October 7, 2026 Salus Forum

Bill G

I’ll chime in and ask Warren a question. Despite all the dedication they’ve shown to progressing in leadership, what has the board done in terms of redefining family medicine as something other than family medicine? There’s obviously a great deal of literature about primary care and the need of primary care. However, very little coming from the board assesses where the board is going beyond primary care. There’s quite a bit of reference to the important discussion on the board about what goes beyond primary care. If primary care is really the integration of multiple specialties dealing with the same elements of primary care, how do we redefine family medicine as primary care?

Warren

Let me give a partial answer, maybe two-step answer. I always think of primary care as functions. They are access and continuity, and comprehensiveness and coordination. Excuse me, and any provider can do that. We’ve done a lot of work with insurers, for example, to begin getting payment for continuity in California. As you may know, we’ve got 3 million covered lives. We’re hoping to get others there. The insurers are going to begin paying for continuity. I think in primary care nationally, we’ve decided that we have what is driving so much policy right now. Although unrecognized are problems with access. And so the focus will be on relearning open access, if you will, and then saying access to continuity and really pushing the comprehensiveness. All those things are sort of supporting a primary care function. And the reality, of course, is it’s mostly going forward in family medicine. And that’s a workforce issue that some of you have been involved with.

The other part of your question, if I’m hearing it right, is how do you get into population health? Is that primary care? We have at this stage a large collaborative of healthcare systems. We call it MP3. It’s always a challenge regarding how you develop acronyms, but that stands for making primary care primary for population health.

And so that’s where we are now. It’s about 7,000 family docs and a total cap of about $120 billion. The spirit which makes these things different is that the primary care service lines are family docs. And so we are working on our first publication, two publications. One is to describe the network. The Second is to say what are metrics for access and definitions of teams, and also continuity and benchmarks. We’re working on that. Does that get you to population health? (As you can appreciate, there’s a lot of different definitions of population health, but that’s where they are going with that.

Bill B

Warren, you were suggesting that leadership development often takes place, not by didactic training, but by reflection on and improvement of one’s practices. Three things came to my mind. First, it suggests that some of the best leadership development doesn’t occur for someone early in their career. Rather it occurs repeatedly during someone’s career. The co-author of a book I wrote always said, “you have people who are theory rich and experience poor, and you have other people who are experience rich and theory poor”. So, what we’re maybe talking about is leadership development that occurs throughout the lifetime of a physician.

Secondly, it’s really about articulating the theory that goes with identifying and appreciating effective moments of leadership. Often what becomes helpful in leadership development is helping people appreciate moments when they’ve been very effective in a leadership role. In a leadership development program, you help them provide an articulation of that and a label.

And third, do it in teams. This third thing goes back to this wonderful wisdom that was imparted by this guy named Warren. who in the previous forum, from out of a hospital bed imparted this wisdom. He said a lot of this stuff occurs when people are in teams. What seems to be applicable here is the suggestion that people go through leadership development in teams. They’re reflecting with one another, not just at the meeting, but in the car on the way, car on the way back and during coffee breaks back at home.