Shaping Keystones in a Time of Transformation: ABFM's Efforts to Advance Leadership & Scholarship in Family Medicine

At no time in the history of our specialty have our diplomates faced greater complexity or more rapid transformation of the health care delivery system, nor such incredible uncertainty and dynamism in their future roles within it.¹ In addition to tackling the most complex clinical encounters,² graduates now leave training expected to immediately understand a health system shaped by such towering forces as rapidly increasing consolidation, value-based and alternative payment models, measurement, internecine scope-of-practice battles, disruptive delivery innovations, genomics, big data, artificial intelligence, and machine learning. Furthermore, the pace of health system change seems to be accelerating, as central players—such as Integrated Delivery Systems, Haven, Google, CVS, Optum, and HCA—grow in number, size, and market influence.³

Furthermore, despite unprecedented growth in health workforce and federal ambitions to achieve a Triple Aim,⁴ per capita costs continue to rise, the quality chasm remains unbridged, health equity is further from reality than ever, and gaps in access to primary health care remain.⁵ Patient-centered, transformed, team-based primary care has long been voiced as a solution^6⇓–8 However, primary care providers retain their longstanding outsider status in academic, health system, and policy environments. One certainty in an era of uncertainty is that this traditional outsider status is no longer tenable.⁸ For the sake not only of its existence but also for that of the Triple Aim itself, family physicians must emerge as thought and delivery system leaders in our health system^9,10

Recognizing both the backdrop of change and uncertainty and the new roles demanded of its diplomates, the American Board of Family Medicine (ABFM) anchored its strategic planning on several core principles, which included the following statements:

1. As family physicians, our most fundamental responsibility is to improve health and health care. This is an expression of the professionalism that is the foundation of our specialty and our profession.

2. We are committed to reform American health care and improve health. No matter how we adapt to local challenges and opportunities, our long-term goal is constant: implementing the Triple Aim.

3. Family physicians, as the most widespread of personal physicians and the most adaptable to the wrap-around systems critical to robust primary care, are essential for meaningful improvement in health and health care.

These statements, and the Strategic Priorities that follow, embrace a role for family physicians that exceeds clinical boundaries and demand both leadership and scholarship. As these are high ambitions put forth on behalf of a discipline, ABFM is aware that it cannot alone advance the lifelong learning required for the highest quality primary care nor can they shape the evolution of interprofessional, technology-driven, medical, and graduate medical education or the continuing need for delivery system innovation. Without strong leaders, family medicine cannot sustain its professional values, advance measures that matter for primary care, or drive “communities of solution” required for the achievement of real population health and wellbeing.^11,12 The ABFM therein recognizes the need to support the development of leaders and scholars from within the ranks of its diplomates, to connect these trailblazers to one another, and to engage them across the course of their careers. As such, and in the interest of developing the future leaders and scholars required to advance family medicine, the ABFM continues to build, with intention, a portfolio of leadership and scholarship programs which include the following:

• Pisacano Scholars Leadership Program.

• James Puffer Fellowship at the National Academy of Medicine.

• Visiting Scholars Programs in Lexington, KY and Washington, DC.

• Center for Professionalism & Value and its Fellowship Program.

• The Montegut Scholars Program.

These programs together reflect attempts not to create leaders and scholars in our discipline but rather to identify those with potential, aid their development, galvanize their natural tendencies to drive thought and innovation, and share with the world their achievements. Words limit us to but a brief examination of each program, which follows.

The Pisacano Scholars Leadership Program was created with original ABFM executive director Dr. Nicholas Pisacano's considerable leadership qualities in mind. It is supported by a foundation, the Pisacano Leadership Foundation (PLF). Awardees reflect Dr. Pisacano's strong belief in the importance of the humanities in each physician's education, their interpersonal and empathic skills, and their demonstrated commitment to contributions to the welfare of human beings. Throughout their 4 years in the funded program, scholars participate in career development opportunities, semiannual leadership skills development symposia, educational programs, and mentoring relationships with current leaders in the field of family medicine. Scholars emerge well connected with past PLF scholars, leaders across the discipline, having built leadership skills as well as awareness of the historic context and scope of family medicine. We are truly excited to announce the members of the 2019 Pisacano Scholar class.

To adequately describe the prodigious accomplishments that merited their selection as Pisacano scholars, we would require more pages than are permitted. Instead, we would invite you to get to know them, and the rest of a remarkable cohort of future leaders and current Pisacano scholars, by visiting the PLF online (http://www.pisacano.org/scholars/current.html). We promise that the dose of inspiration alone will be worth your time and that you will leave with a newfound sense of confidence that the future of family medicine is in good hands.

The Puffer Fellowship offers emerging leaders in family medicine the opportunity to work within the National Academies of Sciences, Engineering, and Medicine (NASEM). This honorary membership society for the nation's leading scientists, founded by a congressional charter during the administration of Abraham Lincoln, is strongly positioned to serve as a learning laboratory for future leaders in health and policy and, in the process, to accelerate their career development. In 2011, the ABFM Foundation (ABFM-F) created the James C. Puffer MD/ABFM Fellowship to permit rising stars in the world of family medicine to get involved in the work of NASEM. The past decade has seen considerable growth of family medicine leadership within NASEM, as follows:

• Family physicians more involved than ever in contributing to its seminal reports that guide the future direction of health care.

• The creation of the first ever Primary Care Interest Group in the Fall of 2018 at NASEM.

• The launch of a consensus study on “High Performing Primary Care,” built on a groundswell of enthusiasm and $1.5 million in fundraising from federal and private sources.

• The influence of Pisacano and Puffer Fellowship on each of these efforts.

We invite you to read more about the fellowship, the competitive application process, and the recently announced ninth Puffer Fellow, Dr. Lars Peterson, MD, PhD, who is already known for his profound impact on scholarship that informs and influences our discipline and is the author of over 100 peer-reviewed publications that have shaped thinking about scope of practice and future characteristics of our discipline.

The Visiting Scholars Programs at ABFM offer future leaders of all ages and stages of training the opportunity to learn about the ABFM and conduct research over a 2- to 4-week period with ABFM's Research Department in Lexington, KY and/or the Center for Professionalism and Value in Health Care in Washington, DC. Scholars work directly with ABFM staff on original research projects that align with their own interests and support the mission and goals of the ABFM. Two experiences are available to scholars. Visiting scholars learn vital skills in the creation of evidence for policy, practice, and health system transformation. The experience intentionally directs scholars toward publication of their collaborative work in a peer-reviewed journal, as well as presentations at national conferences to help grow their vitae and disseminate valuable new information on behalf of the discipline. Individuals at more advanced stages of their careers with significant research experience or expertise may qualify as Lewis Sigmon, MD senior visiting scholars. Sigmon scholars are expected to produce a substantial product for publication as a result of their experience. In addition to scholars, the ABFM Research Department has supported undergraduate, graduate, and medical students in mentored experiences.

The Montegut Global Scholars Program (MGSP) was established by the ABFM-F in 2010, named in honor of Alain Montegut, MD, a member of the board of directors of the ABFM from 2005 to 2010 and the World Organization of Family Doctors (WONCA) North America Region president from 2007 to 2010. His career has been devoted to developing high-quality family medicine practice internationally, especially in underserved and/or undeveloped countries. The MGSP is emblematic of a growing ABFM awareness of its responsibility to inform and shape leadership and scholarship globally. Partnership with the research teams of the WONCA research committee, ongoing application to become a World Health Organization Collaborating Center, and recent scholarly efforts to addressing evidence gaps in Primary Health Care for Lower and Middle Income Countries (LMICs) are further examples of our efforts to reach family physician leaders globally.

Through these programs, the ABFM has and will continue to support diplomates in their growth as leaders in health care. Through opportunities to develop skills, connections, and ideas that change health care delivery, these programs emphasize the vital role of family physicians as “the keystone specialty in American medicine” and ABFM's commitment to “do everything in our power to preserve, enhance, and improve it.”¹³ We welcome your partnership and participation.