Journal of the American Board of Family Medicine最新文献

{"title":"Family Medicine at the Forefront: Advancing Telemedicine for Opioid Use Disorder (TeleOUD) Through Access, Trust, and Community-Centered Care.","authors":"Omolola E Adepoju","doi":"10.3122/jabfm.2025.250419R2","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250419R2","url":null,"abstract":"<p><p>Telemedicine for opioid use disorder (teleOUD) represents a critical opportunity to expand access to evidence-based treatment while reducing stigma and structural barriers that have long impeded recovery. Yet, gaps persist in awareness, education, and trust among both clinicians and patients. Family medicine, grounded in continuity, collaboration, and community-centered care, is uniquely positioned to close these gaps. By embedding teleOUD education into training programs, normalizing its use in primary care, and fostering interprofessional partnerships, family physicians can transform how OUD is treated and perceived. As teleOUD becomes an integral part of care delivery, the challenge ahead is not only technological adoption, but rebuilding trust, reshaping clinical culture, and ensuring that every patient can access treatment without fear or stigma.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Joy Is in the Gray-The Problems Family Medicine Leaders Should Be Talking About.","authors":"Richard A Young","doi":"10.3122/jabfm.2025.250017R2","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250017R2","url":null,"abstract":"<p><p>Family medicine care in the United States has been suppressed through structural impediments in the healthcare system, yet could provide more care and better health outcomes with appropriate changes. The role of general practitioners in other developed countries provide insights on the value of primary care that could be better incorporated into US healthcare. The fundamental value of family physicians' care emerges from generalist thinking, particularly the use of probabilistic reasoning that supports care variation when patient preferences, situations, capabilities, as well as potential outcomes, are incorporated. Important strengths of family physicians include comfort with uncertainty, use of safety-netting, and listening to patient concerns and preferences, thereby providing balance in medical care decisions. These strengths occur through negotiating with patients to balance many concurrent considerations, reducing low-value care, establishing reasonable expectations with patients, providing a comprehensive basket of services, and continuing to function as a reservoir of resilience for the overall healthcare system. Efforts to grow US family medicine have been hampered by: (a) current measures of value-based care, (b) an over-emphasis on team-based care, and (c) some \"un-American\" aspects of family medicine culture, such as the belief that more care is not necessarily better care, that time can be used as a diagnostic tool, that it's important to be comfortable with mortality and end-of-life care, and being mindful of quaternary prevention. If family physicians communicate their value to patients and other stakeholders, and their unique strengths are better supported by stakeholders, patients will be better served, and future family physicians will have more joyful careers.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Are There Never Enough Family Physicians to Provide Care for the People of the United States?","authors":"Richard A Young","doi":"10.3122/jabfm.2025.250018R1","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250018R1","url":null,"abstract":"<p><p>The US environment for healthcare and healthcare research is not conducive to providing adequate family physicians to care for the needs of the US population. Medical student interest in family medicine is discouraged by many factors, including the culture of medical schools; physician-payment realities, including the American Medical Association's (AMA) Current Procedural Terminology (CPT) codes; the rules by which Centers for Medicare and Medicaid Services (CMS) determines physician and hospital payments; a lack of family medicine research funding; and a favoritism of resources devoted to hospitals and partialists (specialists). Family medicine is also negatively impacted by the generally poor understanding of its value among US policy makers and health-system observers. Family physicians contribute to better population health at a lower total cost. But many policy makers and observers have internalized inaccurate assumptions and misunderstandings of: (a) the role of wellness and lifestyle education, (b) the limits of the triple aim and common preventive services and single-disease metrics, (c) the results of 50 years of cost-effectiveness research, (d) inattention to referral rates, (e) inadequate recognition of family physicians' knowledge and ability to work within complex healthcare systems for the benefit of their patients, and (f) an over-reliance on population management. The full potential of family medicine to make its most effective contributions will only emerge when these issues are addressed.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole-Person Care as the Standard of Care.","authors":"Elena Rosenbaum, Andrea Gordon, Wayne Jonas","doi":"10.3122/jabfm.2025.250361R2","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250361R2","url":null,"abstract":"<p><p>The US healthcare system is failing our patients, our clinicians, and our communities, while costs are rapidly increasing. There is interest among practitioners, patients, and Centers for Medicaid and Medicare Services (CMS) in redesigning the healthcare system to one that focuses on prevention and reduction of chronic disease, while improving health and well-being. Whole-person care, a person-centered, relationship-based, team-based model that addresses the social, emotional, physical, spiritual, and behavioral factors that drive health and healing, would accomplish this goal. This article explores the opportunity, the evidence, the challenges, and the policy recommendations to implement whole-person care as the foundation of our healthcare system.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Is the Role of Professionalism in a Model of Care for the Future of Family Medicine?","authors":"Andrea Anderson, Jehni Robinson, Christine Hancock","doi":"10.3122/jabfm.2025.250483R1","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250483R1","url":null,"abstract":"<p><p>This article presents a structured pro/con analysis examining the role of professionalism in a future model of care for family medicine. The pro argument asserts that professionalism represents the ethical and relational core of the specialty, grounding public trust, guiding advocacy for equity and justice, and shaping meaningful, person-centered care across the lifespan. The con argument critically examines how professionalism has been used as a homogenizing and punitive construct, questions its prioritization amid competing crises, and challenges the effectiveness of national professionalism initiatives compared with locally grounded behavioral interventions.In synthesis, we argue that much of the tension surrounding professionalism arises from conceptual conflation-specifically, the failure to distinguish professionalism from professional misconduct and basic professional duties. When professionalism is framed primarily as surveillance or discipline rather than as an aspirational, values-driven commitment, it loses legitimacy and educational value. We propose that family medicine must reclaim and redefine professionalism with clarity, humility, and intentionality, acknowledging past harms while articulating a vision rooted in integrity, inclusivity, accountability, and community engagement. Although this work is difficult and unfinished, it is essential to sustaining the foundational center of the specialty and securing a just, resilient, and meaningful future for family medicine.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Yearnings of a Grateful Physician-Patient.","authors":"Larry A Green","doi":"10.3122/jabfm.2025.250304R2","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250304R2","url":null,"abstract":"<p><p>A family physician recalls the success of his back surgery, critiques the overwhelmingly transactional care he received, and suggests alternatives and possibilities available for family medicine to be a collaborative partner to strive with patients, healthcare professionals, and communities for a more humane and satisfying healthcare system.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Rise of Adulterated 7-Hydroxymitragynine Kratom Products Creates Challenges for Health Care and Policy.","authors":"John Stogner","doi":"10.3122/jabfm.2026.260148R1","DOIUrl":"https://doi.org/10.3122/jabfm.2026.260148R1","url":null,"abstract":"<p><p>Traditional kratom use involves botanical preparations with trace levels of 7-hydroxymitragynine (7-OH). However, the US marketplace has seen a rapid emergence of concentrated, semisynthetic 7-OH isolates sold in retail outlets. These products represent a significant departure from natural kratom, carrying a distinct risk profile. While mitragynine has limited opioid-receptor affinity, 7-OH is a potent μ-opioid agonist with morphine-like analgesic effects. Recent market trends show the proliferation of 7-OH tablets, vapes, and other \"pseudo-kratom\" products. In July 2026, the DEA issued a notice of intent to temporarily classify 7-OH as a Schedule I substance, exempting plain leaf or botanical kratom with 7-OH content less than 0.05%. Consumer's transition from natural leaves to laboratory isolates necessitates urgent clinical awareness to prevent a new wave of synthetic opioid-related harm, especially as recent changes may move 7-OH products to unregulated black markets. Clinicians are advised to inform patients that 7-OH products carry significantly greater risks than traditional kratom and note that the recent scheduling decision may affect some patients' techniques for managing opioid cravings and withdrawal. Targeted clinical research is needed to determine if emerging policy restricts patient access to traditional botanical kratom and which, if any, kratom products assist with opioid cessation.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Black Maternal Mortality: A Crisis in Need of Urgent Redress.","authors":"Eli Y Adashi, Daniel P O'Mahony, I Glenn Cohen","doi":"10.3122/jabfm.2025.250285R1","DOIUrl":"10.3122/jabfm.2025.250285R1","url":null,"abstract":"<p><p>While the latest update from the National Center for Health Statistics of the Centers for Disease Control and Prevention (CDC) announced that the national maternal mortality rate for 2023 decreased to 18.6 deaths per 100,000 live births, in comparison to a rate of 22.3 in 2022, it noted that the maternal mortality rate for Black women was 50.3 deaths per 100,000 live births and that this was significantly higher than rates for White (14.5), Hispanic (12.4), and Asian (10.7) women. More troubling still, the maternal mortality rate for Black women has risen over the past five years from 2.5 times the rate observed for non-Hispanic White counterparts (in 2018) to nearly 3.5 times the rate. Given that > 80% of pregnancy-related deaths are deemed preventable by state-based maternal mortality review committees, every effort must be made to curtail, if not eliminate the bane of Black maternal mortality. It is the objective of this Commentary to review the recent national efforts to delimit the incidence of Black maternal mortality by the federal government and the future prospects thereof.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Student Factors Associated with Future Office-Based Primary-Care Practice.","authors":"William E Freeman, Carl E Sanders, Andrés Hincapié, Donna B Jeffe","doi":"10.3122/jabfm.2025.250266R2","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250266R2","url":null,"abstract":"<p><strong>Purpose: </strong>The shortage of primary-care physicians in the US is exacerbated by declining numbers of US medical-school matriculants planning careers in primary-care specialties (general internal medicine, family medicine, or pediatrics). We examined whether primary-care specialty plans at matriculation, especially in family medicine, would be associated with long-term primary-care practice.</p><p><strong>Method: </strong>Longitudinal data from multiple sources were obtained from the Association of American Medical Colleges for the national cohort of US MD-granting medical-school matriculants in academic years 1998-1999 through 2000-2001. Graduates from 2002-2013 in office-based practice by May 2020 were included. Using two multivariable logistic regression models, we identified matriculating students' specialty plans and medical-school experiences associated with office-based primary-care (vs nonprimary-care) practice.</p><p><strong>Results: </strong>Of 48,533 matriculants, 30,079 graduates (45.1% female) had complete data for analysis. Of 10,331 matriculants reporting primary-care specialty plans, 4,177 (40.4%) reported primary-care practice at follow-up. Matriculants reporting primary-care specialty plans, especially in family medicine (versus nonprimary-care specialty plans: Model 1) were more likely to report primary-care practice at follow-up (adjusted odds ratios [aORs] range: 2.11-4.83). Matriculants reporting internal medicine (aOR: 0.44) and pediatrics (aOR: 0.72) plans (versus family medicine plans: Model 2) were less likely to report primary-care practice at follow-up. Graduating students planning to practice in underserved areas and rating some or all primary-care clerkships \"Excellent\" were more likely to be in primary-care practice.</p><p><strong>Conclusions: </strong>As early as medical-school matriculation, primary-care specialty plans, particularly in family medicine, were associated with long-term primary-care practice. Evaluations of interventions that promote interest in primary-care practice before and during medical school are warranted.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fewer Abortions in States with More Family Physicians.","authors":"Amanda Weidner","doi":"10.3122/jabfm.2025.250295R1","DOIUrl":"https://doi.org/10.3122/jabfm.2025.250295R1","url":null,"abstract":"<p><strong>Purpose: </strong>Primary care physicians providing abortion services-particularly family physicians (FPs), who provide the majority of care in rural and underserved settings-could enhance access to abortion and family planning services. The primary objective of this study was to evaluate the association between the rate of abortions and availability of FPs by state.</p><p><strong>Methods: </strong>This was an exploratory ecological study of secondary data compiled from several state sources in the United States. The primary dependent variable was abortion rate, and the primary independent variable was FPs per population, with internists and obstetrician/gynecologists (ob/gyns) analyzed as comparison. Other variables included pregnancies and abortion clinics per population; percent of a state's population in rural areas; and state abortion law. Each comparison was analyzed with a two-tailed Pearson's correlation test followed by multivariate linear regression.</p><p><strong>Results: </strong>The number of physicians per 100,000 population was significant in all three models when controlling for the other variables, but in different directions: more internists and more ob/gyns were associated with greater abortion rates (B = .253 [.037], P < .001 and B = .807 [.174], P < .001), while more FPs were associated with lower abortion rates (B = -.212 [.064], P = .002). Each model was reliably predictive of abortion rates and explained most of the variance in abortion rates by state.</p><p><strong>Conclusions: </strong>Fewer abortions in states with more FPs and more in states with ob/gyns and internists may suggest an access issue in the states with more FPs. FPs providing abortion care could be part of a solution for improving patient access to that care, particularly in rural areas.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}