| Health equity, social determinants of health, and structural racism | Health inequities exist when health outcomes differ between populations, including factors such as race or ethnicity, gender, sexual identity, age, disability, socioeconomic status, and geographic location.1 Unequal care across race and other factors has long been recognized in the United States, and manifests in differences in access, care process, and outcomes;2 COVID-19 provides another example. Social determinants of health include economic status, education access and quality, health care access and quality, neighborhood and built environment, social isolation, and community context.3 Structural racism in health care includes differential access and financing of care and extends to specific clinical knowledge based on a false assumption of racial genetic differences, such as in pulmonary function tests (PFT), estimated glomular filtration rate (GFR), or pain tolerance.4
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| Value-based care and population health | The US health care system is the most costly in the world. Value-based care is a “health care delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes.”5 Promised for many years, it is becoming more common in many marketplaces. Potential assessment topics: empanelment, principles of population health, evidence-based performance measures and patient centered outcomes, team-based care and the role of primary care, health systems and payers in improving outcomes.6
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| Integrated behavioral health, including adolescent suicide | Integration of behavioral and physical health improves outcomes; the new standards for residency training will require it. Before pandemic, 7% of adolescents had a depression diagnosis, 13% had anxiety, and 19% of high schoolers had considered suicide7. Post pandemic, the proportion of mental health-related emergency department visits among adolescents increased 31% in 2020 compared with 2019.8
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| Multimorbidity | Multimorbidity is the co-occurrence of 2 or more chronic conditions.9 Older adults with multimorbidity utilize 2-5 times more physician appointments than patients without multiple conditions.10 Overall, multimorbidity causes the majority of mortality, morbidity, and cost in the United States. Over the last generation, there has been a rapid and accelerating rate of multimorbidity. According to the 2018 National Health Interview Survey, nearly 30% of US adults have multiple chronic conditions. Prevalence has grown from 21.8% in 2001 to 27.2% in 2018.11
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| Opioids, addiction, and pain management | An estimated 10.1 million people in the United States misused opioids in 201912, and nearly 100,000 people died from opioid overdoses in 2020. From March 2020 to March 2021, overdose deaths across the country increased nearly 30%.13
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| Embracing technology (POCUS, genomics, artificial intelligence/machine learning) | Point-of-care ultrasound can improve care and be learned by family physicians14; the new ACGME standards highlight point-of-care ultrasound (POCUS) training. Genomic medicine uses individual genomic information in clinical care and addresses the health outcomes and policy implications of that clinical use.”15 The rapid spread of AI/machine learning presents opportunities for deeper knowledge use by physicians.
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| Obesity, including nutrition and inactivity | Between 1999 and 2018, US prevalence of obesity increased from 30.5% to 42.4%, and morbid obesity increased from 4.7% to 9.2%. Obesity increases risk of heart disease, stroke, type 2 diabetes, and certain types of cancer.16 The US Preventive Services Task Force (USPSTF) recommends that physicians promote behavioral interventions such as physical activity as the primary focus of effective interventions for weight loss in adults.17
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