BACKGROUND:Women physicians face multiple systemic and social biases in the clinical setting that erode mental and physical well-being. Gender-based discrimination was reported by 76% of early-career women physicians, decreasing to 57% for mid-career, and 36% for late-career. While these trends suggest that these biases may diminish with career progression, they remain a persistent burden of women physician's careers. This article offers a unique contribution by centering early-career women family physicians, a group underrepresented in qualitative research on workplace bias. This article focuses on participants' microaggressive experiences in the clinical setting to better understand the biases they face. METHODS:Via email we recruited 25 geographically and racially diverse early-career women physicians who responded to the 2021-2023 American Board of Family Medicine National Graduate Survey. A semi-structured interview guide was developed following a life-history approach to better understand the transitionary phase from residency to the practicing workforce. Interviews were transcribed verbatim, cleaned, and analyzed via Inductive Content Analysis in NVivo by qualitative researchers. RESULTS:We identified three main themes that emerged from the data. First, biased communications within the clinical setting exposed a pattern of gender bias. Second, patients invalidate physicians' positions based on appearance and perception. Third, women physicians described navigating the emotional and psychological labor of clinical and societal expectations. CONCLUSION:In the context of primary care, microaggressions demand direct and intentional intervention. Failing to address these experiences jeopardizes both equity and workforce sustainability. Leadership must be equipped to recognize, interrupt, and respond to microaggressions-not only to support individual clinicians but to strengthen organizational culture and the broader primary care mission. Interference reflects the broader societal imperative and commitment to equity in healthcare.
INTRODUCTION:Clinicians require concise, accurate summaries of new research to inform practice. Patient-Oriented Evidence that Matters (POEMs), published in American Family Physician, are a benchmark for summarizing primary literature in family medicine, while large language models (LLMs) offer scalable summarization but require rigorous evaluation. The objective of this study was to evaluate the accuracy and quality of summaries generated by large language models compared with expert-authored POEMs. METHODS:In this study, we compared LLM-generated summaries (Microsoft Copilot, GPT-4o class) with 24 recent matched POEMs using a standardized prompt. Two trained raters independently scored each summary with a 13-item tool (score range 0-13), cataloged errors, recorded word counts, and indicated preferences on a 5-point scale. RESULTS:LLM summaries outperformed POEMs in total score (mean 12.1 vs 10.6; mean difference 1.5, 95% CI 1.1-2.0; P < 0.001), with similar lengths (328 vs 353 words; P = 0.23). Errors occurred in fewer LLM-DOCSs (2/24) than POEMs (9/24), with a mean error score difference of 20% (95% CI 7% -33%; P < 0.001). POEMs most often missed in the categories Contextual Background and Limitations; both approaches frequently missed in Clinical Applicability. Reviewer preference favored LLM-DOCS (mean 2.44 on a 1-5 scale; 95% CI 2.1-2.8). CONCLUSIONS:An enterprise LLM, prompted in POEM style, produced accurate, low-error clinical summaries that matched or exceeded expert-edited POEMs and were generally preferred by reviewers, though further research is needed to assess broader applicability and impact. Findings support pragmatic LLM-assisted summarization and highlight the need for standardized evaluation tools and explicit prompts for clinical applicability.
A commonly used GLP-1 agonist, semaglutide, reduces the risk of adverse cardiovascular outcomes in non-diabetic individuals with obesity and pre-existing cardiovascular disease.
Comprehensiveness has long been a defining principle of family medicine (FM), and a reason that primary care delivers better outcomes at lower cost with greater equity. Yet rising patient complexity, narrower scopes of practice, workforce strain, and misaligned payment and credentialing systems have made sustaining traditional "full-basket" care increasingly difficult. In 2025, the Family Medicine Leadership Consortium convened a national dialogue to examine whether and how the discipline should reaffirm comprehensiveness as its core organizing principle. Participants agreed it remains essential to family medicine's identity and public value but emphasized the need to redefine it for modern realities, balancing breadth and depth of care, recognizing limits on individual physicians, and shifting accountability toward interprofessional teams and broader care ecosystems. The envisioned next-generation model situates comprehensiveness across the clinician, team, practice, and community levels, supported by longitudinal relationships, team-based care, and enabling technologies such as artificial intelligence (AI). This reconceptualization offers a framework for training, workforce strategy, measurement, and payment that preserves family medicine's generalist identity while advancing access, quality, equity, and sustainability.
BACKGROUND:Loneliness has increased in recent years and is associated with poorer physical and mental health outcomes. While much research has focused on older adults, to date there has been limited research into loneliness in young adults who have the highest rates of loneliness. This study explores loneliness rates among subgroups of emerging adults ages 18-25. METHODS:A cross-sectional survey was conducted in a large primary-care health system in Washington State. RESULTS:Out of 243 emerging adult respondents, 136 (56%) reported experiencing loneliness. Bivariate analyses showed no significant difference for racial/ethnic minorities, while women and nonbinary individuals were significantly lonelier than men (P = 0.03), sexual and gender minority (SGM) groups were lonelier than heterosexuals (P < 0.01) and single individuals were lonelier than those in a relationship (P = 0.02). In a logistic regression model (R2 = 0.11), SGM individuals had OR = 2.01 of loneliness compared to heterosexuals (95% CI = 1.09-3.75; P = 0.03) and individuals in a relationship had OR = 0.37 compared to single individuals (95% CI = 0.20-0.66; P < 0.01). DISCUSSION:These findings show that it is feasible to identify emerging adults with loneliness and demonstrate the need for targeted loneliness interventions in primary care settings to reduce health disparities among this demographic group.
INTRODUCTION:Artificial intelligence (AI) and machine learning are increasingly used in dermatology, primarily for diagnosing skin cancer and classifying disease severity. Primary care providers (PCPs) and emergency physicians have higher error rates in diagnosing dermatologic conditions compared to dermatologists. This study evaluates the performance of an AI-driven dermatologic image analytics tool in identifying common skin disorders from classical images used in medical education. METHODS:This prospective study analyzed 42 classical images of common skin disorders using the bellePro application (version 2.1.0; BelleTorus Corporation), trained on over 400,000 dermatologic images. A set of dermatologic images used in a national board review course underwent blinding and independent validation by an academic dermatology department. This module provides AI-powered predictions from cell phone photos, ranking them by "image match scores" (higher values indicate better predictions). The primary outcome was the accuracy of three image predictions in identifying known diagnoses, along with the corresponding image match scores. RESULTS:The AI tool correctly predicted 38 out of 42 skin disorders (positive predictive value was 90.5%) as the top differential on the first attempt for all three attempts. Four conditions (angioedema, squamous cell carcinoma, hand foot and mouth disease, and chickenpox) were included in the prediction differential list each attempt but never ranked first, bringing the total to 42/42 (100%). None of the correctly identified disorders had an average image match score below 0.64. The average image match score for correct diagnoses was 0.896 (SD = 0.098). CONCLUSIONS:The findings suggest that this AI-based dermatologic image analytics tool performs effectively on classical images of common skin disorders typically seen in clinical practice. This has potential to serve as an adjunct for providers to improve patient outcomes in environments lacking timely access to dermatology resources.
In August 2025, leaders from family medicine organizations and representative patient stakeholders met for discussions regarding the evolution of the clinical model for family medicine. Performance improvement (PI), long a part of the continuing board certification process, was among the topics discussed. Pockets of concern or confusion remain about the relevance, importance, practicality, and administrative burden of PI for practicing family physicians. This discussion paper summarizes concerns about PI as commonly currently operationalized and outlines the rationale for inclusion of PI in the clinical model of family medicine. It outlines opportunities for the progression of PI to become less single-disease metric focused to practically focus on team-based care, complexity, and patient-centered outcomes, while accounting for the variety of contexts in which family physicians practice.
Family physicians should be providing care for hospitalized patients. This fulfills part of our mission and opens opportunities for us to improve patient care and metrics, advance in leadership, teach residents and medical students, and influence and do research; caring for hospitalized patients also brings value to the patients, the system, and family physicians generally. Some of the value we bring to hospital-based care includes addressing workforce shortages, continuity across care settings, cost-effective and high-value care, educational impact, enhanced career satisfaction, flexibility in career options, holistic patient care, improved health outcomes, support transitions of care, training and professional growth, and versatility and breadth of training. The question is not if we should deliver hospital-based care, but rather how we should deliver it.
This commentary examines the implications of the Community Health Worker (CHW) Access Act introduced by Congress. If passed, primary care practices would be able to receive reimbursement for CHW services. CHWs are lay members of the community that help people address the social determinants of health, understand their health, and get the health care they need, especially in communities where resources are scarce. They have been shown to improve health outcomes, yet many serve in unpaid positions and their services have not been readily reimbursable in the healthcare system. We highlight the potential of the Bill to facilitate the uptake of CHWs in primary care. This is particularly important at a time when the provision of primary care is scarce. We examine the potential and pitfalls of the Bill and recommend implementation strategies to support the uptake of CHWs into primary care. This commentary aims to inform stakeholders about the Bill's broader impact on primary care and future CHW sustainability.
Family medicine takes a whole-person, contextual approach to patient care, and understanding community context is important. The Centers for Disease Control and Prevention (CDC) definition of community, "a group of people with diverse characteristics who are linked by social ties, shared common perspectives and identity, and engagement in joint action," provides a broad conceptual framework. While community service doesn't have a standard definition, many physicians and residency training programs incorporate such activity into practice and training. Community engagement consists of ten key principles framing public health and programmatic involvement in improving the health of a community. Despite the importance of understanding the community in practice, true community engagement for contemporary family physicians, given panel size, visit volume, and documentation burden, is unrealistic as a core part of the work of most practicing family physicians.
BACKGROUND:Virtual scribe services are increasingly utilized to reduce documentation burden and mitigate clinician burnout. While evidence supports their positive impact on clinician wellness and productivity, the effect on patient experience has not received as much attention. We hypothesized that clinicians using virtual scribes would demonstrate improved patient satisfaction scores due to enhanced face-to-face interaction during visits. METHODS:Using a pre-post design, we analyzed patient satisfaction data for 81 primary care clinicians utilizing asynchronous virtual scribe services (two different vendor programs) within a large integrated health network in Eastern Pennsylvania. Patient satisfaction was measured using four vendor-administered questions assessing overall rating of care, likelihood to recommend, clinician listening, and trust. Pre-implementation scores (6 months prior to scribe utilization) were compared to post-implementation scores (months 3-9 with a scribe service) using related-samples Wilcoxon signed-rank tests. RESULTS:Statistically significant improvements in patient-reported satisfaction metrics were observed in overall rating of the visit (P < .001) and trust (P = .012). Likelihood to recommend and listening showed positive trends but did not reach statistical significance (P = .086 and P = .705, respectively). CONCLUSION:Virtual scribe implementation was associated with significant improvements in patient-reported overall experience and trust in their clinicians. These findings suggest that reducing documentation burden may enhance the patient-clinician relationship, providing additional justification for scribe investment beyond clinician wellness.
Britz et al present an important contribution to the understanding of primary care capacity by identifying all Primary Care Physicians (PCPs) in one state and quantifying their patient panel sizes. Their findings, showing median panels between 1196 and 1290 patients, provide critical insight into how many individuals each PCP can realistically serve amid a national primary care shortage. This commentary explores emerging trends that may reshape how ideal panel size is defined in the future, particularly the increasing integration of non-physician providers, digital health platforms, and artificial intelligence (AI) tools. Technologies such as ambient dictation, automated order entry, and AI-driven patient messaging can reclaim valuable clinician time and help mitigate burnout, potentially allowing physicians to manage larger panels. Likewise, wearable sensors, virtual visits, and non-traditional care outlets such as retail clinics and urgent care centers offer additional opportunities to expand system-wide capacity. However, these efficiencies must be balanced against current capacity issues in primary care, including potential added monitoring workload, increasing complexity of patients, as well as currently over-burdened primary care practices due to administrative burden and high volumes of patient messaging. Future studies are needed to determine whether these innovations truly expand capacity or simply redistribute effort within the evolving ecosystem of primary care.
OBJECTIVE:Continuity of care with a primary care physician is critical for appropriate healthcare utilization, particularly among seniors with complex health needs. This study examines the association between the length of care continuity and the usual place of care for minor health problems, focusing on emergency department (ED) use. METHODS:Data were drawn from the 2019-2020 Canadian Health Survey on Seniors (CHSS), a nationally representative 15-minute supplement to the Canadian Community Health Survey (CCHS) for Canadians aged 65 years and older. Of 245,639 selected households, 100,797 individuals responded to the CCHS (41.0%), and 41,635 of 45,863 eligible respondents completed the CHSS (90.8%). Minor health problems or nonurgent conditions were defined as self-reported difficulties accessing immediate care for issues such as fever, vomiting, headaches, sprains, minor burns, cuts, rashes, or other nonlife-threatening conditions. A multinomial logistic regression model examined the association between continuity of care (< 1 year, 1-< 2 years, ≥ 2 years, or no regular provider) and usual place of care, adjusting for demographic, socioeconomic, health, access, and provincial factors. RESULTS:Among 41,060 seniors, most reported having continuity of care with a primary care physician for two years or more. Males and those reporting poorer health were more likely to use the ED for minor problems, whereas individuals with higher income or education more often sought care at a doctor's office. Longer continuity of care was associated with lower odds of ED use for minor problems, with consistent effects in both unadjusted (coef. = -0.251, P < 0.001) and adjusted models (coef. = -0.086, P = 0.083). Other determinants, including income, access to care, and province, also influenced care location. CONCLUSION:Longer continuity with a primary care physician is associated with reduced ED use for minor health problems among seniors. These findings highlight the value of sustained patient-provider relationships in promoting appropriate care utilization and alleviating pressures on emergency departments.
BACKGROUND:Half of the women who develop cervical cancer in the US have never had a cervical cancer screen. Self-sampling is an equivalent technique to the invasive speculum exam. We aim to evaluate the current knowledge, attitudes, and behaviors toward self-sampled primary HPV testing in family medicine. METHODS:The annual cross-sectional survey of the Council of Academic Family Medicine's general membership included knowledge, attitudes, and beliefs about primary human papillomavirus (HPV) screening using self-sampling. The knowledge questions were based on current guidelines, as defined by the 2024 United States Preventive Services Task Force (USPSTF) 1. The attitude and belief questions were based on the Question-Behavior Theory 2. All surveys were emailed to the membership with up to five weekly reminders to complete. RESULTS:We had a 62% survey response rate with 744 respondents. Regardless of demographic descriptors, all respondents significantly changed their intended behavior regarding offering self-sampling for cervical cancer screening (p < 0.001). Of those with a baseline attitude of not offering self-sampling, 88% changed their response to offer self-sampling at the end of the survey. Baseline knowledge of the advantages of primary HPV screening was lowest among underrepresented minority Hispanic respondents (52% correct, compared to 80% among Whites, p < 0.001). Women respondents were 2.96 times more likely to intend to offer self-sampling for cervical cancer screening than men (OR 2.96 (95% CI: 1.18, 7.44, p<0.05). CONCLUSIONS:Based on the Question-Behavior Theory, over 90% of family medicine educators intend to offer women self-sampling for cervical cancer screening.
PURPOSE:Studies have shown that facilitating patient dialogue through a structured question prompt list (QPL) during patient encounters results in greater patient engagement, improved communication and increased patient understanding. Topics most interesting to patients are unclear, thus limiting how to optimally design and use QPLs. This study identified topics most interesting to patients to discuss with their clinicians in primary care office visits. METHODS:We collected responses to a 20-item visit guide including questions to ask, concerns to tell, and positive behaviors to report. We focused on the ask and tell sections which involved general questions and concerns patients could choose from. Participants were 50 years or older and taking 5 or more medications at family medicine clinics from a public safety net hospital system (240) and an urban private practice (211). RESULTS:Of 451 visit guides collected, the selected top topics involved: 1) Diet (20.4%), 2) Taking fewer medications (15.3%), and 3) Understanding their condition (14.6%). The most common medication concerns included: 1) stopping or skipping medications due to cost, side effects, or other reasons (11.1%), 2) medications from multiple doctors (8%), and 3) specific concerns about medications (5.7%). CONCLUSIONS:Patients reported interest in discussing questions and concerns related to diet, reducing medications, and self-care knowledge on their conditions. The questions and concerns identified in this study provide insight into the communication priorities of older adults managing multiple medications. These findings can further inform the future development of QPLs and therefore potentially reap the benefits of improved clinician-patient communication.
PURPOSE:There has yet to be a comprehensive multi-state study describing the children that use school-based health centers (SBHCs). This study seeks to determine sociodemographics, care utilization patterns, and prevalence of asthma and overweight among children seeking care at SBHCs. METHODS:This retrospective cross-sectional analysis examined electronic health record data of children utilizing SBHCs within a large network of community-based clinics, consisting of 180 SBHCs in 14 U.S. states from 2012-2018. Demographics of exclusive SBHC users (SBHC-only group) were compared to utilizers of SBHCs plus non-SBHC community health centers (SBHC+ group). RESULTS:Of 179,970 children with ≥1 ambulatory visit at a SBHC, 75.6% received care exclusively at SBHCs. Many SBHC-users reported family income <138% of the federal poverty line (48.9%) and self-identified as Hispanic (45.7%). Among SBHC utilizers, the prevalence of asthma (8%) and overweight (30%) were comparable to national statistics. Overall, 33% of children received well-childcare and 24% received influenza vaccinations exclusively at SBHCs. When comparing the two groups within the study, the SBHC-only group were older, and more lacked insurance (13.4%) compared with SBHC+ children (2.6%). The SBHC-only group had fewer total yearly visits, fewer yearly well-child visits, and fewer influenza vaccinations. In age stratified groups, preschool-aged children received the most well-childcare and influenza vaccinations in SBHCs. CONCLUSIONS:SBHCs serve a pediatric population that is disproportionately low-income, uninsured, and Hispanic. Children, particularly preschoolers, receive preventive healthcare at SBHCs. Given the population served, SBHCs have strong potential to address pediatric health inequities if adequately resourced, utilized, and integrated with other facilities including community health centers.
The increasing advance of artificial intelligence (AI) in medicine will affect the future of Family Medicine in many ways. Some of the effects may be salutary, but others may infringe on the real work of family medicine/primary care. AI will change the way we experience practice. If AI can perform many current physician tasks, what will be left for the practicing human family physician? We believe that there will be several types of patient encounters that will still require the human touch that comes from established long-term continuous healing relationships between family physicians and their patients. As AI applications in primary care become more robust it will assume the function of a new member of the multi-professional healthcare team, and physicians will learn to operate in a new triad: the "doctor-patient-AI partner relationship". We explore possible further effects on the practice of family medicine under these new AI-enhanced circumstances and contemplate their impact on the current gap in primary care availability, continuity of care and the attractiveness of primary care careers. As we pass through this potential "hard fork" for family medicine we are convinced that family medicine is the most likely component of the healthcare system to survive and prosper with AI.
