Elevating Family Medicine Is Key for New AAFP President

On September 25, family physician Jen Brull, MD, was sworn in as the new president of the American Academy of Family Physicians (AAFP). MedPage Today Washington Editor Joyce Frieden talked with Brull about what her priorities are and what challenges and opportunities she sees ahead. The interview, which was conducted online with a public relations person present, has been edited for length and clarity.

Tell us about yourself. How did you end up becoming a doctor?

Brull: I grew up in Kansas — where I lived until just a year ago — and chose medicine pretty early, while I was still in college at the University of Kansas, in Lawrence. I went to medical school right out of college, at the University of Kansas in Kansas City.

Then I did my residency in Topeka, and then went back to the western part of the state where I had grown up and spent about 20 years in private practice, in a little tiny community called Plainville, Kansas, with about 2,000 people. I was in my own practice, but partnered strongly with four other family physicians who had similar small or solo practices, and we took care of most of the people in the county. And because there is a paucity of primary care access in the rural [areas] — but especially Kansas — we had people who came from neighboring counties everywhere. The group that we took care of was about 10,000 people.

I moved from that lovely place to Fort Collins, Colorado, last August. I’m now the vice president of clinical engagement for a company called Aledade, which helps independent primary care practices across the United States form value-based care arrangements. It’s lovely in that it is a remote role, so all of those days that I’m on the road, I’m able to work on airplanes and in hotels. It’s very different than a practice-based role where I would need to be home to see patients. My kids are all grown and flown, so I don’t have any small ones that I need to worry about at home. And my husband is one of the most amazing humans I know, and absolutely is a critical partner in being able to hold all of these things and do them all.

And how did you end up choosing family practice as your specialty?

Brull: My mentor in college was a pediatrician, and I actually went to med school thinking that I, too, would become a pediatrician, to the point that I was the president of the pediatric interest group my second year. In my third year when I arranged my rotations, family medicine ended up being my first rotation, and I got to my first day with another family physician who became a mentor to me. And on that first day, we saw kids — that was awesome. We also saw adults, pregnant people, people in acute need, and people with chronic health conditions. We delivered a baby that day, which was so unique — it turns out [my mentor’s] practice had a strong obstetrics component. We took off a mole. And at the end of that day, I realized I love primary care, and I love all ages, and so I actually changed to family medicine at the end of that first day of my first clinical rotation, when I knew that I wanted to do this.

When did your involvement with the AAFP begin?

Brull: My AAFP journey began at a conference that is currently called the National Conference of Constituency Leaders. It is a conference designed to engage the voices of family physicians who are underrepresented in leadership in the academy. So there are various constituencies; I went as a member of the New Physician constituency for the first year I went. I have subsequently gone as a member of the LGBTQ Constituency and of the Women’s Constituency. They are all constituencies underrepresented in our leadership.

In the hallway on the first day, someone walked by me and said, “You should run for something.” Little did I know that person was the convener of the meeting, and said that to basically everyone! But I took it as a directive, and I ran for the New Physician delegate spot, and won that year, and got sent to the AAFP Congress of Delegates, and fell in love with the process of setting policy for our academy and the representation that family physicians gave in that space.

Then I did the leadership track for my state, and served as the president of my state [chapter], and then went on and was the president of our foundation board for about 12 years. And I was a delegate for my state, and that’s where the AAFP leadership came from — really seeing what the board was doing and how they took the policy that the Congress of Delegates set and put it in motion for our academy.

In 2020 I made the decision to run for the board. I was the first class elected in a virtual meeting. In the first year and a half of my tenure on the board, I served completely virtually, which was very interesting. And then last year, at this time, I ran for the president-elect role for our academy, and won that election, and now I’m serving as the president.

You mentioned being a delegate for the LGBTQ Constituency back in the early 2000s. Are you a member of that community?

Brull: I am not. I joined the constituency as an ally, and it turns out I have three wonderful children who all identify somewhere in those letters, though that was long after I served as a representative. Back then, there were not a lot of physicians who were sharing that personal information about themselves — it was certainly a different time and place — so it was also a space for allies that constituency of physicians and patients.

The constituency leaders’ conference is composed of these groups: New Physicians, Women, International Medical Graduates, BIPOC Physicians, and LGBTQ Physicians. The delegates at that meeting elect delegates to the AAFP Congress of Delegates. Interestingly enough, our membership data tell us that conference is successful, as we have seen underrepresented groups become much more significantly represented in our leadership at all levels — chapter presidents, delegates, commissions, the board, all of those things. We have seen the impact of that meeting improve representation across all groups. And if you look at a picture of our board this year, you will see that we are majority women, which is exciting. I think that’s the first time in the history of AAFP that the majority of board members have been female.

When I interviewed [then-AAFP president] Steven Furr, MD, last year, he listed three top priorities: expanding the family physician workforce, improving reimbursement for physicians, and reducing hassle factors and administrative burdens. How are things going on in those fronts?

Brull: The exciting news is that we did make progress on all three of those fronts in the last year, and I was privileged to be part of the group who created AAFP’s new strategic plan for the next 3 years. I’m going to give you our four priorities.

The first is elevating family medicine, which means ensuring that family doctors are in every conversation about the health of the United States. It’s very clear that when primary care is involved, outcomes are better and costs are lower. So people should be looking around the table and saying, ‘Where’s our family doctor in this space?’

Priority two is enhancing well-being — which is not just about reducing administrative burden, although that is included in this sphere — but it’s also about helping family physicians find fulfillment in their careers and lives, which involves work/life integration.

The third priority is improving systems — and by systems I mean things like the system in which you operate to get paid. Is it value-based care? Is it fee-for-service? Is it direct primary care? We need to make sure that systems support family medicine, regardless of where a family physician chooses to practice or how they choose to practice.

And the fourth priority is about really strengthening our future, and that’s that pathway tactic that Dr. Furr talked about — making sure that individuals from communities have a path to become family physicians, and that family doctors look like the communities they serve, because we have really strong data that when that happens, health outcomes are better.

Can you give an example of work that the AAFP is doing in one of these areas?

Brull: We do a lot of policy and advocacy work around payment — things like the G2211 code [for complex, high-value visits] that we worked very hard last year to get implemented, and the changes that we’re working on right now in terms of the way that that’s paid and who pays that code. We’re also advocating for change in the care space, promising models like the [CMS] Flex model and REACH, which look at how we can do prospective payments to physicians and move away from fee-for-service and into this idea of payment for value-based care.

What about another payment issue that seems to come up every year — the proposed cut to payments under the Medicare Physician Fee Schedule?

Brull: That’s absolutely on our lobbying and advocacy radar. It’s very, very clear that physician spending is not the problem in healthcare. Physicians across the board should get a raise from Medicare, and that is part of our advocacy in the coming year.

Do you favor an annual inflation-based adjustment in Medicare physician pay?

Brull: I think that there are several paths we have that might get us to a place of better payment stability for family medicine, primary care writ large, and physicians writ large. So I would hesitate to comment on the specific strategy, because that’s what our amazing team in D.C. does — figure out what legislation is on the dock that we could partner with, collaborate with, and we tend to try not to limit ourselves to the possible scope.

This is an election year, and healthcare is again in the spotlight. What stance is the AAFP taking on issues such as state abortion bans and restrictions on transgender care?

Brull: We consistently oppose any legislation or regulation that interferes with the confidential relationship between a patient and a physician, and the provision of evidence-based patient care for any patient. So whether we are talking about gender-affirming care or abortion or we are talking about prescribing a medication for weight loss, these are all spaces that legislation has tried to get in the middle of. We believe strongly that any laws that get between that physician-patient relationship or that interfere with the practice of evidence-based medicine should not exist.

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