Family Medicine Revolution (of Peace)

by Jay W. Lee, MD, MPH, FAAFP
Originally published in the California Family Physician, Spring 2024

“Rev·o·lu·tion (noun): a forcible overthrow of a government or social order, in favor of a new system”

So you’ve been using the #FMRevolution hashtag since 2011, now what? Lest you envisioned a bloody, violent affair back then, the Family Medicine Revolution has neither been bloody nor violent. Rather, it’s been a steady, deliberate force that has bent the arc of the healthcare landscape towards a foundation of family medicine.

Here are several important accomplishments of note over the past 13 years:

5000+ available family medicine residency positions(i) in 2023 (compared with 3000+ in 2013)
Advancement of prospective, value-based primary care payments models
- Including G2211 add-on code(ii) which adds $16.05/visit in 2024 rewarding continuous care of complex patients
Ongoing advocacy focus on reducing administrative burden(iii)
In California, we are approaching nearly universal health care with continued expansion of full-scope Medi-Cal(iv) for all ages with the recent addition of those who are 26-49 years old
Thousands of social media posts using the #FMRevolution hashtag to tell the story of family medicine, inspiring hundreds of residency applicants(v) many of whom proudly post their headshots emblazoned with #FMRevolution

“Peace (noun): an equilibrium; the absence of conflict or strife”

Alas, Family Medicine Revolution is one aimed at achieving peace. In my mind’s eye, it’s the kind of peace that allows us to become the physicians we wrote about in our personal statements, unencumbered by the tyranny of urgency infusing the modern medical-industrial complex, where we can focus on doing our best to do what is right for our patients. It may be the kind of peace we will never know in our careers but that doesn’t mean we shouldn’t resist or continue to struggle to achieve it. After all, as George Bernard Shaw once wrote: “Revolutions have never lightened the burden of tyranny, they have only shifted it to another shoulder.”

So we need to find ways to accelerate the changes:

We celebrate the 5000+ available family medicine residency positions but we are not satisfied because it’s still not enough to bridge the widening primary care workforce gap(iv)
Even with the advancement of prospective, value-based primary care payment models, our nation spends <$0.05 of each healthcare dollar on primary care(vii)
While there is promise in emerging technologies like AI+machine learning, family physicians still experience high amounts of administrative burden due to prior authorizations, quality and performance management, medical supply coverage requirements, and medical record documentation(viii)
Although uninsurance rates are historically low(ix) in California, lack of insurance disproportionately impacts people of color and those who are poor and/or live in rural areas
In spite of the enthusiasm (and wisdom) of those who choose family medicine as their medical specialty, there are real microeconomic and systems-based reasons why more students are not choosing family medicine(x)

Suffice it to say, we have deep, existential challenges ahead for family medicine, especially as we struggle to escape the gravitational pull of the pandemic. Let’s take whatever tailwind comes. Now is the time to revisit our spirit of resistance so that we may better achieve the peace to make health primary for the patients and communities we serve. As Lewis Lapham wrote: “No country can preserve its political liberties unless its rulers know that their people preserve the spirit of resistance.”(xi) And let’s endeavor to take on the headwinds together with the long term goal in mind: everyone deserves a family physician who practices medicine that is first-contact, continuous, comprehensive, and coordinated. ¡Viva the Family Medicine Revolution!

i https://www.aafp.org/students-residents/residency-program-directors/national-resident-matching-program-results.html

ii https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/evaluation-management/G2211-what-it-is-and-how-to-use-it.html#:~:text=G2211%20is%20an%20add%2Don,care%20services%20the%20patient%20needs.

iii https://www.aafp.org/news/blogs/inthetrenches/entry/2024-wins-in-effect.html

iv https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/32424

v https://www.aafp.org/news/blogs/freshperspectives/entry/20220121fpacgme.html

vi https://kffhealthnews.org/news/article/lack-of-primary-care-tipping-point/

vii https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/primary-carescorecard.html

viii https://www.aafp.org/about/policies/all/principles-administrativesimplification.html

ix https://healthpolicy.ucla.edu/our-work/publications/california-achieveslowest-uninsured-rate-ever-2022#:~:text=Summary%3A%20Based%20on%202022%20California,a%20historic%20low%20in%202022.

x https://www.aafp.org/about/policies/all/studentchoice-familymedicine.html

xi https://www.laphamsquarterly.org/revolutions/crowd-control