This past month I had the opportunity to attend the American Academy of Family Physicians (AAFP) 2022 Congress of Delegates (COD) and The Family Medicine Experience, commonly referred to as FMX, in Washington DC. 

One evening I exited my hotel to go to dinner, and about a block away, I came upon a statue of Edmund Burke. Not knowing enough about him, I did my research. Burke was a famous member of the British Parliament, a highly respected philosopher and economist, and considered by many to be “The Father of Conservatism.” He was actually an advocate for the American Colonies, arguing in Parliament against unfair taxation. Thus the statue, I presume. 

Reading about Burke, I discovered the following quote: “People will not look forward to posterity, who never look backward to their ancestors.” It got me thinking about Family Medicine, how we got to where we are, and how important it is that we not forget those who went before us. 

So, a brief history. It was after the Second World War that American Medicine moved toward specialization. So-called general practitioners were looked down upon. Discrimination, especially in the hospital setting, was common. 

In time, however, these generalists banded together and fought for their identity, their professional privileges, and their deserved respect in the house of medicine. 

Thanks to the efforts of many, Family Medicine became recognized as a specialty in 1969. The American Board of Family Medicine was established in 1970, becoming the first specialty to require recertification. Originally the American Academy of General Practitioners, it was renamed the American Academy of Family Physicians in 1971. And today, the AAFP is the second largest specialty association in the country. I recognize, by the way, that our osteopathic brothers and sisters has a similarly rich and important history. 

None of those accomplishments occurred without a fight, without opposition, without amazing leadership. Leaders like Dr. Gayle Stephens, a general practitioner in Wichita, Kansas, who eventually served as Chair of Family Practice at UAB, who referred to Family Medicine as a “counterculture” movement, rising up against the status quo of the day. The consummate Family Doctor, Dr. Lewis Barnett, who practiced in Woodruff, South Carolina, and ultimately served as Chair at the University of Virginia in Charlottesville. And Dr. Jim Jones, still referred to as “The Godfather of Family Medicine” in North Carolina, who practiced in Jacksonville, North Carolina, and went on to develop and chair the Department of Family Medicine at East Carolina in Greenville. Just to name a few. 

We owe them all our gratitude. Without them, and many others, it is likely we Family Physicians of today would have never received the broad training we have enjoyed, the privilege to practice in the hospital – from delivering babies to caring for patients in the intensive care unit – and the respect we have as a specialty in the halls of Congress and in state legislatures across the country. 

And I doubt Direct Primary Care as we know it today would even exist. 

I see so many similarities. DPC has had its own founders, early adopters, and leaders. Think Bliss. Forrest. Another Bliss. Lamberts. Gunther. Farrago. Neuhofel. Edwards. Umbehr. 

Pardon me for leaving out literally dozens of others. They remind me of our Family Medicine predecessors. Visionary. Courageous. Determined to change the status quo. The kind of physicians we all aspire to be. 

And – hold on tight – I suspect those early days of the AAFP resembled our DPC organizations of today, including the DPC Alliance. New. Misunderstood by many. Swimming against the current. Trying so hard to gain footing, recognition, and respect. Committed to change. 

Now, I realize some of my DPC colleagues have been frustrated and impatient with “organized medicine.” like the AAFP, and maybe their own state academy. (The discontent with the American Board of Family Medicine might be an entirely separate discussion!) 

I have heard the protests. Why can’t the Academy promote DPC more? Why is it taking so long? Shouldn’t DPC be a priority of the Academy? Why should I even remain a member? 

I get it. Dues require money, and money can be tight in a small, growing, independent business. It is easy to become cynical of “organized medicine.” We have all waited so long for real change. Progress seems slow. Progress is indeed slow. 

I understand our impatience. We strongly want to attract many more Family Physicians to DPC. We have lived it. We know it works. We know it saves careers. We believe DPC is “the way it should be.” I totally agree. 

Nevertheless, I was reminded in D.C. of not only the history of Family Medicine, and those ancestors who got us here, but how prominent a role DPC now has in the AAFP, and how much attention DPC does get, despite less than 5% of membership being in the DPC world. 

In his opening remarks to the 2022 COD, the CEO and Executive Vice President of the AAFP, Mr. Shawn Martin, addressed a number of issues of concern to Family Physicians today. The most important, he shared, was “administrative burden.” He then specifically mentioned DPC (yes, DPC!) as a viable option for Family Physicians seeking a more satisfying career. He did not have to. But he did. 

At COD, there were DPC physicians in attendance as Delegates, Alternative Delegates, Chapter Presidents, President-Elects, among other roles. Dr. Teresa Lovins, a DPC physician from Indiana, was re-elected to the AAFP Board of Directors. 

DPC is indeed represented in the AAFP. We have a growing presence. We have a voice. 

And we have support. The AAFP has done much. Financially enabling and promoting the DPC Summit. Devoting staff to DPC (Thank you Bethany!). Supporting a member interest group (MIG). Developing a DPC toolkit. Including DPC in its CME programs. 

All this, when many AAFP members care little or none about DPC at this moment, even those who should. Some would prefer to debate climate change and reproductive rights rather the neck-strangling administrative burden addressed by their own EVP/CEO. 

Yes, we have work to do. But I see progress. 

Our voice is being heard. Just recently I had a most poignant conversation with a now-retired Family Physician, still one of the most influential leaders in the AAFP. This physician told me that if he were to re-enter the practice of medicine, he would do so as a DPC doctor. I considered this a compliment to all of us in DPC. An affirmation of the model. What we have been saying all along. 

I want to be optimistic about Direct Primary Care going forward. Like you, I am convinced it is the best future for primary care. It will save careers. It will extend careers. It will enable better patient care. It will lower costs. And it will restore the doctor-patient relationship. 

To get to that future, we need to remember our past. That gives us perspective. It grounds us. It reminds us that we in DPC are not the first to fight for what we believe. Our predecessors and our associations did the same. It’s in our blood. Our DNA. 

One day, our own valued organizations, like the DPC Alliance, might even seem out of step and not moving fast enough! History does seem to repeat itself. 

So here we are. 

A time for us to remember how we got here. A time for us as both Family Physicians and DPC Physicians to understand that we are standing on second base, but we did not hit a double all by ourselves. A time for us to say thank you. A time for gratitude. A time to embrace our past, and remember it, as we pave a new path. With those who share our values, and are looking for the same future. 

Edmund Burke, a defender of the Colonies, stands tall in DC to remind us!