Family medicine in the United States faces major challenges related to the discipline’s future viability in its current form, despite convincing evidence of its crucial role in preventing illness and untimely death, and assuring more equitable distribution of health.1 Efforts to sustain and invigorate the discipline over the years have largely failed.2,3 To address these challenges, in 2021 NASEM commissioned a committee to make recommendations to “rebuild the foundation of healthcare.”4 Two subsequent reports found little progress in improving primary care.5,6 The report released February 2024 demonstrates disturbing trends seen in Table 1.6
Trends in Primary Care, 2024
The Association of Departments of Family Medicine (ADFM) identified and planned its 2024 meeting to focus members’ attention on the existential threats to family medicine and consider responses to ongoing threats. The meeting featured Professor Timothy Hoff, PhD, Professor of Management and Healthcare Systems at Northeastern University as the keynote speaker. Dr. Hoff’s 2022 book, Searching for the Family Doctor: Primary Care on the Brink was the starting point for his call to action, asking department of family medicine leaders to respond to the current crisis with new and innovative strategies to improve family medicine’s viability as a medical specialty, based on pursuing specific key areas to reinvigorate the discipline.7
In order to enhance collective innovation and discovery among our conference participants, we organized 4 facilitated discussion groups to address 4 key areas in a “hackathon” style brainstorming format.
Key Areas
Relational Medicine/Partnership Building With Patients. This group discussed enhancing and reimagining the doctor-patient relationship in a changing primary care delivery system, including the patient as a key team member involved in making health care decisions.
Digital Health Immersion. This group brainstormed how family medicine could embrace digital tools and technology to enhance relational care and clinical practice.
Advocacy for FM Within the Workplace. This group brainstormed the question of how we can more effectively advocate for family medicine both within the workplace and for family physicians as salaried employees, as more find themselves in this situation.
Career Sustainability/Wellness. This group brainstormed how to ensure career sustainability for family doctors in a way that guarantees a robustly satisfied family medicine workforce.
We used a nominal group technique process for the mini-hackathon, which included several stages: (a) idea generation, (b) group voting on ideas; (c) ranking of ideas; and (d) discussion of rankings. Throughout these stages, facilitators guided participants in focusing on key questions of “Through the specialty training, clinical practices, and research what does family medicine do now to address a specific topic” (eg, relational medicine) and “What isn’t it currently doing that it should?”
The nominal group process yielded the following consensus-based action items for each of the 4 strategic areas discussed.
Relational Medicine/Partnership Building With Patients
Build trust by improving convenience and access and organize clinical services to meet patient needs and expectations.
Define the terms of the relationship and resource it appropriately. Build support and appropriate reimbursement of care and clinical expectations which allow the establishment and growth of the interpersonal connection.
Help patients understand and residents believe in the identity and ability of family medicine and the meaning and value of relationship, and how they prefer to connect and teach boundaries and limits.
Digital Health Immersion (Artificial Intelligence/Machine Learning)
Develop and use a chatbot with patients to collect history before patient appointments, enabling more efficient and effective visits.
Develop a panel management digital tool that can locate, identify, and contact patients who are falling through the cracks and in need of follow-up.
Improve electronic medical record (EMR) functionality to respond to ongoing patient requests with AI/ML facilitated inbox management.
Advocacy for Family Medicine Within the Workplace
Universal value proposition—partnering and speaking as one “primary care voice” (defined as family medicine, general internal medicine, geriatrics, general pediatrics)
Consistency in reporting and data usage—obtain reliable, actionable data that can then be used to show the value of family medicine
Collaborate with other departments and professions to advocate for positive change and necessary resources
Career Sustainability/Wellness
Leverage technology to demonstrate career flexibility
“This is what a family doc looks like” through social media (showing all the opportunities, values, relationships components, choosing your own path, flexibility)
Moving Forward: Urgency, Speed, and Enabling Conditions
Several of the themes identified were seen as crucial and will be challenging to implement given the changing landscape. Taking the example of digital health immersion, there was strong consensus that family medicine must develop and use digital tools more effectively to manage EHR information overload, identifying and connecting with hard-to-reach patients, and integrating artificial intelligence tools like chatbots to assist with pre-visit planning and patient care. Participants recognize that slow adoption of digital tools will not meaningfully improve practice at the rate needed to recruit and retain additional practicing family physicians. We need collective focus on digital adaptation and implementation with rapid testing, dissemination, and building on successful practices. For departments of family medicine specifically, this implies moving quickly over the next few years to incorporate digital health tools meaningfully into training, research, and practice, acknowledging these tools as an enhancer of family medicine work. For the other strategic foci involving advocacy, career sustainability, and relationship building, similar imperatives were discussed around implementation speed and quick adoption. Participants recognize that the very survival of family medicine depends on the field exhibiting a robust capacity to experiment and embrace change, even if there is uncertainty in how that change may ultimately play out.
At the meeting, participants also discussed several enabling conditions required to move these areas of innovation forward. Again, using digital health immersion only as one example, this means encouraging departments of family medicine to frame digital tools and technology such as artificial intelligence as a net positive for patient care, and for improving the work lives of family doctors. We also need to know and implement an appropriate panel size for family physicians taking into account patient complexity and implementation of digital tools to assist with delivering primary and secondary prevention measures. Newer family physicians need organizational support and everyday capacity to test and integrate digital tools and family medicine researchers and clinicians need to collaborate in real time to describe, measure, and define the benefits of such tools. For digital immersion and the other innovation areas identified here, we also as a discipline need to develop and promote a pro-innovation mindset across the traditional mission areas of clinical practice, education, and research. Innovation for our specialty must consume a significant portion of everyone’s energy in family medicine for at least the next decade.
Given that family medicine is one component of increasingly competitive and integrated health systems, we are no longer functionally an independent discipline; we cannot accomplish these goals by merely working within our academic departments. We need to work within and across our respective health systems and other entities to shape improvements in primary care practice, with a focus on high quality and equitable health care delivery. We need to join our voices and influence to ensure that innovation in areas such as digital health, relational medicine, career sustainability, and workplace advocacy is prioritized across our academic health centers, collaborating with and influencing larger systems. We need to ensure that the innovation priorities associated with making primary care better and family medicine survive appear at the top of every health system’s list of priorities. Broad institutional and multi-stakeholder support is critical for implementing these and other ideas that will ensure future viability of our specialty.
- © 2024 Annals of Family Medicine, Inc.
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