A Historical Perspective of the Florida Academy of Family Physicians (FAFP).
The Florida Academy of General Practice (FAGP) was chartered as the 21st chapter of the American Academy of General Practice (AAGP) on May 24, 1948. The FAGP grew rapidly in membership and stature in Florida medicine.
During the fifties, the Florida Academy of General Practice was limited largely in function and accomplishments to the taking of its rolls and talking to itself. Concern over the imminent demise of the general practitioner in an era of increasing sub-specialization took the form of protective self-interest and a discouraging search for solutions. In 1957, Marshall Brainard was hired as Executive Secretary and a state office was established in Jacksonville, FL.
The American Academy of General Practice changed to the American Academy of Family Physicians (AAFP). On June 2, 1969, the American Board of Family Practice was established to conduct examinations to measure competence in family practice. Family Practice became the 20th medical specialty and was the first to require recertification by examination every seven years.
In the early 1970s the Academy was very concerned about the physician shortage in Florida, particularly the shortage of family physicians. According to a 1972 special report on education and training for family practice, the Academy held as its NUMBER ONE PROJECT the development of more family physicians for the state. In response the Academy launched its Medical Student Orientation Program. One important component of the program was the Family Practice Weekend seeking “to acquaint each medical student in Florida with the true nature of family practice so the student could make an informed decision for his own future in medicine.”
The first Family Practice Weekend took place January 22-23, 1972, at the University of Miami School of Medicine. Forty-four physicians and 32 medical students rubbed elbows, exchanged ideas and attended orientation and scientific discussions during the Weekend. Lunch, cocktails and dinner for all participants provided further opportunity for student-physician conversation. Thanks were extended to Dr. Lynn P. Carmichael, Director of the Family Practice Residency Program at the University of Miami, FAFP Director Dr. Charles A. Dunn of Miami, and the University of Miami Student Director Robert Hoff for their efforts in helping to arrange this first-of-a-kind presentation. Throughout the ‘70s, Family Practice Weekends continued and were held at locations at or near Florida’s three medical schools—University of Miami, University of Florida and University of South Florida. Initially there were many more students in attendance than physicians. Leaders encouraged more physicians to participate to provide the one-on-one conversations between physicians and students considered to be the most effective tool of the student orientation program.
In 1977, a committee was charged with studying previous Family Practice Weekends and making recommendations for the future. They found the Weekends to be useful as a quarterly forum for practicing physicians and the promotion of family practice to medical students. They recommended their continuation with some modifications. They suggested meeting sites other than in the academic centers and the inclusion of at least six to 12 CME hours of AAFP Prescribed, FMA Mandatory, and AMA Category 1 accreditation. Interestingly, fees at the time were $2 for medical students, $5 for residents, and $15 to $25 for practicing physicians and guests.
In 1971 and 1972, activities of the Florida Academy of Family Physicians gave promise of fruition. The Florida Legislature, at the urging of the Academy, mandated the creation of departments of family practice at all medical schools in Florida which received state funding.
In November 1979, an Institute on Florida Government brought together 25 Florida government executive and legislative leaders for informal discussion with 50 selected medicine leaders. This seminar signaled the beginning of a legislative program in support of State of Florida funding for family practice and resulted in the appropriation of $1,500,000 in categorical funding for family practice residency programs for fiscal year 1974-75. In 1976, legislation amended the Community Hospital Education Act to assure that a minimum of $10,000 per resident per year would be allocated for family practice residents in the State of Florida. Three Student Directors, one from each medical school, and three voting family practice residents were added to the Board. Active membership dues were increased to enable the establishment of a full-time administrative office in January 1974. The end of the 80s found FAFP with a budget of $227,600 and a membership of 1,553.
By 1980, changes had been accomplished. “The most physicians and the fewest students …” describes attendance figures for the Family Practice Weekend held at Key Biscayne on October 31 – November 2, 1980. The 12 hours of FLORIDA-PRESCRIBED CME sessions attracted over 100 practicing physicians and medical educators, 19 residents, but few of the 22 registered students attended. The Key Biscayne Weekend characterized the trend of FAFP weekends toward meeting sites more attractive to physicians, a first-class CME program focused to the practicing family doctor, and other features oriented more to physicians than to students. Family Practice Weekends (now called Family Medicine Weekends to conform to new verbiage) continue to flourish. While initially much of the planning for Weekends was done by one or two individuals, the Scientific Program Committee and now the CME Committee, has evolved into a sophisticated, professional planning group. This dedicated group of family physicians has propelled the FAFP and the FAFP Foundation into one of the premier CME providers in the state. When it comes to CME for the family physician, no one does it better!
Four scientific programs (three Family Practice Weekends and the Summer Break Away) were held annually and attract 275-500 family physicians at each. The Florida Academy had seven full-time staff members who provided outstanding administrative assistance. By 1998, the budget totaled $1,134,750 and membership exceeded 3,550. In 1992, Governor Lawton Chiles held a Health Care Conference in Orlando to which the FAFP was the only medical specialty group invited. As a result of this participation, 12 FAFP members and the EVP were appointed by the Governor to various committees looking a health care reform in Florida. By 1994, managed care became a real influence in Florida. More than 30 managed care companies were doing business in the state. Members sold their practices to hospitals and other entities. Capitation, de-selection, HMOs, gatekeeper, fraud and abuse, primary care physician, disease management, referral authorization and many other new words became part of physician’s vocabulary. Discounted fees accounted for most of the office income and regulations and documentation took more time.
Meetings with Florida’s medical school Deans continued on a biannual basis. During this decade we saw all three deans replaced. In 1996 John Clarkson became the new dean at the University of Miami, Martin Silbiger the new dean at the University of South Florida and in 1997 Dr. Kenneth Berns became the new dean at the University of Florida. During this decade increased emphasis was placed on graduating more students into primary care, especially family practice.
In 1996 the Long Range & Strategic Plan was updated to guide our decisions into the next millennium. In 1994, Mayo Clinic Jacksonville added a family practice residency; in 1995 North Broward Hospital District in Fort Lauderdale did likewise. In 1998 Morton Plant Hospital, Clearwater took its first residents.
They joined programs at University Hospital, Jacksonville; Halifax Hospital, Daytona; St. Vincent’s Medical Center, Jacksonville; Tallahassee Regional Medical Center, Tallahassee; Alachua General Hospital, Gainesville; Florida Hospital, Orlando; Bayfront Medical Center, St. Petersburg; and Jackson Memorial Hospital, Miami.
FLORIDA FAMILY PHYSICIAN, the quarterly journal which had existed since the fifties, was discontinued except for one annual issue in February 1997. In August 1995, the first issue of BYTES was mailed, providing information on economic, legislative, practice management, regulation, and other pertinent practice information. In 1996 the Academy established its own site on Physicians’ Online and in 1998 Richard Rathe & Ed Dodge developed a new, more sophisticated online page through the University of Florida Department of Family Medicine. On October 1, 1998, FAFP moved into its new building at 6720 Atlantic Boulevard.
It seems the Academy has come full circle. The shortage of family physicians continues to be a major concern. In 2002, Martha Moores retired and the FAFP engaged Tad Fisher as the third executive vice President. Tad had served as the FAFP Legislative Coordinator since 1993. In 2003, the FAFP joined with the Florida Osteopathic Medical Association establishing the Coalition for Patient Access to Care to serve as the advocacy voice for patients concerned about losing their physician due to the liability crisis. That year the legislature endured 8 legislative and special legislative sessions before passing liability reforms. The FAFP successfully engineered a membership grassroots program entitled “Ten Minutes a Week.” The program generated thousands of member/patient communications to members of the Florida Legislature.
Beginning in 2004 through 2006 the FAFP designed programming to introduce its members to electronic health record systems. The Academy sponsored three major workshops educating over 500 physicians about the need to purchase EHR systems. Furthering the effort to help family physicians will adopting EHR technology, in 2006-2008 the Academy served as a subcontractor to the Florida Quality Improvement Organization to educate, evaluate, and encourage adoption of EHR.
Beginning in December 2005 the Board of Directors began a new student initiative to encourage medical student participation in Family Medicine Weekends and to recruit students to the specialty of family medicine. Generally we see 25 to 40 medical students at each Weekend. Academy leaders have found the opportunity to talk with medical student rewarding and their enthusiasm stimulating. In 2006, Florida Family Physician was reestablished as a quarterly journal under the leadership of Amber Isley, Editor.
The more things change, the more they stay the same! In 2008 the Florida Academy celebrated 60 years of milestones and memories and 35+ years of Family Medicine Weekends. Truly, the 100th Family Medicine Weekend was a milestone. Thanks to Florida’s family physicians who have supported these programs over the years and to the many dedicated individuals responsible for their planning, execution, and longevity.
The FAFP continues to advocate for its membership and is accessible through social media, fafp.org, and the journal. The toll-free telephone line still exists, but doesn’t ring like it used to! There is much work to be done and there are qualified and committed family physicians and a staff capable of moving things in the right direction to better serve our membership and their patients. With over 70 years of history, we are able provide a portrait of an association that has grown and matured into Florida’s premier medical specialty society with its mission to support Florida’s family physicians. In 2012, the FAFP hired the current EVP Mr. Jay Millson, who leads a team of six staff with nearly 100 years of organized medicine experience. Strategic plan updates in 2014 and 2017 have charted the FAFP's Course for the future.