October 7, 2026 Salus Forum

Jeremy

Great. I think you’re touching on something very important there, Jack. I think there’s the power political orientation of leadership. And then there’s the relational influence. I sense that family physicians are geared towards relational and this is probably true of primary care-oriented internists. Yet we get dominated by authoritarian folks in higher level power positions. So, part of the challenge concerns how we transcend that to some degree. This is where a relationally influence oriented person wants to be like Warren. Putting himself in an authority position and managing without feeling like they betrayed their clan. This is often what happens to us. If we get too far in the leadership authority positions and systems, there’s a tendency for the physician group to abandon us. There’s this threat of abandon. I’m just curious what people’s thoughts are about that.

Howard

I think that’s exactly right. I’ve seen that in times of my career. I think everyone who’s decided that they’re going to leave clinical practice for a time and become a leader of one kind or another loses some of that validity that you have from being a physician. You can wear it as an emblem on your lapel and say, I am a physician and I’ve been there and done that. But if you’re not actually doing that at the same time, you lose some credibility with the physicians. Or if not lost, it’s a little harder to maintain and you are not at full strength in terms of credibility. And if you lean too heavily toward the clinical side, you lose some of that ability to be a non-clinical leader.

It’s a tight rope. And I don’t think there’s any real answer to that. You think people can move in and out of those roles, but it’s really hard to have a full clinical leader. There’d be a full-time clinician and a full-time fully capable leader. There are a few people that can do that, but it’s a challenge. And I think that’s particularly the case now as we’re more corporatized in healthcare overall. it really is a deciding factor for a lot of people. Am I going to give up being a clinician even though in my heart, that’s where I am? But I know that in order to change this system, I need to be full force, fully committed to the non-clinical leadership roles. So, it’s a challenge. Warren, I don’t know how you do that, but I think it takes a rare person who can really do both things capably at one time.

Warren

A question for me is how we need to change the culture of family medicine. I’ll give you an example.

And I think this is an extension of the change. How do you bring change? I’m impressed that it has been difficult for family physicians and the family medicine organizations to accept a formal role for patients in the organization of clinics and others. And a little bit in contrast to Canada, which is otherwise similar to us. As you know, Jeremy, we now have a requirement for patient advisory groups. It comes from FQHCs. (42:58) And I’m intrigued that only three of the national family medicine organizations have embraced patients. It was the ABFM, ADFM, and NAPCRAC. But STFM has taken a stand against them. AFP doesn’t think it’s important. AFMRD doesn’t include it. And this is 10 or 15 years. There are all sorts of good reasons to bring patients to the table. It’s important politically, but also you can improve care with their input. And you have to figure out the right way to do it.