President's Column: What's On Our Plate
March 10, 2022
On Burnout, Grace and Resilience
I must admit, as we emerge from the intense difficulty and complicated mess that has been the pandemic, that I feel guilty that I am not recovered yet. There are a lot of exciting things going on in the specialty that I should be more excited about – residency redesign, AHRQ’s new focus on health equity and primary care transformation, the possibility of an innovative four-year family medicine training option, and the release of the National Academies of Science, Engineering, and Medicine (NASEM) report: Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. At ADFM, the expansion of our LEADS fellowship and the unexpected popularity of our Building Research Capacity Fellowship call for optimism as well. I find myself, however, surprisingly slow at recovering from what I have endured, and leading a group of faculty and staff that need time to recover their optimism and trust. If you are feeling that as well, the good news is that you are not alone.
What’s the Problem?
Burnout was already a problem before the pandemic, with one author finding that 54.4% of physicians reported at least one symptom of burnout in 2014, using the Maslach Burnout Inventory. Then the pandemic hit, creating emergent changes in schedules and teaching methods, longer hours at work, increased fear and uncertainty, prolonged grief, and feelings of inadequacy (as evidence-based treatments were not readily available). The pandemic also highlighted inequitable access and treatment of our patients, further handicapping our ability to help. This burnout mirrored high levels of dissatisfaction across employment in general.
In the Harvard Business Review article “Beyond Burned Out,” Jennifer Moss describes gathering feedback from more than 1500 workers in 46 countries at various roles and levels in the Fall of 2020. Here are some statistics from her article:
- 89% of respondents said their work life was getting worse
- 85% said their well-being had declined
- 56% said their job demands had increased
- 62% of the people struggling to manage their workloads had experienced burnout often or extremely often in the previous three months
- These workers also scored very high for cynicism and exhaustion – two markers for burnout.
Furthermore, this data is from 2020 –arguably the stresses related to the pandemic have only gotten worse since then. These signs of burnout may be even more keenly felt among executives and administrators, such as department chairs.
In a classic Harvard Business Review article, Harry Levinson describes Christina Maslach’s definition of burnout as “…a syndrome of emotional exhaustion and cynicism that frequently occurs among people who do ‘people work’- who spend considerable time in close encounters.”
Levinson identifies people suffering from burnout generally as having these identifiable characteristics:
- Chronic fatigue
- Anger at those making demands
- Self-criticism for putting up with demands
- Cynicism, negativity, and irritability
- Sense of being besieged
- Hair-trigger display of emotions
What we are dealing with as leaders, in addition to our own feelings of burnout, has been a wide range of sometimes destructive behaviors resulting from our colleagues’ suffering from these feelings. All of sudden, in addition to dealing with the pandemic, we may find ourselves dealing with faculty and staff who are exhausted, suspicious, angry, and more self-centered – and we are called to deal with these emotions and behaviors and somehow create a motivated work group, despite these feelings of frustration.
So as leaders, what do we do about burnout, both among our faculty and staff, and for ourselves? One thing that I think is critical and that I haven’t really seen discussed anywhere else, is a bit of grace. For our purposes, think of grace as the dictionary defines it: as “courteous goodwill” – something that is not asked for nor deserved, but is freely given. I think this is critical as we move forward.
I grew up in Alabama, and I experienced many things that we may all share in common, such as eating family meals together, attending local sporting events, and attending church on Sunday, Wednesday, and other days (I said I was from the South!). But there was one tradition that I suspect was unique to my family - the tradition of “love offerings”. We would go to Baskin Robbins and I would get mint chocolate ice cream in a cake cone. I would carefully pack the bottom of the cone with ice cream and give that last perfect glorious bite to my Dad – not because I didn’t want it, but because I loved him and knew he would love it. These “love offerings” were given between family members with a couple of rules: (1) It had to be something the giver and the recipient both LOVE; and (2) The recipient could not refuse it out of guilt, but rather had to embrace the love it represented. It could be anything – a warm pair of gloves on a cold day, the front seat of the car even though “I called it,” the seat by the fire, or the last piece of pie. That gift, that grace – that wasn’t deserved or earned, but was given out of love - continues to be one of my favorite traditions. I have carried that tradition of the “love offering” to my own family.
My favorite contemporary theologian Frederick Buechner in his book Listening to Your Life describes grace this way: “No way to earn it or deserve it or bring it about any more than you can deserve the taste of raspberries and cream or earn good looks or bring about your own birth.” So what does this concept of grace have to do with burnout, the pandemic, or the challenges facing us as department chairs?
During the pandemic, during this combined trauma we have experienced, one of the things that seems to have disappeared is this “courteous goodwill” – this bit of grace or the benefit of the doubt that we would normally give to others. Isolated from people, folks have become more judgmental, less optimistic, and less willing to be forgiving, understanding or collaborative in facing the unique challenges of this age. Faculty and staff approach leaders with trepidation and paranoia – what is their motive here? Where are they trying to lead us? Are they acting in our interest?
My colleague and psychiatrist Shannon Tyler describes it this way: our brains, tricked by the high alert we have all been on during the pandemic, look at everything through a tainted, filtered lens. Consider this picture:
This entry was posted in Cognitive Psychology, Fun Facts And Optical Illusions and tagged attention, cognitive illusion, optical illusion, perception, vision, visual illusion, woman or skull on March 9, 2012 by WIP.
What did you see first? The skull or a lady at a dressing table?
We have all been through a collective trauma, and our faculty and staff, and perhaps even our supposedly superhero chairs and administrative whizzes may be seeing everything through a tainted filter – a filter that distorts our normal view, puts us all a bit on edge, increases our cynicism, and perhaps makes us all a bit less optimistic.
For example, one week in June I had a particularly bad week – one of those weeks when you feel inadequate for the job. I had a faculty member quit, handled an unusual number of complaints from faculty and staff, was late on an important assignment, and was yelled at by a patient’s family.
I remarked casually to my daughter at dinner that the only nice thing anyone had said to me all week was my Candy Crush app telling me “Great Job!” as I finished a row. “That’s terrible!” she said, reached over and planted a smiley face sticker on my shirt, and said “YOU are doing great.” And thus, a new tradition was started out of this pandemic’s lack of grace – is there a word for that? Ungrace? Unkindness? Indecency? Ugliness?
We began giving out smiley face stickers at dinner time and offering a bit of grace. Each person at dinner would be asked – Did you get up this morning? Did you try your best? And when they said “yes” to this ridiculous but gracious standard, they were congratulated with the phrase “YOU are doing great,” and were given a smiley face sticker. It didn’t matter whether we had a terrible day or a good one, or whether we messed up at work or at home, we were all given that little bit of grace.
We need to do the same for our colleagues now – offer a little grace, a small love offering, and avoid all the things that are un-graceful – the bad manners and crudeness and indecency and thoughtlessness.
We have survived the morass of complexity and uncertainty and loss of control that has been the pandemic. Now comes the hard part, “the rehabilitation,” as David Rock calls it in his article “We Need Time to Rehabilitate from the Trauma of the Pandemic.” If leaders grow the more they are challenged, boy have we grown in the last two years! But the biggest challenge may be in this next phase, when we are expected to be resilient and to help our departments recover and consolidate the gains that we have made.
That Harvard article lists three needs to consider as we rebuild, repair, and regrow –
- The need for certainty
- The need for control
- The need for connectedness with others
Of course, I will add my favorite as the fourth need – the need for grace – that benefit of the doubt, that compliment on a job well done, that undeserved gift that we all need in order to believe again that we are all in this together.
And by the way, YOU are doing great! 😊
November 2, 2021
What’s on our plate as departments? Like many sectors of society, we are facing “The Great Resignation,” as it has been called. A year and a half of pandemic uncertainty and staring mortality in the face have prompted many burned-out workers to rethink their careers and deeply question the role of work in their lives. If you are facing the loss of employees in your department, you are not alone. According to many sources, close to half of the workforce is considering leaving their employment this year. Not surprisingly, resignations are highest in the tech and health care industries, where the pandemic-driven increase in demand led to increased workloads and burnout. A wide range of experts from economists to psychologists have weighed in, and many are suggesting an existential crisis of sorts. UC-Berkeley economist Ulrike Malmendier suggests that the pandemic and the rise of remote work have changed the way we view our lives and the world.
Behavioral Scientist Aaron McEwan suggests that employees want to be seen as more than just workers, but as complex human beings with rich, full lives. Many people are being driven less by ambition and advancement, searching for fewer hours, less responsibility, and less stress. His advice to employers is to seize this once-in-a-generation opportunity to "reconfigure work so that it's actually designed for this new world that we find ourselves in.” He argues that "[t]he way that we work, particularly in offices, is leftover from the 20th century, arguably the 19th century," and suggests that “[w]e work nine to five because that's when the sun is up. We worked in offices because chances are no one had a computer in their house, let alone a fax machine or any of those things." So what does this mean for our departments? How do we respond to changing ideas about the value of work and the goals of our workers?
Harvard had a terrific webinar earlier this month called “The Great Resignation,” in which they gave the following important recommendations for holding on to your employees in the midst of this “Great Resignation:”
- Do things explicitly that you would have normally done at the water cooler. Meet with people to check-in, see how they are doing, understand their burdens (work and personal) and find out what they are excited about in the future.
- Remind your employees of the importance of the organization’s mission, celebrate the satisfaction and joy in its accomplishment, connect people very intentionally to the mission, and emphasize how they are personally making a difference. This has been hard with restricted activities and reduced teaching.
- Understand that we are in a marathon instead of a sprint now and adjust accordingly. Now that we have figured out methods to survive the challenges of the pandemic, we need to transition to do more than survive – now we need to take time to reflect on the beautiful, wonderful, desirable things that we accomplish in our work every day.
Panelists on the webinar emphasized that we have all been in avoidance mode- avoiding the virus and avoiding people - and that this combined stress has been punctuated by relief at each period we survive. But now we need to create moments not just of calm or relief, but of real joy and satisfaction.
One of my favorite leadership quick reads is Lencioni’s The Three Signs of a Miserable Job. In his book, Lencioni identifies the three signs of job misery as anonymity, irrelevance, and "immeasurement" and defines them as follows:
- Anonymity: Employees feel anonymous when their employer has little interest in them as people with unique lives, aspirations, and interests.
- Irrelevance: Irrelevance occurs when workers cannot see how their job makes a difference. "Every employee needs to know that the work they do impacts someone's life -- a customer, a coworker, even a supervisor -- in one way or another," Lencioni says.
- Immeasurement: This term describes the inability of employees to assess for themselves their contributions or success. As a result, they often rely on the opinions of others -- usually the manager -- to measure their success.
So, in applying these principles to my own department, I will be working towards combatting these three signs of misery to avoid the great resignation hitting my department. For me, that means at least the following:
- More face time with faculty and staff
- More time spent developing each individual as a faculty member
- More emphasis on mission and how each person plays a key role in that mission
- More evaluation of key performance indicators relative to our strategic plan to make sure people feel engaged in the mission.
By taking these steps, I hope to make sure that my faculty and staff feel valuable, connected, and engaged in meaningful work. What do you see as the challenges of “The Great Resignation” to your department and how will you respond? The need for a vibrant and growing family medicine specialty demands that we think hard about these questions.
Chelley Alexander, M.D.
ADFM President, 2020-2021
What else is on our Plate at ADFM? ADFM continues to benefit from extraordinary leaders who are moving our initiatives forward! Look at all of these initiatives below!
We have two incredible fellowships this year. Plan now to put them in your budget to continue to grow your faculty expertise.
Expansion to the LEADS fellowship is underway, with support from the ABFM-Foundation and has grown to 13 fellows this year. The fellowship has taken a big step forward in adding a dedicated, paid director and mentors for 2022. The fellowship has an expanded curriculum, formal learning communities, and a new summer workshop. Applications are due Summer 2022, so plan now to identify an up-and-coming leader to apply.
The BRC fellowship is a popular new opportunity this year, boasting 14 new fellows (the hope was to recruit 4 fellows the initial year!). The fellowship will equip fellows with skills in leadership, research organization and faculty development. Candidates will be change agents for building their organization’s capacity for producing scholarly activity. Applications for next year’s cohort open up in mid to late July 2022, so plan now to identify a faculty member to apply.
Family Medicine Committee on Anti-Racism (FM-CAR)
We are excited to take the next step in our journey to advance issues of anti-racism and diversity and health equity within Family Medicine. The family of Family Medicine is working together to develop and coordinate the implementation of an antiracism roadmap for the specialty, including measures of success and a communication plan. While each organization has its own unique plan and has made progress in that regard, the FM-CAR committee will make a recommendation on issues of common priority within the Family of Family Medicine. The committee will be led by Danielle Jones and her team at the AAFP Center for Diversity and Health Equity. If you have ideas or want to be more involved, reach out to our representatives, Amanda Weidner and Beth Wilson.
The agenda is shaping up for an incredible in-person (with safety measures) conference with lots of time to remember how to socialize! If you have become somewhat feral during the COVID pandemic, register for the conference and enjoy the live company of your friends and colleagues!
Our opening plenary will focus on the complicated interaction between our health and our planet’s health (suggested reading is the book Changing Planet, Changing Health). Back by popular demand will be the always enlightening leadership dilemmas workshop and we are adding a workshop for all on advocacy. We are also excited this year to have a special focus on living with the tension between our clinical and academic missions, as well as ignite discussions led by our LEADS fellows. Look for much more detail in the newsletter!
July 27, 2021
I would like to think, after this pandemic experience, that I am better at change - that the shock of being thrown into an apocalyptic, pandemic world with constantly changing rules and priorities has made me more able to be flexible going forward. I like to think that I can pivot more easily, take things in stride, and perform small miracles, such as virtual visits or developing online curricula on the fly - And maybe, just maybe, there is some truth to that.
When our medical school last week announced a merger with our independent non-profit teaching hospital and announced the CEO of our hospital was now also our new dean, my initial reaction was simply “that’s interesting.” Maybe after the year we have had nothing can surprise me. Perhaps the theme of the past year (or more) has been, simply, “change.”
I have found myself reviewing all of my favorite articles and books on change lately, and I find that Kotter’s eight-step process for leading change seems old fashioned in this time of unprecedented change. The concept of “building a sense of urgency” seems laughably obvious – everything is urgent. Whether confronting a newly merged medical education system, an international pandemic, or perhaps “new-to-you” racial inequities that horrify you, urgency is the new, pervasive normal. Even strategic planning seems passe or naïve as we are pummeled by change so quickly that pivoting to respond seems to be the standing order of the day.
I have been searching for wisdom and, more particularly, for wisdom for THIS moment. The most comforting wisdom that I can find is simply this:
- We are in the right field, doing the right thing. Family Medicine physicians continue to be pioneers that can flex to help any person in any circumstance. This is especially true amidst unpredictable, widespread change. If you think of your medical school’s most immediate and effective responses to COVID-19 – testing, precautions, prevention, education, I bet many of them were spearheaded by family physicians. This makes us invaluable and impactful, and what else can we ask for but to leave a mark on the world, to make a difference?
- The key to leading amidst change is knowing which critical values we MUST hold on to no matter the cost, while recognizing what must change no matter the cost. What patients need to be treated and why? That cannot change. How, and where - that we can flex on.
- Change will happen no matter what, and often happens to us without our consent. Our choice is then whether to be open to growth in that process, to participate actively in the change process, and to try to guide that change in a positive direction and grow ourselves personally in the process. Are we too old to learn? Will we become bitter or better?
As I work through the changes in my institution over the next year and consider the possibilities that these changes present, I will try to adhere to the newfound flexibility and openness to change that the pandemic has reminded me is possible and is critical to success and improvement in the future.
I encourage my faculty regularly to stay flexible, remain committed to our values, and strive to get better; but also to remain open to change and all the growth that comes with it. With this attitude, I hope we can all successfully navigate our changes to improve the health of our communities.
Thankfully, we are blessed with experienced and supportive colleagues in ADFM – colleagues who are happy to help in an ADFM organization that is dedicated to supporting us all as we experience rapid, unrelenting change.
The NASEM Report
In April of 2021, the National Academy of Medicine examined the current state of primary care in the United States and developed an implementation plan to build upon the recommendations from the 1996 IOM report, Primary Care: American’s Health in a New Era, to strengthen primary care services in the United States, especially for underserved populations, and to inform primary care systems around the world. This was the first report in 25 years on creating high-end primary care. Their first report, put out in 1996, was instrumental in moving the needle but did not take us to where we needed to be. These reports tend to be used by payers, policy makers, and specialty organizations (such as the AMA and AAMC) to make broad policy decisions. The report has implications for ADFM’s strategic plan, and for your individual departments as well.
I am hopeful that the NASEM report can help push forward some of the change we need for FM to flourish in the rapidly evolving healthcare environment. Members of ADFM had a chance to discuss the report and its implications for our Departments on a WebEx with Co-Chair Bob Phillips, and Warren Newton of ABFM on Thursday, July 15th.
Key to the recommendations is the declaration that primary care should be a common good, as it is the only part of the health care system that results in longer lives and more equity. The report calls for payment reform, better financial support for primary care services and institutions, and for the training of residents in the communities we want them to work in. It also emphasizes better IT infrastructure to support primary care, a robust research funding institution be established, and a coordinating Secretary’s Council on Primary Care to enable the vision of primary care captured in the committee’s definition. The discussion from the July 15th Webinar will be used by our leadership to help determine what we as departments and ADFM as an organization can do to help implement the reports’ recommendations. We appreciate all those who participated!
Open Board Positions
Now is your chance to get involved! The board meets four to five times a year (twice in person, the remainder virtually) and provides leadership for the ADFM organization. If you are looking for a way to get more involved, this is a great way to do so! The conversation and company are excellent, and you have a chance to impact departments of family medicine around the country. The formal call for applications will be released in the Fall, but now is a great time to consider joining the ADFM Board of Directors! If you are interested, we have the following positions open starting in February 2022: President-Elect, Treasurer, 2 member-at-large positions, Conference Planning Committee Chair (Chair of conference in 2025), Education Transformation Committee Chair. Please join us!
It’s Time for LEADS Fellowship Applications
Have good leaders in your department? Now is the time to send us your best and brightest and help us train up the next generation of leaders! Applications are due by August 2, 2021. You can encourage your faculty to apply here https://forms.gle/kgsXZpUYZB4jUgW16 /. For more details on the program and eligibility requirements - please visit our site: https://adfm.org/programs/leads-fellowship/ or reach out Sam Elwood (email@example.com).
This is part of our strategic plan/grand scheme with ABFM to take over the universe with family Physicians by preparing a large number of well-trained leaders to serve in whatever role our systems need leadership in. Consider nominating one of your faculty and putting this in your ongoing budget to send one fellow a year. Help us make that a reality!
Take Advantage of a NEW Research Fellowship!
We are also accepting applications for our inaugural class of BRC (Building Research Capacity) fellows! Sponsored by NAPCRAG and ADFM together, we are launching this fellowship for the 2022-2023 year. Does your department need to increase its research and scholarly output? Do you need to foster an environment of academic inquiry? ADFM in association with NAPCRG has created the Building Research Capacity Fellowship to teach individuals how to build research capacity within their departments and institutions.
For more information click this link: Building Research Capacity Fellowship (adfm.org/programs/building-research-capacity-fellowship/...
For those interested, here is the application: forms.gle/ZosPvcUzct8FuLMY9
Applications close August 15.
2022 Conference in Person!
Its time to plan to attend our 2022 conference in beautiful Denver, Colorado! Block out the dates on your calendar Feb 23-26, 2022 and join us downtown in the Sheraton for fellowship and learning!
April 14, 2021
Welcome to spring! This year feels a bit different, as though life is returning not only to our trees and flowers but also to us as though we have been in hibernation and are just emerging into hope again. What’s not on our plate? Would probably be the better question for this column in April of 2021. This incredibly difficult year seemed to magnify everything – healthcare disparities, political division, depression and anxiety, structural racism, the importance of being seen and heard, and the importance of communion with others. I miss laughter and hugs and family gatherings and in-person faculty meetings and conferences. But we are emerging! So now is the time to build on the lessons learned from the past year.
Our annual conference Feb 17-20 was appropriately themed “Crisis as a Stimulus for Lasting, Positive Change,” and it was amazing! I am so impressed with the hard work of Linda Speer and Amanda Weidner and the entire planning and staff teams. To shift as you all did to a virtual format and provide such good content was incredible. We so appreciate everyone continuing to support the conference despite its virtual format. One benefit of a virtual conference is that many of our keynote speakers have posted their slides and there is a video of all the keynotes! If you missed any of the lectures, I highly recommend going back and listening to them as they were insightful and impactful. Check out the link at the member website.
One thing on our plate is structural racism. The past year has highlighted the importance of focusing on this problem and taking concrete steps to dismantle historic structural racism, while also preventing the establishment of new racist political determinants of health. Daniel Dawes in his keynote challenged us to address the political determinants of health; to advocate for changes that will make a difference in health disparities. Now is the time to ask what will your department do? And to explore how you can advocate for change. Our colleagues also challenged us to move the needle on racial justice in medical education, and to create an anti-racism plan for our department. How will you rise to that challenge? Need inspiration? Check out the link at the member website. Need help figuring out how? Let us know at ADFM and we can arrange another session with our DEI committee to help you take steps. We ALL must have this on our plate. What progress can we make before February 2022? Would love to hear your stories at the next ADFM conference.
Also, on our plate at ADFM is appropriately the creation of an advocacy committee led by Cynthia Haq. This new committee will build on an important foundation in part built by Hope Wittenberg. During the conference, Hope laid out critical legislation that she has helped make progress on over the last several months. There is a lot of good potential news in this report, including a re-set of caps for rural hospitals, as well as the potential for 1,000 new residency slots! If there are new residency slots approved, there would be an application process probably in October of 2021 for implementation in the 2022-2023 academic year. Hope has also been working hard on Teaching Health Center funding, Title VII primary care training and enhancement grants as well as on funding for AHRQ Center for Primary Care Research. We appreciate Hope’s advocacy and look forward to future updates. Looking to make a difference in this space? Don’t forget STFM’s Free online advocacy course – https://www.stfm.org/facultydevelopment/onlinecourses/advocacycourse/overview as a great first step for yourself, and for your faculty. Need more education on current academic FM key federal issues to be effective? Check out this link at STFM: https://www.stfm.org/about/advocacy/resourcesandissues/ On a local level, to make an impact, get involved with your state AAFP chapter. No doubt future generations will ask you what did you do during this crisis? How did you lead to promote change? Here is an opportunity! Get involved with our new advocacy committee.
Another exciting thing on our plate is the expansion of our LEADS fellowship this year, with 17 fellows currently participating. So many of you are serving as mentors, and we greatly appreciate your service in this regard. ADFM has trained fellows to be future Chairs and other senior leaders of departments of Family Medicine since 2009, accommodating 4-8 fellows per year. Over the past year, however, we have reached an important milestone in our journey of growing the fellowship, in partnership with the ABFM Foundation under the leadership of Warren Newton. Together with financial support from AB FM, we will be expanding the curriculum, hiring a part-time director, and are expanding the fellowship over the next few years with the intention of having 40 fellows a year. The goal is to train mid to late-career family medicine leaders interested in pathways to leadership in a variety of roles academic health systems and should complement rather than duplicate other leadership training programs. We would love to further train your current leaders, so be thinking about who from your department might benefit from inclusion in the fellowship for next year and put that in your budget.
Finally, I would say on all our plates is 'burnout,' and developing a culture of wellness. As we emerge from our COVID hibernation, at least at my institution, the level of burnout is high. Dr. Chantal Brazeau asked an important question in her presentation: What are three words to describe the culture you would like to see in your department? She offered up important measures to tell where you are in the journey towards a culture of wellness and offered specific examples of strategies to foster the culture of wellness in your department. Do you know the drivers of wellness in your organization? Do you have adequate peer support? This talk can put you on the road to driving a more supportive culture of wellness in your department. The pandemic has put a highlight on professional burnout and depression. How can we make lasting positive change in this space? What first steps can you take in your department?
Lastly, I want to highlight our new board members and thank them for their willingness to serve! This organization is an incredible source of support and ideas, and we couldn’t do it without volunteers. New board members include Dana Nguyen, Rich Lord, Peter Catinella, Allison Arendale, Deb Clements, and Harry Strothers. These new members join established volunteer board members John Franko, Allen Perkins, Shade Omole, Elisabeth Wilson, Peter Carek, Dave Schneider, Megan McGhean, Michelle Roett, Irfan Asif, Annamalai Ramanathan, Cynthia Haq, and Terrance Steyer. We are also thrilled to have our new public board member, Bryant Campbell, and to be led by our amazing Amanda Weidner!
Please note that if you are looking to get more involved in ADFM like our volunteers above, the ADFM committees are in the every 2 -year process of reforming – so it is a great time for anyone interested in getting more involved with ADFM to join (all chair and administrator members and associate members are welcome!) Committees will also be updating their strategic goals along with this, so our organizational strategic work plan will be updated in the coming months.
I am hoping for lots of in-person laughter and hugs for our next annual conference. Knowing the criticality of fellowship even more keenly after this past year, we may have to add in extra time for communing and really relish our time together.
Take care of yourself and make a lasting, positive change!
More than ever, now is the time.
October 29, 2020
Only 5 more days left until, well, something…
Here we are in October and, so far, what a year it has been. I don’t know about you but I am tired of Zoom meetings and talk of COVID. However….
All Things COVID
We have all entered the brave new world of telehealth thanks to COVID. There has been an interesting discussion on the list serve regarding how telehealth visits fit into our learners training portfolio. Many of you are having trouble with face-to-face visits as the novel coronavirus causes patients to avoid waiting rooms and in-person encounters. ADFM, as a convener, managed to incorporate the voices of the RRC, the ABFM, and many of you into a very interesting discussion regarding the meaning of the number 1650. It is worth remembering that the RRC sets PROGRAM requirements and the ABFM sets the INDIVIDUAL requirements.
Family Medicine Residency Program Requirement Major Revision
Which brings us to our significant effort of the quarter, ADFM's contribution to the upcoming revisions to FM Residency Program Requirements. As you are no doubt aware, the RRC makes major revisions to the program requirements only every 10 to 15 years. We have been asked to provide vision, voice, and leadership to the process and many of you have answered the call. The way the revision process works is that we, as a Family of Family Medicine, provide input to the RRC. They then, through a third party vendor, use this input to create scenarios. It is through these scenarios that the final document is created and sent for review. We were asked to be conveners and seek input from Chairs, patients, and C-suite types and we are wrapping up that process now. I remain in awe of how thoughtful and passionate you, my colleagues, are about the specialty. I am also amazed at the loyalty and good feelings our patients have for the specialty. In addition, we are finding out how valued generalists are as systems look to improve the health of populations.
Annual Conference, Zoom style
Atlanta will have to wait a couple of years (the hotel has given us a “store credit” to be used at a later date) but the 2021 Annual Conference goes on, virtually speaking. We are pleased to have Daniel Dawes as our keynote speaker and I would encourage you to read his book, The Political Determinants of Health, prior to the conference. The program committee has done their very best to try and retain the feel of the conference as we all sit in our own personal space. Please join us as we focus on how we as departments can be a resource for those fighting systemic racism in healthcare, discuss how to deliver care equitably in the time of COVID, and how to work to create lasting, positive change. Learn how not to let a good crisis go to waste, an important lesson in these times.
As we prepare for our board meeting in November, the big news is that we say goodbye to our public member. Julie Moretz has been an active member of the Board for the past 3 years. She has been an amazing addition, providing a voice that has been incredibly valuable. As many of you know, the addition of a public member was a pilot. We have elected to continue to support having a public member and interviews for the position are ongoing. I would say replacement but there is no replacing Julie. She will be deeply missed by the Board and others.
The other big news is that we have received money from the ABFM Foundation to expand the LEADS Fellowship. To date, the fellowship has been small and focused on developing candidates for the Chair role. With this funding, the LEADS Fellowship will be expanded in size (the number trained will expand) and in scope (an emphasis on leadership in all areas of healthcare). For those that want to participate, details will be forthcoming. We anticipate building on the work of the CAFM Leadership Development Task Force for those of you who want to read ahead.
I will close with a quote from Martin Luther King, Jr as found in Daniel Dawes' book:
It may be true that the law cannot change the heart but it can restrain the heartless. It may be true that the law cannot make a man love me but it can keep him from lynching me and I think that is pretty important, also.
Stay safe, wear a mask, socially distance, and don’t forget to vote on, or even better, before, November 3rd.
July 30, 2020
Welcome – and thank you for your service.
I continue to be amazed that it has been only 5 months since we were together in New Orleans. Sir Michael Marmot left us with a charge to leave the Annual Conference and right societal wrongs as they became apparent. Little did we know how quickly that charge would grow in importance.
All Things COVID
Just weeks after the end of this year's conference, COVID was in the headlines, and emergency rooms. I was amazed and proud of the yeoperson work many of you put in to take the lead in your organizations’ response. From running inpatient COVID units, setting up drive-through testing centers, setting up telemedicine, and the many other jobs you did, please pat yourselves on the back. Without the efforts of our members, America would be weaker still. For some in the northeast, normalcy is approaching. For others of us in the south and the west, the hard part may be just beginning. Keep all of us in your thoughts and prayers and everyone stay safe.
Consistent with our tagline (Vision, Voice, Leadership) and values, ADFM spoke out regarding our country’s ability to meet this crisis. Calling for a consistent shelter at home order, contact tracing, and adequate PPE we added our voice to those calling for a change in “business as usual” and protection for our healthcare workers, our statement was adapted and signed onto by all of the academic Family Medicine societies. My hope is that because of our efforts, lives were saved.
One good to come from this crisis is our “hot topics” series, which evolved from the weekly open forum debriefs during the first weeks of the pandemic. We have been offering the hot topic sessions on a bi-monthly basis as a forum for discussion of all things related to the posted topic. It is a good opportunity to meet up with colleagues and get some perspective. For those of us knee-deep in coronavirus, perspective is welcome. Notice goes out for these in advance so please join in the conversation.
Another good to come out of the crisis is the ability to disseminate information accurately and rapidly. Jen DeVoe and Amanda Weidner worked with the Annals of Family Medicine to create a blog (Family Medicine Case Notes from the Covid-19 Front Lines https://medium.com/case-notes-from-the-covid-19-front-lines). I encourage you to go and check it out. It contains clinically relevant information as well as information that you can tap into to provide better, more efficient care.
George Floyd’s death, Health Care Equity, and Black Lives Matter
Then our attention was called to racial inequity by the murder of George Floyd and the resurgence of the Black Lives Matter movement. Reminded in February of the importance of race in life expectancy, the need for formalized efforts to combat inequity, and the need to overcome institutional inertia, our members did not stay silent. Some were affected by the violence, many were affected by the need for change. Resources were shared amongst our members and ideas on how to respond were shared as well. The Board put out a statement that can be found on our home page and includes the following:
As an organization, ADFM asks that each of our member departments and associate members serve as role models for inclusiveness and seek out and embrace opportunities to include individuals with diverse backgrounds, opinions, experience, skills, and capabilities for the betterment of all individuals, their institutions, our organization, and society in general.
We continue to pledge to work towards equity in all we do. Specifically, we are working on a draft policy statement and concurrent action plan with specific commitments and timelines, which the Board will be reviewing in early September and we will then share with the membership. This policy will include what ADFM can do as an organization, what we can do collectively as a group of departments, what we can do with our collaborative partners like AAMC, STFM, and the rest of the Family, and what we can do as individual departments. We will be focusing in particular on our role as leaders - e.g. advocating within our institutions, calling attention to microaggressions, and making sure our employees are making a living wage. To this end we have asked a number of questions on our annual survey to help start to direct our organizational and collective actions, especially the work of the Diversity, Inclusion, and Health Equity committee - with plans to create a template diversity plan for departments
AFMAC: The Mechanism for Policy Change
One of the things you may not be aware of is that we (ADFM) in conjunction with the other academic Family Medicine societies have a council (the Academic Family Medicine Advocacy Council, or AFMAC) through which we take ideas and convert them into advocacy positions that Hope Wittenberg helps us fight for. This council has been especially busy over the past 5 months, as you might well imagine. In addition to the usual defense of Title VII, we were able to make some progress in the fight to fund rural residency programs, take a stand (and help change) the teaching physician rules around virtual visits, and push for a viable primary care workforce. In addition, the council (mostly Hope) keeps Family Medicine at the table for AHRQ and other key agencies. This cannot work without YOU. Please, if you are contacted, commit to contacting your representative and voice your support for Academic Family Medicine’s position.
The Board met in June and addressed the following:
- Approved adding an Administrator member to the Membership Committee.
- Agreed with the creation of a taskforce to determine the feasibility of an Advocacy Committee that helps push our legislative agenda forward.
- Revised our strategic workplan to include the Diversity, Inclusion & Health Equity draft SMART goals -- on our website under "About Us", at the bottom of the page here: https://adfm.org/about/about-us/
- Ratified the creation of a consultative service around clinical care, built with input from the Building Research Capacity Initiative’s consultation model.
Additionally, we are actively planning for what the 2021 budget year might bring, and whether we will move our meeting virtually based on the status of the public health emergency and the preferences of our membership.
- Please complete the annual survey by August 17th (if you have not already done so) as your feedback will be very helpful for our organizational and strategic decisions and offerings in the coming year.
- We need a public member for our Board to replace Julie Moretz. Nominations to Amanda Weidner, firstname.lastname@example.org, please. And thank you to Julie for all of her hard work.
- Applications for the upcoming LEADS Fellowship are due by August 17. This is an outstanding opportunity for growth for a rising leader in your department. And a huge thanks to Myra Muramoto for all she does as (volunteer) fellowship director.
- We have a new ORR representative, Austin Witt, introduced elsewhere in this newsletter. Thank you to all who sent in nominations. There are some very strong individuals in the cohort of applicants which gives me hope for our future.
One of the strengths of our organization is our ability to play well in the sandbox with others. We are seen by others as an important ally. As the CEO of AAMC said in a recent meeting with us, the only people with power in the medical school are deans and department chairs.
May 5, 2020
Wow, only 3 months ago we were in New Orleans, listening to Sir Michael Marmot discuss the need to pay attention to disparities across our patient populations. Now, here we are, in the middle of a once-in-a-generation (I hope) pandemic. One take-home point from the meeting that has certainly been brought home to me is the uneven distribution of healthcare, even in a pandemic. Living in a majority minority city, I watch my African-American patients and their family members succumb to the disease in disproportionate numbers, and I am reminded of Sir Michael’s call to to fight for an end to disparities.
I assume like myself, you were somewhat taken aback by the rapid spread of the virus throughout the country. I remain grateful that none of our members seem to have contracted the virus while we were together in New Orleans. I am also in awe of the incredible leadership amongst our members that, when they got back to their respective departments, soon realized that the vandals were at the gate. Many of us took leadership positions within our parent institution. A brief review of the ADFM listserv revealed that common areas for membership engagement were as follows:
- redeploying faculty and residents to cover for surges (or for the possibility of a surge)
- setting up COVID-19 testing tents and community outreach
- leading telehealth efforts at the institution and beyond
- promoting evidence-based resources
- creating student rotations for outreach to high-risk populations, conduct contact tracing, and other creative opportunities (see blog post)
- gathering data on impacts and outcomes
- issues of wellness and burnout facing our clinicians and staff
How has ADFM served as a resource for you? I hope you have engaged in our active listserv discussions around these topics. I know that, as we pursued many of these efforts at my institution, I have relied on you to help with everything from ideas to operationalizing. Many of you have been very generous in your offer (and delivery) of advice and assistance for your colleagues. If we as a country survive intact, it will be because of people like you. I am only glad the organization was able to match those with knowledge to those with interest. In addition, we have been working on new ways to share information and to maintain a library of resources that is more searchable than the list-serve. To that end, we have made the website more user friendly and more of a repository for information of a less evanescent nature. You may find these shared resources in our Drive folder. In addition, if you have not joined our weekly Open Forum (Fridays) I encourage you to do so. It is an opportunity to share ideas, commiserate, and show off your Zoom skills. Lastly, we helped to establish the new Annals of Family Medicine blog. If you have not been to it, please go and take a look at the stories and other information compiled as a resource for you. It is initially focused on Covid, and, with luck, we will soon be able to turn to more mundane issues such as non-Covid learner education.
Additionally, we took advantage of an opportunity to stay true to our mission statement (Vision, Voice, Leadership) and weighed-in on a topic of national importance. We determined, after a long listserve discussion, that it was important for ADFM, as an organization, to comment on the impending health crises brought about by COVID-19 and the lack of leadership by policymakers. Based on our discussion, we took the lead in creating and disseminating a policy statement calling for urgent actions to reduce the spread of COVID-19 in order to protect the lives and safety of the public. This policy was signed by ADFM, STFM, AFMRD, NAPCRG, and ABFM and disseminated March 27th. Although small in numbers, we can have an outsized influence.
In summary, I could not be more proud to be a member of this organization. You have made a difference in untold ways both at the macro and micro level. To paraphrase a friend of mine, I am proud to call myself a family medicine chair because of my association with you.
Keep up the good work and stay safe,
February 3, 2020
Welcome all to 2020 - a new decade for ADFM!
The most important thing on our plate is having a smooth (and so far successful) transition in Executive leadership from Ardis Davis to Amanda Weidner. Ardis Davis and Jeff Borkan have a commentary coming out in this month’s Annals of Family Medicine about ADFM’s growth and evolution over the past 15 years under Ardis’ tenure as Executive Director and last month Amanda Weidner nicely articulated for us her immediate vision for ADFM in areas of membership, communication, and data.
To help with this transition, we are streamlining our communication efforts starting with this column. You will notice that the “What’s On Our Plate” Presidential comments are now incorporated into a regular Presidential column which will come out quarterly in the ADFM Newsletter.
As we start off this new year, below are a few highlights regarding what is on ADFM's plate as we enter into this new decade.
Highlights from the November Board Meeting
To continue the plate analogy, the November ADFM Board meeting was the meat and potatoes of the quarter. Key action of the Board included establishing a 3-year, renewable term for a Public Member on the Board (pending member approval) and formation of a standing strategic committee devoted to Diversity, Inclusion and Health Equity. Much Board attention was devoted to our strategic directions which you all will hear more about over the coming months in the form of webinars (e.g. this month’s webinars on telehealth), our Annual Conference (where we will feature our work on a Best Practice Guide for Student Choice of Family Medicine), an “opt in” consultation service around healthcare delivery efforts, expansion and revamping of our successful ADFM Leadership Education for Academic Development and Success (LEADS) fellowship with support from the American Board of Family Medicine Foundation, and growth and continued evolution of our Physician Scientist Pathway (PSP) program, in collaboration with the American Board of Family Medicine.
ADFM is Growing!
On our plate as well is making sure that our membership reflects the changing educational environment. The unit of Membership in ADFM is the Department and we are excited that we have received new Departments requesting to join ADFM in 2020. If all Departments from last year renew their dues for 2020 and all of the new Departments currently in the application process join, we will be at around 155 member Departments in 2020. There is a new policy taking effect this year which requires Department's to pay their Chair, Administrator, and Associate member annual dues prior to the Annual Conference, in order to open up registration for each category. This will help streamline both the dues and registration processes.
Our growth will increase the diversity of thought and experience present at our Annual Conference. In this vein, ADFM is working closely with the Council of Academic Family Medicine (CAFM) to be intentional about increasing our diversity in leadership in academic family medicine. All of the CAFM organizations have agreed to use their Member Profiles as a means to track diversity – you will note some variables we are tracking when you login to your profile to renew your Department's Membership (with Chair, Administrator, Associate categories). These data will help us track our progress as we continue to move forward with CAFM around this leadership initiative.
CAFM Education Research Alliance (CERA)’s Data Clearinghouse
As a reminder, in addition to the ability to submit questions for any of the CERA surveys (learn more here), ADFM Chairs and Administrators have access to the CERA Clearinghouse of data for use in promoting scholarly activity within each of your Departments. This is a direct benefit to ADFM as a member of CERA. You can access this Clearinghouse from the CERA webpage at stfm.org under “Past Topics and Data”. Data which have not been published from past surveys of Program Directors, Chairs, and Clerkship Directors are available for your scholarly work. New in 2020 will be data from surveys of residents and students.
External Reviews for Promotion
Always on our plate is helping you in your job as department Chair. You may recall the conversation thread in 2019 on our ADFM listserv regarding external reviews for promotion. The ADFM Executive committee discussed this in depth, as did CAFM (Council of Academic Family Medicine) and STFM (Society of Teachers of Family Medicine). There will be a breakfast session at the 2020 Annual ADFM Conference in New Orleans for those which wish to discuss further.
In the meantime, the Executive Committee has summarized the following as advice to those who are looking for Chairs and other Senior Faculty to help with writing letters for Promotion:
1) While ADFM does not directly facilitate finding reviewers, the best way to find reviewers is through networking at our annual meeting and being a member of one of our committees. While we realize this is playing the long game it does pay off with time.
2) In the short term it is helpful to develop relationships with colleagues at peer institutions of equal size and who have equivalent measures of scholarly activity (this may be a list that ADFM can put together). Finding external reviewers requires not only an equivalent rank but institutional equivalence as well.
3) Lastly, equivalency should take into account academic pathway. Be aware that what is called a clinical professor in one institution may well be an educational track in another (as one example).
Resources available to ADFM as Inaugural Member of Societies Consortium on Sexual Harassment in STEMM
In February 2019, ADFM joined the Societies Consortium on Sexual Harassment in STEMM. We are the only family medicine organization as yet to have to do so. As a result, we will have access to resources made available to “members only” before going public. As of now, the resources center mostly around drafting organizational policies (e.g. honors and awards policies) – but we expect the list of resources to grow over time. We will keep you all informed as to useful policies and resources we encounter through our participation in this important work.
Nominations Committee Appointment.
Just before the holidays, the ADFM Board approved the appointment of Amy Keenum, DO, to the Nominations Committee. The current composition of the Nominations committee is:
Kevin Grumbach, MD
Deborah Clements, MD
Joseph Hobbs, MD
Amy Keenum, DO
Gary Shokar, MD
Barbara Thompson, MD
Liaison/Past Committee chair
Valerie Gilchrist, MD
Staff (Ex-Officio) Amanda Weidner, MPH
ADFM and Advocacy around social issues.
We enter into this 2020 election year with much division within our communities. I want to remind you again that ADFM is ideally positioned to amplify the academic and fellow specialty organizations’ (e.g. AAFP, AAMC) positions on issues germane to the broader health of our patients (e.g. gun safety, separation of families, climate change as a public health concern). We will continue to “push out” communications about these issues. We do this for two reasons: a. To facilitate conversations among faculty and staff in your departments; and b. to help you and your faculty to engage students through your FMIGs. Medical students are now concerned about social justice. Family Medicine’s engagement in issues impacting the health of our communities is broad and deep. Please make sure students are made aware of this In his meeting with the Board, Scott Shipman of the AAMC informed us of the importance of these issues going forward. He called our attention to the thoughts of AAMC CEO, David Skorton regarding healthcare implications of terminating DACA and gun violence. We will have a session on how to incorporate and facilitate challenging conversations within your Departments around polarizing issues that affect our patients’ health at the 2020 Annual Conference.
Speaking of the Annual Conference, don’t forget to make reservations at your favorite New Orleans restaurant, bring your dancing shoes for Ardis Thursday, or read The Health Gap for Sir Michael Marmot’s talk on Friday.
I am looking forward to seeing many of you in New Orleans!
Allen Perkins, MD, MPH