Why family medicine for you?
I discovered family medicine in 1975 as a first-year medical student at UC San Diego. I recall my excitement that there was actually an allopathic specialty that was “holistic,” one that appreciated the importance of caring for the whole person, mind-body and spirit. This was the natural outflow from my premed experiences at Notre Dame, where I began transcendental meditation, which led me to study the science of the mind-body-spirit connection. While I loved biology and science, I elected to minor in theology. So, family medicine has always been fundamental because we are the most grounded specialty in the “biopsychosocial model.”
Who were the role models who inspired you to go into family medicine?
My father was my earliest role model. He was a general internist in Sunnyvale. I recall making hospital rounds with him and being struck by the sense that being a personal physician was such a noble way to serve others. While I “knew” by elementary school I wanted to be a physician, at times in early adolescence I thought I should become a priest. Ironically, it was Father Glass, a mentor when I was a teenager, who told me he thought my calling was actually medicine. I see those elements of sacred calling at times as a family physician still.
What piqued your interest in becoming active with your county and state AFP chapters?
I connected with the San Diego Chapter when I was in medical school at UCSD. They hosted a dinner for medical students … with dancing. I was so happy to be amongst physicians who seemed to “get it,” I knew then that this was “my tribe,” “my family.” Later, in Santa Rosa when I was CEO of Primary Care Associates of the Redwood Empire, a multi-specialty group of mostly great FPs (about 30 of us out of 70), I was blessed to practice with Bo Greaves (CAFP President in 2006) and Mary Frank (CAFP President in 1992 and AAFP President in 2002), who both encouraged my Academy engagement.
I have enjoyed a progressive involvement with CAFP the past 15 years as my other professional responsibilities permitted. My term as Sonoma chapter president, 2006-2012, taught me a lot. During that time, we grew our relationship with the Santa Rosa Family Medicine Residency, established a chapter board of directors, a formal budget with dues, and enhanced our member education and advocacy programs. I learned a lot about other chapters, merging in 2011 with the Marin chapter to become the North Bay Chapter, thanks in part to the leadership of the then CAFP District Director, Irina deFischer and Panna Lossy who remains the North Bay Chapter president, (my bias, but I believe … one of our most dynamic state chapters.)
Is now the best time ever to be a family physician, in your estimation?
Great question. It’s a hard time for many, with higher rates of burnout and huge medical school debt. I think if we get to the system issues that obstruct many FPs from having sustainable joy in practice, truly this could be the best time to be a family physician. I do believe that for some, it is a good time, and that the future could be even better. Family physicians continue to be the most sought-after specialty; compensation and benefits continue to rise faster than most other specialties; technology, while often complained about, actually promises to make family medicine more effective and interesting than ever.
As an AAFP Residency Consultant, I also get to visit many programs around the country. Seeing the tremendous growth of residencies, which has gone from 400 to 620 in the past decade gives me great optimism.
What are the most important challenges confronting CAFP?
Staying relevant. Adapting to the changes in members’ diverse needs. What rural physicians need in their first years of practice is different from a UC faculty, a senior medical director, large medical group or one in direct patient care practice.
What has been the best part of being an officer in CAFP so far?
Comradery, continuous education in the dialogues our board has about the state of affairs and learning how to more skillfully advocate for health equity and social justice. The latter has shown me that the power and privilege we have as physicians can be uniquely effective influencing health care policy that directly affects the quality of the care our patients receive.
How do you balance your family life … two grown kids, and a new grandbaby on the way, a full-time practice, teaching and your volunteer work with CAFP?
Honestly, I’m not a good example… but I constantly strive for it. I have taught a faculty development workshop, “Finding Balance in a Medical Life,” inspired by a now deceased dear friend, Lee Lipsenthal (highly recommend Lee’s books “Finding Balance in a Medical Life” and “Enjoy Every Sandwich”). We mention a famous quote, “You will soon understand that work is a rubber ball. If you drop it, it will bounce back. But the other four balls – family, health, friends and spirit – are made of glass. If you drop one of these, they will be irrevocably scuffed, marked, nicked, damaged or even shattered. They will never be the same. You must understand that and strive for balance in your life.”
How do you maintain what former President Jay Lee calls “the joy” of family medicine?
That’s easy. I rarely do anything that I don’t love doing. When you find “work” you love you never “work” another day of your life — I’m there. I get to teach residents and medical students every day, see patients, do geriatric consultations, and more. I’m truly blessed. In addition, I meditate for one to two hours each day and exercise most days, practicing a pretty healthy lifestyle as well as being mindful of the aforementioned ball juggling priorities.
What do you see as the best ways CAFP can help its members maintain the joy?
CAFP is already doing a lot. The March Clinical Forum had several session addressing wellness and we’ll continue to work with the AAFP to enhance support of our members. My incoming president address in March focused on our three-year strategic plan – practice transformation, payment reform and pipeline as they relate to addressing the need to improve joy in practice. In the end, this fourth aim of the Quadruple Aim may be the most important purpose for our Academy.
Where will family medicine be in 10 years and what role will CAFP have played in it?
If my car can now drive itself, even be summoned on my iPhone app, then I can’t imagine how fun the future of family medicine leveraged by the augmentation age could be! I imagine handheld point of care ultrasound at the bedside, video/FaceTime visits to patients’ homes, interactive sessions with patients using artificial intelligence, advanced genomics. As information integration matures it will be amazing what FPs have at their fingertips, like point of care evidence-based guidelines at the bedside or electronic records that are as seamless and effortless extensions of ourselves as many of the smartphone apps that we now take for granted.
I see CAFP playing the role it always has, providing members with state-of-the-art professional development to better embrace the future, advocating with our lawmakers to ensure that technology and innovations affecting FPs supports our members and closely engaging with members to invent the best possible future of family medicine imaginable.
What’s your message to the next generation of FPs – what will sustain them?
If you're calling is to be a family physician, the future will be bright. Learn and practice resiliency, learn and use performance improvement science to re-engineer the systems that impair your ability to sustain joy in practice and read the book “Grit” by Angela Duckworth!
Finally, what one thing should CAFP members know about you?
I want members to know I would treasure them reaching out to me and telling me how I can serve them, personally, as president. A phone call (cell 707-494-0070), text, email (firstname.lastname@example.org) anytime of the day/night/weekend is welcomed, about ANY concern that I can help tackle.
I get energized working with other FPs. I’d like to be at member chapter meetings, visit offices, or come wherever it’s useful. I’d like to personally know how to support our entire California family of family physician practices – rural, suburban/urban, safety net, academic, direct patient care or solo to large group.