structures underpin processes that beget outcomes. As we see many structural foundations of science and medicine dismantled around us, the future looks grim for many processes and outcomes to which our profession has become accustomed. But out of crisis rises opportunity, and if we family docs want things to change, now is a tantalizing moment to engineer it. That work was well displayed at this year’s AAFP COD in Anaheim, California. Two reflections on this year’s Congress come to mind. First, the energy in the room was different than when I was a delegate for our state two years ago. While there was always a sense that the work of the COD was important, this year it held more gravity and urgency than before. As part of the usual opening rounds of business, Speaker Russell Kohl of Missouri called for any late resolutions to be presented. Because they have not undergone the procedural scrutiny of the regular resolution submission process, late resolutions can be an eclectic mix of urgencies and imperfectly reasoned desires. This year was different. There was only one late resolution brought before the congress: an ask by Dr. Steven Furr, past AAFP president and family doc from Alabama, to include healthcare work as an independent risk factor for infectious diseases due to repeated pathogen exposures, thus allowing healthcare personnel without other conditions to have access to any available immunizations, personal protective equipment and pre/post exposure prophylaxis. In a year when writing prescriptions for COVID shots took up greater than zero hours of physician time, I not only appreciated the spirit of Dr. Furr’s resolution, but also how it highlighted that organizations matter. When healthcare workers are facing barriers to their own safety, a policy statement from a major national physicians’ organization, such as the AAFP, can help them push back. The second reflection that made an impression is that if we physicians want the healthcare system to change in a way that supports our patients’ health and our role therein, using our professional societies to get there makes good sense. Management strategist and Harvard Business School professor John Kotter famously outlined an eight-step model for episodic change management. (See Miles et al., 2023, PMID 36817526, for an accessible description of the model and how a GME program utilized it for candidate recruitment.) I’ve listed the first four steps below, along with how current events and the AAFP’s existing infrastructure already put us halfway to major change. The First Four Steps of Kotter’s Model for Change Management 1. Create a Sense of Urgency: Current events have already done this. 2. Build a Guiding Coalition: The AAFP’s leadership and influential groups. 3. Form a Strategic Vision: The work of the AAFP COD. 4. Enlist a Volunteer Army: All of us as the membership of the AAFP. The remaining four steps — enable action by removing barriers, generate short-term wins, sustain acceleration and institute change — are still works in progress. However, if we want a future healthcare system that works for us rather than against us, family physicians are well-positioned to drive that change. Newly sworn-in AAFP President, Dr. Sarah Nosal, gives her president’s address. 14
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