not only to develop a diverse skill set and knowledge to handle almost any patient concern, but also to build a connection with numerous patients of different ages to learn from them as they learn from me.  

Fast-forward to now, I’m in the depths of a busy clinic, stabilizing a crying baby’s ear and desperately searching for a reflective hue amid a narrow tunnel of earwax. I’m not finding it.  I glimpse for 2 seconds before the child’s war cries rattle my own tympanic membranes and I abort the mission. On my third try, I hit the jackpot and visualize a reflective drum. My job is done. I instill some confidence in the mom that her baby will do fine without a goodie bag of antibiotics. We share a bonding laugh at the absurdity of spending over an hour out of her day for a one-second examination with a magnifying glass.

I scamper to my computer and slam in some orders for vaccines, glance at my schedule, and then briskly walk to the next room down the hall. Behind the door is a 70-year-old woman seated in the infamous tripod pose, hunched over with retracting neck muscles, swollen legs and appearing worried. She was discharged just 2 weeks ago for heart failure. I examine her and order 40mg of IV Lasix. A half of an hour later she’s still retracting. I kneel to tell her she’s going to get through this and she nods appreciatively, hoping I’m right. I send her to the hospital for more diuretics as I tap on the door of my next patient.

It’s a wiry 60-year-old man who describes brief spouts of right upper quadrant pain so severe that he swears it’s worse than childbirth. I examine him and explain the possibility of a problem in his liver or gallbladder. After ordering some labs and a right upper quadrant ultrasound, he thanks me for my care.  Days later, my suspicion is confirmed. Gallstones are present and off to surgery he goes.  

While I enjoy these hectic days and the meaningful connections I find through them, I also understand that in 10 years, my family medicine clinic will likely run differently.   

For the screaming baby with possible otitis media, if mom had sent in photos of her baby’s eardrum with a smartphone, perhaps a 10-minute video call would have provided all information that supportive care is appropriate.  

For the 70-year-old woman with persistent CHF exacerbations, perhaps if she were plugged into a system of communicating nurses trained in heart failure management, maybe she wouldn’t be in need of another hospitalization.  

For the 60-year-old man with right upper quadrant pain, if a quick bedside ultrasound by the physician were possible, perhaps he could have been referred to surgery that day.  

With small improvements in patient care, we have the opportunity to develop a more efficient and inexpensive health care system with better health outcomes.  While I delight in new technology that enhances our care for patients, some aspects of family medicine won’t change. Technology won’t change the reassuring words we can offer to a worried parent or acutely ill patient. It won’t alter the power of our receptive ears being present for a scared patient. And it definitely won’t replace the wisdom, laughs, perspectives, and connections we encounter with our patients each day. And that’s good thing.  

The Role International Medical Schools Play in Addressing America’s Primary Care Needs

heidi_chumley_march-2016

Heidi Chumley, MD

This year, the American Academy of Family Physicians’ report on the ACGME Family Medicine Match goes further than any of its previous 34 editions by acknowledging the existence of international medical schools, which collectively are a major contributor to the primary care workforce of the United States.

How big is the contribution? The report doesn’t tell us, though its purpose, according to its authors, is to help medical schools understand how well they are doing their part in contributing to the primary care workforce and guide strategies for further development. There is much to learn from international medical schools, particularly those that primarily educate and train students originating from the US to return to it for residency and practice.

International medical schools provide the ballast for a primary care workforce that desperately needs it. This year, Ross University School of Medicine, St. George’s University School of Medicine, and American University of the Caribbean School of Medicine (where I serve as executive dean) accounted for about 15% of all new family medicine residents in the United States. That’s not a passing comment in the US family medicine workforce story—that’s a major theme. And it’s a consistent theme: about 30% of the graduates in AUC’s history are practicing in family medicine.

International schools vary in size, and among the three mentioned above, AUC is the smallest. In 2015, 62 (28%) of our graduates entered family medicine residencies, a higher number and percentage than any US allopathic school reviewed in the report. For perspective, the 13 public and private schools in New York had 83, the six University of California system schools totaled 75, the four University of Texas schools had 70, and all seven medical schools in Florida combined for only 44.

Meanwhile family medicine advocates continue to worry over how to get more students into US medical schools instead of supporting the international schools that continue to produce family physicians. Two very powerful myths cloud the discussion about family medicine as a discipline and schools like mine as a separate issue. The first myth is the outdated notion that a US allopathic graduate is somehow better than an IMG. The second myth is actually a fantasy: the idea that US MD schools will somehow get better at producing family physicians. The evidence just doesn’t bear that out.

We all know of remarkable initiatives underway at some schools, but consider the US MD institution (AAMC, LCME, etc) as a whole. If there was real concern about family physicians, at a minimum new medical schools would be required to produce them, but it’s not happening. Last year the newer medical schools contributed very few family physicians. University of Central Florida, Florida Atlantic University, and Florida International University combined for only seven family medicine residents. Oakland in Michigan had just two, Texas Tech University Paul L. Foster five, and Virginia Tech Carillon three—while Hofstra had none. The best result I see is USC-Greenville notching six family medicine residents, which puts them at 8.5% and therefore at least close to the US average of 8.7%.

Schools like AUC want to be part of the solution when it comes to creating and nurturing a family medicine workforce that meets the country’s needs. Given that commitment and the desire of the vast majority of our students and graduates to practice in the US, there are numerous actions the family medicine community can take to support our participation and continued contribution:

  • Host sessions at your major educational meetings to increase the awareness of and understanding of international medical schools.
  • Allow medical students at international schools to be regular student members of your organizations. If you can’t go that far, at least allow US citizens attending international medical schools to join as regular student members.
  • Voice opposition to the practice of residency programs using percentage of US MD graduates who are residents as a quality measure.
  • Ask hard questions about social accountability of family medicine residency programs who will not consider international graduates who came from the underserved parts of their states and plan to return there to practice.
  • Encourage and support studies that look not only at the attributes of US allopathic schools but also at the attributes of international medical schools associated with higher percentages of graduates choosing family medicine.
  • Advocate for all loan repayment programs to extend eligibility to international graduates.
  • Help educate family physicians in your pre-med mentorships and shadowing programs to encourage students who are not admitted to US medical schools to consider an international school with a proven track record in producing family physicians.

There is much work to do to ensure that the US has an adequate supply of family physicians to make progress on the triple aim. It is time to be working together.