Erica Swegler's address to AAFP Congress of Delegates during the election for AAFP President-elect

Tags: AAFP President-elect, Swegler

By Erica Swegler, MD

Hello friends and colleagues spread across the country, I bring you greetings from Austin, Texas. I'd like to begin by expressing my profound gratitude for the opportunity to serve these past three years on your board of directors. It has been a distinct pleasure to work alongside such a dedicated group of physicians, furthering our agenda of health care for all, fighting for more comprehensive payment for the care we provide, and prioritizing diversity and a more equitable health care system.

But I must admit, as I stand here looking into this lens, I really wish we were all together right now! Of all the things I love about the Academy, one of my favorites is being at these meetings surrounded by our colleagues, all those smiling faces, the handshakes and the hugs, engaging in civil discourse and disagreements, but leaving as friends. We will be together again, and when we are, it will be wonderful.

So much has changed since the novel coronavirus hit our shores. It has changed how we care for our patients. It's changed how we interact with friends and family. It's changed how we debate and set policy, and how we do the important work of the Academy.

Amidst all this change, I find I'm inspired by the opportunity we have to imagine a better, more equitable health care system. A system built on primary care. A system that truly rewards the continuous and comprehensive care we provide. A system that can reduce overall health care spending while investing more in primary care. And a system that can prepare us for future public health emergencies. We have an opportunity, like never before, to use our stories and our experience as Family Physicians to move our agenda forward.

The past several months have been perhaps the most difficult of my career, and I know that's true for many of our members. Many of us have had patients fall ill with COVID-19 and suffer, we've seen some die, and we've seen their families grieve.

As an independent, solo family physician, I, like many of you, have had my practice upended. Our patient visits evaporated overnight and our revenue withered. We scrambled to piece together makeshift PPE and to find testing supplies.

The pandemic forced us to make some very difficult decisions, but we never gave up. We did what any family doc would do — we adapted, we transformed and we improvised. We began providing telemedicine. We obtained PPP funding and made our lean practice leaner. We kept our doors open so we could be there for our patients.

The power of my story and countless others like it is not that we survived, but rather how years of underfunding our primary care and public health system led to this. Our health care system failed us at the moment we needed it most to protect us and to serve our patients. We must use our stories to effect change and reinforce the need for a primary-care-based system of care.

This pandemic has revealed in stark relief the fissures and cracks in our broken health care system. It has also crystalized our need to transform the way we pay for primary care services. During the first wave of COVID-19, practices that depended on patient volume were crippled financially. But physicians operating under prospective payment remained viable and nimble in the care they provided.

I will continue to fight for a model that appropriately values family physicians while unburdening us from the administrative hassles of the fee-for-service third-party insurance scheme. We must seize this opportunity to align our forces and demand change. It is time to leave behind a flawed RVU system and adopt alternative payment models for primary care.

The pandemic has also laid bare the undeniable racial and ethnic inequity endemic to our health care system. People of color are experiencing higher rates of COVID-19, which sadly mirrors longstanding disparities in rates of maternal mortality and chronic disease. Through this pandemic, we see clearly how our health care system fails to address social determinants of health. I am reminded about my patient, Mary, a 72-year-old Latin-x woman, still working as a nurse's aide in home health, referred to me by her hepatologist. She was jeopardizing her place on the liver transplant list because her diabetes was so poorly controlled. In getting to know her, the reason she was "non-compliant" was she could not afford her insulin. No one had previously asked her this.

I will continue to prioritize AAFP's Center for Diversity and Health Equity and The Everyone Project, which have played an important role to promote health equity and address social determinants of health, but as America's family physicians, we can and must do more, delving down to where people live, work and play.

There is another inequity we must address. In the third decade of the 21st century there is absolutely no reason why female physicians should make 25 to 30% less than their male counterparts for equal work. It is time we abolish the gender pay gap for good and move forward together as equals. EVERYONE.

I have always been guided by Barbara Starfield's four Cardinal Cs of Primary Care: first Contact accessibility, Coordination, Comprehensiveness, and Continuity.

In service to AAFP and to our specialty, I pledge my own four Cs: critical thinking, my ability to serve as a catalyst, challenging the status quo, and creating solutions to forge paths forward.

It is only by the grace of God and financial help from family and friends that my essential business, worth 4 million dollars to the local economy and worth everything to my patients, still exists today. I look forward to the day I need not look at my business bank balance first thing when I wake up to see if I am still solvent, but can focus again on the real reason I go to work each day, to SERVE my patients.

We'll get through this difficult time, and we'll come together again, and we'll shake hands and we'll hug one another. Together, we can rebuild our health care system from the ground up, with access and equity for all.

I'm Erica Swegler and I ask for your vote for President-elect.


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