Executive Memo: What will 2021 Bring?

I distinctly remember late 2019. I was working as the Director of Policy and Strategic Initiatives at the California Academy of Family Physicians, and I had my perspective fixed squarely on the horizon. My colleagues and I were optimistic; the state projected a large budget surplus and Governor Newsom routinely shared his interest in issues related to health and healthcare. New investments in graduate medical education, loan repayment, and Medi-Cal payment rates were coming online. A new prospective Medicare payment model was being tested in California by the Centers for Medicare and Medicaid Services. An initiative led by Covered California, the state’s insurance exchange, explored reducing health disparities among the exchange’s beneficiaries. It felt to me as if California had entered a rare period of investment and reform.

Everything changed in early 2020 with the emergence of the COVID-19 pandemic. Our policy agenda—our hope for care in the new decade—was seemingly wiped clean. The health policy community quickly turned from our aspirational macro-discussions to the nuts-and-bolts issues of personal protective equipment, public health orders, and the availability and quality of testing. I joined the San Francisco Marin Medical Society in May 2020, and had the opportunity to get to know its membership and understand its experiences on the frontlines of this pandemic.

The pandemic unmasked underlying realities about our health care systems, practices, and communities. Economic inequality, disparities in access to care, and political polarization already existed, but the pandemic exacerbated these forces and illustrated how the most vulnerable among us are disproportionately impacted during emergencies. The acceleration of forces was also felt within the profession. Market consolidation, already rampant in California, increased further. The proportion of our membership practicing in medical groups of five or fewer physicians continued to shrink. Small, solo, and independent practitioners, especially in primary care, felt the pressure as the volume of essential and elective procedures alike fell precipitously.

Throughout it all, our physicians shone. While I had never in my life experienced the intensity of the challenges we were facing, I had also never experienced such intense meaningfulness of our work. In the past seven months, I have heard, first-hand, from the emergency room physician who manages a surge of new patients through the hospital doors; from the pediatrician who keeps us focused on the long-term effects of this pandemic on our children; from the primary care physician who reorganizes their entire office workflow to continue to provide full-spectrum care; from the sub-specialist who screens and tests to ensure preventative care doesn’t fall by the wayside; from the public health officer who shares their expertise with the public in full view, without a net, to keep us all safe. In 2020, physicians inspired us all by rising to this occasion, putting patients first, as their oath demands. Despite the challenges, I’m heartened by physicians’ consistent dedication, integrity, and excellence. This article is titled, “What Will 2021 Bring?” and while I have learned to forgo predictions, I know that the profession will continue to inspire in 2021. My promise to you is that the San Francisco Marin Medical Society will be there for you every step of the way, in the macro and the micro. Gratefully, Conrad Amenta