Q&A: New AAFP president will focus on 'strengthening our future' in a culture of wellness

Key takeaways:

• The American Academy of Family Physicians inaugurated Jennifer L. Brull, MD, FAAFP, as its current president.
• Healio spoke with her to learn more about the organization’s priorities for the coming year.

New American Academy of Family Physicians President Jennifer L. Brull, MD, FAAFP, said she is committed to helping create a more stable system focused on physician well-being during her tenure.

The family physician in Fort Collins, Colorado, was inaugurated as American Academy of Family Physicians (AAFP) president on Sept. 25, replacing Steven P. Furr, MD, FAAFP.

Brull has been a member of the AAFP since 1995, according to a press release. She practiced for more than 20 years as a family physician in rural Plainville, Kansas, and is now vice president of clinical engagement for a company that helps independent primary care physicians succeed in value-based care.

In an interview with Healio, Brull discussed her plans for the AAFP and how the organization will help address some of the challenges facing primary care.

Healio: What are your priorities for the AAFP, and what do you think the organization should be focused on right now?

Brull: I'm going to sum up my priorities as three things: pathway, payment and well-being.

The data show that the primary care workforce shortage is real and getting worse. I think the most recent data say that, by 2036, we will be more than 40,000 primary care physicians short. That's a big deal. Patients can't access health care when that happens. It's happening now; it's going to get worse. One of the things that I feel most passionately that the AAFP has to do in the next year, and the year after that, and the year after that, is begin to close that gap. This is going to involve a lot of work.

It's important that we close it, not just with numbers, but with the right people. When we think about what great health outcomes look like, they happen in places where doctors look like their patients, which means we have to get med schools to recruit people from communities that are traditionally underserved and from populations that are traditionally underserved. Although, certainly, there are shortages of other specialties across the United States, none has as great a shortage or as great of an impact as primary care. Why family medicine to solve this gap? Family medicine is primarily the primary care of America. When you look at the majority of people who are providing frontline, comprehensive care, it's family docs. We take care of everyone: pregnant people, infants, children, adults, older adults, people who require increased care at the end of their lives. We're in all settings; we're in hospitals and ERs, nursing homes and offices. If we can solve this shortage with family doctors, we've won in a lot of different ways.

The second priority is payment. The value of great primary care is under-recognized in the current system. Most physicians in the U.S. are still paid within a fee-for-service (FFS) system. It means you see a patient and do a thing for them, and you are paid for that thing. In general, primary care services, while they deliver the greatest outcomes, are often the lowest paid because they are not procedural in nature.

We can fix that in small ways in the FFS system. We can try to leverage the value of primary care to increase payment to family doctors for doing that FFS type of work, and we've done some of that in the last year. There's a new code called G2211 that recognizes the value that primary care clinicians serve for their patients. Probably, though, what we're going to have to do is blow it up and break the system, and that's using something called value-based care, which is this idea that physicians and systems are paid not based on the number of patients they see, but the health of the patient population they care for. And what this means is if family doctors — or any other system or physician in health care in the U.S. — can create such a value that they can prevent spending.

We're doing a lot of advocacy in this space and a lot of preparation for family physicians to feel comfortable in whatever system they're in, to feel empowered to move to a value-based care space and to get great results when they invest all the work that it takes to truly convert to a value-based care payment system.

That work will also pay off in more people who have high loan debt coming out of med school being able to choose family medicine as a specialty, so that they can follow their hearts and not their wallets when it comes to choosing a specialty. So, we think payment will impact the pathway there.

We also think payment is going to impact that third thing I talked about, which is well-being. Administrative burden has grown so much in the time that I have been a family physician. As we made more requirements for how physicians have to write things down in order to be paid, as we made more requirements for how we track data, the burden was laid squarely on the physician — that's been really hard in terms of physician well-being. It's also been hard in terms of payment, because when a family physician spends hours documenting what they've done or answering messages or reviewing labs in a way that is not streamlined or efficient, those are hours that they cannot be seeing patients. There is an incredible need to lobby effectively and improve systems to reduce the overall administrative burden.

Well-being in general should be something that is important to everyone who's a family physician. Not just resilience or reward, but instead, foundational well-being. So, we're putting a lot of effort into helping family physicians learn to lead cultural change in their own spaces in a way that promotes well-being for everyone on the team.

Healio: Aside from being inaugurated as AAFP president, what are some other highlights of your career?

Brull: The biggest highlight of my life is the fact that I have an incredible family. Being a wife and a mom to three wonderful humans is a big highlight for me. Thinking about family medicine as a career, my career has been in two phases, plus the AAFP work on top of that.

The first phase was 20 years as a solo family doctor in a community of 2,000 people called Plainville, Kansas. That was life-shaping in terms of who I am, what I believe in and why I'm so passionate about family medicine. To be in that space and really understand what it looks like to practice incredible, comprehensive, holistic primary care gave me a perspective that I think I will carry forward forever.

The second part of my career is that I just closed that practice in 2022 and transitioned full-time to an administrative role. I serve as vice president for clinical engagement at a company called Aledade. It's a company that helps geographically disparate, independent primary care practices form accountable care organizations, and do that hard work with value-based care. In this role, I get to work with a group of about 20 regional and senior medical directors who are all primary care physicians who engage and help doctors all across the U.S. transition to and deliver on this promise of better care, better health and lower costs.

And then the AAFP role is really fun. I have always enjoyed leading in spaces of community. The Kansas Academy of Family Physicians is where I first did that, and it was at the encouragement of a mentor who said, ‘I think you should run for something.’ And I should have, and I did, and I enjoyed it.

Healio: What is the AAFP doing to help physicians with some of the field's top concerns like physician burnout?

Brull: The AAFP does a lot. We're a member organization of 130,000 family physicians, so I could talk to you for hours about what we're doing. But I will narrow it down to physician burnout, which is that other side of the coin for wellness. When people don't have wellness, they are at risk for burnout. I think that it's important to recognize that when there is wellness as a foundation, there is a lot less burnout.

Family docs have one of the highest rates of burnout when it's measured, so that is absolutely something on our radar. In the last few years, AAFP has focused on not fixing burnout or creating resilience. Instead we are working on wellness 2.0 — wellness 1.0 is like pizza parties and thank you cards and developing resilience and teaching people meditation, and wellness 2.0 is thinking about the systems in which people are operating, and how to change those systems so that they support well-being for everyone.

There are a lot of tools and resources focused on this. I am most excited about one in particular: Leading Physician Well-being, which is a year-long program that family doctors and others can enroll in, and it is around this idea that many family physicians are leaders by nature. They lead their teams. They often lead in their communities or in their local or state organizations. Oftentimes, somebody teaches you how to lead, but you sort of learn as you go. Nobody teaches you how to lead in a culture of wellness. So how do you not only get things done, but get things done in a way that everybody is more productive and happy with this culture. The Leading Physician Well-being Certificate Program is designed to do exactly that. It is a cohort of more than 100 family physicians every year who are taught how to integrate this concept of your wellness and team wellness in the work that you do. So it's not this separate concept of ‘be well and then go to work.’ It's ‘be well at work.’ I'm really excited about it. I am part of the cohort this year, and although I've done tons of leadership, I've never done leadership in a culture of wellness.

Healio: What are your thoughts on some of the hot topics in medicine right now, like AI?

Brull: I’m super excited about AI. There are folks who say, ‘Oh my gosh, AI is going to take doctors out of their jobs,’ and they feel very threatened by it. I don't think family doctors are ever going to be replaced by AI, because as far as I know, a computer cannot hug you, and that is one of the best things we get to do as family docs. They also can't connect in a deeply personal way, or think about you outside of the chat that you've got going. You can feed a lot of information in, but as soon as you close that chat, it has forgotten everything about you, and if you start over, you are starting over. Whereas family doctors are longitudinal and continuous and comprehensive, and we connect. So, I have zero threats. I have a lot of excitement.

We talked about administrative burden, and I think AI is set to help us with that. It's starting to and it's just going to get better.

The AAFP just launched an incredible collaborative project on AI. We're really excited because what we're doing is not trying to design AI — that's not us; we're not the people who do that stuff — but to partner, to figure out how AI can best help family physicians, and how we can accelerate the integration of AI, no matter what kind of practice you have, what kind of electronic health record you have, make it so that it is accessible and understandable for family docs to be able to use.

Healio: Where do you see the future of the AAFP going? What are some goals that you hope to achieve in this position?

Brull: We already have a lot of family docs who are members, but I hope we have all family docs as members. There are some incredible benefits for being a member, and I think that if we could make sure that everybody knows that and make them available, that would be incredible.

In terms of where we're going for the future, we actually just finished our strategic planning for the next 3 years. Our core competencies are advocacy for family doctors, connections for family doctors — to each other, mostly, but also to other important people in places — and education for family doctors. In those spaces, we are going to work to elevate family medicine so that when there's a health care conversation, people look around and say, ‘Where's the family doctor at this table?’

We're going to improve systems. I talked a lot about how the current FFS system is not optimized and probably needs to be transitioned out of, but we don't want to kick people out of a space they are in. We make it as good as we can for them, and then we want to optimize value-based care so that when you step into that space, it's achievable, comfortable and financially viable.

We are going to work on strengthening our future, making sure that everyone who wants to become a family doctor has a path to that, and that when they get to med school and then residency, they have all the training and competency they need to be a great family doctor. Finally, is that focus on well-being. We're going to make sure that family doctors have fulfillment in their lives, which includes their careers, and that it's not a matter of balancing how good you feel outside of work with what you’ve got to do.

References:

• AAFP welcomes Jen Brull, MD, FAAFP as new president. https://www.aafp.org/news/media-center/releases/aafp-welcomes-jen-brull-president.html?jvjv. Published Sept. 25, 2024. Accessed Sept. 23, 2024.
• Engaging physician voices to transform primary care: Announcing the “Advancing AI and digital health for primary care initiative.” https://rockhealth.com/insights/engaging-physician-voices-to-transform-primary-care-announcing-the-advancing-ai-and-digital-health-for-primary-care-initiative/. Published Sept. 24, 2024. Accessed Sept. 24, 2024.
• The complexities of physician supply and demand: Projections from 2021 to 2036. https://www.aamc.org/media/75236/download?attachment. Published March 21, 2024. Accessed Sept. 23, 2024.