In the face of a government shutdown, our ask is clear: Congress must safeguard the programs that keep care within reach. Funding for the Teaching Health Center Graduate Medical Education program and the Community Health Center Fund is essential, not just for training tomorrow’s primary care physicians but also to ensure that every family has a place to turn when they need help. Additionally, telehealth serves as a lifeline for so many; preserving flexibility and access is crucial. Read our full statement here, and read our letter to the administration here.

We are particularly concerned about the announcement that the Centers for Medicare and Medicaid Services will hold claims for Medicare services impacted by the expiring programs, including telehealth services.

AAFP weighs in on new proposed rules impacting IMGs

Why it matters:

The health of our nation depends on a strong primary care foundation. Despite overwhelming evidence to support primary care as the solution to the chronic disease crisis, it is projected that the U.S. will face a shortage of up to 40,000 primary care physicians by 2036.

Placing unnecessary restrictions on U.S. visa programs could discourage international medical graduates from entering family medicine or accepting positions in high-need areas, which would exacerbate existing workforce shortages, limit communities’ access to essential care and compromise public health outcomes.

What we're working on:

• AAFP wrote a letter to the U.S. Department of Homeland Security, as well as joining two sign-on letters, opposing a proposed rule to force non-U.S. medical residents to reapply for their visas after four years. Currently, IMGs visas are approved for the duration of their program, no matter how long the program is. If finalized, this rule would have far-reaching consequences for the primary care workforce. 
• We urged DHS to recognize IMGs’ importance in building a strong primary care workforce and to acknowledge how transparent, clear visa processes contribute to expanding that workforce. 
• AAFP urged DHS to use its authority to advance visa policies that support medical students, residents and physicians being able to serve U.S. patients and communities. 
• AAFP also wrote a letter and signed onto a joint letter with the American Medical Association pushing back against new rules that require a non-U.S. citizen applying for a new H-1B visa to pay a $100,000 fee. 
• The letter explains that doctors, including family physicians, are essential to our country and should be excluded from this requirement. 
• It also points out that physicians who hold H-1B visas are especially important in rural and underserved communities, and that states with more H-1B visa-holding doctors usually have fewer physicians per capita, making the contributions of IMGs even more critical.

AAFP endorses bipartisan Safe Step Act 

Why it matters: 

Step therapy is a prior-authorization policy that requires patients to try and fail one or more insurer-preferred treatments before coverage is granted for the medication originally prescribed by their clinician. While intended to reduce unnecessary utilization, these protocols too often jeopardize patient health, increase administrative burdens for physicians and undermine continuity of care. 

What we’re working on: 

AAFP applauds Congress for reintroducing the Safe Step Act, which would limit the use of step-therapy protocols to ensure that patients have access to treatment. This bipartisan legislation is a concrete step toward minimizing care delays for patients.

AAFP: Linking vaccines to autism is unproven and dangerous

Following remarks from the president and the Health and Human Services secretary, AAFP doubled down: Vaccines do not cause autism and taking acetaminophen while pregnant does not cause autism. These claims risk public health by causing people to suffer, delay or defer vaccination out of fear. Read our full statement.

AAFP will always be an agent of truth when it comes to public health. The 2025 Edelman Trust Barometer found that 82% of respondents trust their doctor more than any other source of medical information, including the internet and family and friends.

Sarah C. Nosal, MD, FAAFP, takes office as AAFP president

On October 6, Sarah C. Nosal, MD, was installed as AAFP president. Nosal, a family physician in Bronx, New York, brings nearly two decades of experience serving diverse and under-resourced communities, as well as state and national advocacy and leadership. Nosal is vice president for innovation and optimization and chief medical information officer at the Institute for Family Health, a network of federally qualified health centers spanning the Mid-Hudson, Bronx, Manhattan and Brooklyn. 

The AAFP also announced its 2025-26 officers and board members. Read our full press release here.

What we're reading

AAFP released fall immunization recommendations. "History shows us that vaccines have eradicated diseases that were disabling and deadly in the past, and we can keep it that way if we continue to vaccinate," said Margot Savoy, MD, MPH, CPE, chief medical officer of AAFP.

AAFP Board Chair Jen Brull, MD, spoke with NPR about changing public health guidance, what doctors are hearing from patients and how to best navigate changes. “If you hear something, wherever that source is — whether it's the television, TikTok or a headline — and you have a question about it, that's the time to have a conversation with the person who knows your health best,” she said. 

Dr. Brull wrote in the Oklahoman about the importance of family physicians as trusted messengers. “The expertise your physician brings and the self-advocacy you bring to appointments are what helps us navigate the uncertainty and questions — big or small,” she wrote. 

Robert Graham Center Director Yalda Jabbarpour, MD, spoke to Medscape about how Medicaid cuts reflect a “deeply concerning trend” in health policy: the “systematic underinvestment” in primary care. “At a time when more than a third of adults and 15% of children lack a usual source of care, we should be expanding access — not restricting it,” she said.

For the latest policy updates impacting family medicine, follow us at @aafp_advocacy.

Thousands of family physicians and other health care professionals traveled to Anaheim earlier this month for AAFP’s Congress of Delegates and FMX. This included more than 300 attendees from Texas including TAFP leaders, family physicians, and family medicine residents.

The Congress of Delegates met for two and a half days to conduct official Academy business including elections, writing resolutions, hearing addresses from officers, commission and board of directors updates, and more. Thank you to all TAFP members for attending, including this year’s Texas delegation: Emily Briggs, MD, MPH; Lindsay Botsford, MD, MBA; Tricia Elliott, MD; and Clare Hawkins, MD, MSc. Briggs was also selected as chair of AAFP’s delegation to the American Medical Association.

AAFP also honored this year’s award winners during COD, including third-year resident Shana-Kay Lambert-Johnson, MD, who won the Award for Excellence in Graduate Medical Education. Lambert-Johnson is a third-year resident at the Family Medicine Residency Program at Medical City Fort Worth. She created a clinic guide to help medical students navigate their family medicine rotations, which is now being developed into interactive digital curriculum. She also mentors students and residents and volunteers with organizations that support underserved and military communities. AAFP only honors 12 residents each year with this award, recognizing their exemplary patient care, leadership, and community involvement.

As the Congress of Delegates events wound down and FMX ramped up, TAFP hosted a reception for all Texas attendees. Around 100 TAFP members and Texas guests gathered at a rooftop bar in Anaheim for fellowship time with colleagues, refreshments, and a good time! Thank you to everyone who joined us.

Thank you again to everyone who traveled to Anaheim to represent Texas at yet another great AAFP Congress of Delegates and FMX.

View more photos on TAFP's Instagram

Micah Nishigaki, MD, has spent the majority of her young medical career at UT Southwestern, having completed both medical school and residency there, then joining the faculty. Still in the first seven years of her family medicine career, Nishigaki has discovered that she enjoys working in outpatient and inpatient settings, as well as teaching. She is currently doing the Climate and Health Equity Fellowship with the Medical Society and Consortium on Climate and Health, where she is learning about advocacy solutions to address the effects of climate on health.

Who or what inspired you to become a family physician?
I did my family medicine rotation in the middle of my MS3 year, and fell in love with it. I felt like I was with my people and I got to have a variety of visit types, which was intellectually stimulating to me. I had liked every rotation before and after my family medicine rotation, which solidified that family medicine would be the best fit for me, since I get to do a bit of everything.

You were an active student member not that long ago - what would you tell other students interested in family medicine about the significance of being active in TAFP during the student years?
Take advantage of all the opportunities! For example, I participated in the preceptorship summer program. It was fun to experience the daily life of a family medicine physician and the fruits of longtime relationships with patients. In retrospect, that was my first inkling that family medicine was for me, though I didn't know it at the time (haha).

What surprised you most about family medicine?
I always have fun learning about the different paths family medicine physicians take. There are a variety of niches or non-traditional roads that we can end up on. It makes this journey fun. You truly don't know where you will end up next, or with whom!

What do you enjoy doing outside of medicine?
Indoor rock climbing, reading, and playing video games are my main hobbies. I enjoy playing (and losing) at board games. If you ever need someone for a board game night, I'm ready to learn and play! Additionally, I'm involved in some community groups that align with my values, bring me joy, and contribute to my community in whatever way I can.

TAFP’s Member of the Month program highlights Texas family physicians in TAFP News Now and on the TAFP website. We feature a biography and a Q&A with a different TAFP member each month and his or her unique approach to family medicine. If you know an outstanding family physician colleague who you think should be featured as a Member of the Month or if you’d like to tell your own story, nominate yourself or your colleague by contacting TAFP by email at tafp@tafp.org or by phone at (512) 329-8666. 

As you prepare and have conversations with patients, providing vaccination options that meet their needs is key. One such option is FluMist (Influenza Vaccine Live, Intranasal), a needle-free flu vaccine for healthy individuals ages 2 through 49. Administered as a gentle nasal spray, FluMist provides protection against three influenza virus strains (two A strains and one B strain), offering broad seasonal coverage.

FluMist has been approved and used for many years, but the FDA recently approved this vaccine for at-home use by eligible patients. If your practice does not carry FluMist directly, patients can visit the FluMist website to determine eligibility and place an order for FluMist Home.

FluMist may offer a comfortable and familiar alternative to traditional injections, which could help improve uptake among vaccine-hesitant populations. Review this infographic for more information on the process.

Key elements to remember:

• The at-home option, FluMist Home, is available exclusively through an online pharmacy assigned with its own unique National Drug Code.
• FluMist Home is intended to complement — not replace — traditional in-office and retail pharmacy FluMist administration.
• In-office and retail pharmacy administration of FluMist remains unchanged and fully available for those who prefer or require vaccination in a clinical setting.
• Patients interested in the at-home option can visit the FluMist website to determine eligibility and place an order.

To learn more about FluMist and FluMist Home or explore educational resources for your patients and team, visit the FluMist website.

TAFP’s Partners in Health program connects family physicians with organizations committed to supporting family medicine and promoting the health of all Texans. Our Partners provide patient education and high-value tools designed to help family physicians and their care teams deliver well-coordinated, comprehensive primary care. Go to Partners in Health to learn more.

Why it matters: 

Health care costs keep rising, straining physicians, families and communities. Too many patients still struggle to access primary care, partly due to a graduate medical education system that doesn’t produce enough primary care doctors. Despite spending more than peer nations, the U.S. continues to lag in outcomes such as treatable diseases and preventable deaths.

What we’re working on: 

AAFP urged Congress to expand support for primary care by:

• Reauthorizing and funding key programs that expand access, especially in rural and underserved areas (Teaching Health Center Graduate Medical Education, Community Health Center Fund, National Health Service Corps).
• Making permanent the telehealth flexibilities that empower patients and physicians to choose the best mode of care.
• Protecting federal investments in core health programs through appropriations.
• Permanently extending ACA Advanced Premium Tax Credits to keep coverage affordable for lower-income families.

AAFP responds to ACIP decisions

Why it matters:

Vaccines have saved countless lives and remain one of our most important tools for protecting patients and communities. Narrowing vaccine recommendations limits patient autonomy and risks undermining the trust in public health we’ve worked so hard to build.

What we're working on:

• AAFP submitted written testimony go the Advisory Committee on Immunization Practices (ACIP), calling on ACIP to “restore and prioritize scientific integrity, transparency and continuity in deliberations.”
• The ACIP’s vote to remove shared clinical decision-making for the combination MMRV vaccine for children under four years old could limit access to vaccination against preventable diseases and undermines efforts to protect vulnerable populations.
• The vote on COVID-19 vaccines will create real confusion and consequences for patients’ trust. These vaccines have prevented countless hospitalizations and deaths for both children and adults. Family physicians remain the best source for conversations and trusted information about vaccines.

Family physicians call on president to reconsider Secretary Kennedy’s ability to serve 

Under HHS Secretary Robert F. Kennedy Jr.'s leadership, key public health protections have been weakened, and the immunization review process is devoid of experts and evidence. AAFP urged the president to prioritize the health and safety of the American people by re-evaluating Secretary Kennedy’s ability to serve in his current capacity. Read our full statement.

AAFP also expressed concern about turmoil at the Centers for Disease Control and Prevention. The firing of Director Susan Monarez, the resignation of multiple senior officials, and circumventing processes for reviewing data and science are alarming, threatening our nation’s public health infrastructure. Leadership and oversight from Congress are needed now to ensure that our nation’s public health is protected.

Physician leaders call on lawmakers to support access to care

Why it matters: 

AAFP President-elect Sarah Nosal, MD, joined leaders from the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, the American Psychiatric Association and the American Osteopathic Association in Washington, D.C., to champion legislative policies that bolster access to care. The Group of Six fly in is one strategy in which we push for policy priorities that elevate primary care. Many of these echo our fall priorities, which we shared with lawmakers above. 

What we’re working on: 

• Making telehealth flexibilities permanent: Telehealth has improved access and reduced missed appointments, especially in rural and underserved areas. With Medicare flexibilities set to expire Sept. 30, the AAFP, AAP, ACOG, ACP, AOA and APA urged Congress to make them permanent.
• Strengthening the primary care workforce: The U.S. faces a shortage of up to 40,400 primary care physicians by 2036. Key programs, including the Teaching Health Center Graduate Medical Education program, the National Health Service Corps and the Community Health Center Fund, expire Sept. 30. Congress must reauthorize and fully fund them to preserve access to care in communities that need them the most.
• Protecting vaccine access: At the start of flu and respiratory illness season, patients need clear recommendations by qualified experts to ensure easy access to vaccines. Recommendations made by the Advisory Committee on Immunization Practices set insurance coverage requirements, and conflicting guidance is creating barriers to vaccine access.

Family physicians spotlight priorities in 2026 Medicare Physician Fee Schedule

Why it matters: 

The Centers for Medicare and Medicaid Services is recognizing the vital link between community-based physicians and community health, a step forward for primary care.

What we’re working on: 

AAFP is urging CMS to:

• Advance payment accuracy: Implement an efficiency adjustment for non-time-based services and update direct practice expense inputs, so payments better reflect real-world clinical practice and technological advancements.
• Modernize data sources: Transition to empiric, regularly updated data — such as Medicare claims and hospital cost reports — for rate setting and collaborate with medical specialty societies to ensure that future data collection is robust and representative.
• Strengthen primary care management: Refine and expand Advanced Primary Care Management codes and waive patient cost-sharing for APCM services to improve access and uptake for Medicare beneficiaries.
• Recognize care complexity: Expand the use of the G2211 add-on code to home and residence visits, ensuring that physicians providing longitudinal, relationship-based care are appropriately compensated for the complexity of their work.

AAFP is also supporting CMS proposals in the 2026 Outpatient Prospective Payment System to reduce site-differential payments that reward consolidation and improve hospital price transparency. CMS should develop a more consistent, cohesive approach to addressing upstream drivers of health across all Medicare payment programs.  

AAFP weighs in on health IT certification rule

Why it matters: 

Federal student debt relief programs are important tools that strengthen American communities and help fill critical workforce shortages. Reliance on the Public Service Loan Forgiveness program has increased significantly over recent years, with some studies showing more than 40% of physicians are enrolled.

Student loan debt incurred during training is a significant barrier to addressing the physician workforce shortage the U.S. is facing, which is why AAFP supports efforts to reduce the debt burden incurred by physicians, including through medical school educational loan forgiveness programs.

What we’re working on: 

AAFP submitted two recent comment letters to the U.S. Department of Education, emphasizing that addressing the burden of student loan debt for physicians and medical students is one essential step to improving our nation’s health care system. We also highlighted that:

• Implementing H.R.1 loan provisions in ways that support future primary care physicians will strengthen the health care workforce in the long term.
• Minimizing administrative burdens on medical students is crucial to those students successfully accessing federal debt relief programs that enable them to choose the practice environment that best suits them.
• Protecting GRAD PLUS loans is critical to supporting medical students.
• Recognizing and supporting the PSLF program as an important tool in building a strong primary care workforce will contribute to a healthier America with fewer chronic diseases.
• Expanding federal loan repayment programs will reduce debt and help address physician shortages in rural and underserved areas.

What we're reading

AAFP released fall immunization recommendations. "History shows us that vaccines have eradicated diseases that were disabling and deadly in the past, and we can keep it that way if we continue to vaccinate," said Margot Savoy, MD, MPH, CPE, FAAFP, chief medical officer of the AAFP.

AAFP President Jen Brull told Prevention, “we need innovation that strengthens connection, not just efficiency.” She added: “In my dream world, every person in America would have access to a trusted primary care physician, and AI and automation would help free up physicians to do what we do best: listen, connect and care.”

Robert Graham Center Director Yalda Jabbarpour, MD, spoke to Medscape about how Medicaid cuts reflect a “deeply concerning trend” in health policy: the “systematic underinvestment” in primary care. “At a time when more than a third of adults and 15% of children lack a usual source of care, we should be expanding access — not restricting it,” she said.

For the latest policy updates impacting family medicine, follow us at @aafp_advocacy.

Physicians and other health care providers can find the new Texas COVID-19 information sheet on the DSHS website.

The legislation requires that the sheet include details on:

• risks and potential side effects associated with the vaccine,
• the expedited development process of the COVID-19 vaccine,
• the status of long-term scientific studies related to the vaccine,
• civil liability status of vaccine manufacturers for vaccine-related injuries, and
• the federal Vaccine Adverse Event Reporting System, including how to report adverse reactions.

Under the new law, physicians who fail to comply with the informed consent requirements could face penalties, including fines or disciplinary action by the Texas Medical Board. Health care providers will be required to keep documentation of both the signed consent form and the provision of the information sheet in their patients' medical records.

For more information and to access a list of all available vaccine information statements, visit the Texas DSHS website.

“We are excited to host an expert panel to help demystify the recently passed One Big Beautiful Bill,” TAFP CEO Tom Banning says. “By placing this session on our CME schedule at the Annual Session and Primary Care Summit, we want to ensure our members not only understand the bill and its implications for practices and patients, but also feel better prepared for the changes ahead.”

The panel members are: 

Mark Chassay, MD, Med, MBA
Vice President and Chief Medical Officer, Texas Plan
Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma and Texas

Todd Thames, MD, MHA
Professor of Practice in Health Care Administration
Trinity University, San Antonio 

Lance Spivey
Co-Founder and President
Catalyst Health Group, Plano 

According to the TAFP advocacy team’s recent report, the bill will cut almost $2 trillion from numerous health care programs, including cutting at least $863 billion from Medicaid and the Children’s Health Insurance Program. It’s estimated that over the next decade, 1.9 million Texans will lose health care coverage due to the bill’s various provisions. Helen Kent Davis, a senior policy advisor on TAFP’s advocacy team, says that it “is a complicated bill, using a spider web of red tape and wonky financing restrictions to curtail coverage.” 

Panel members will discuss key provisions of the bill affecting health care financing, delivery, and workforce, as well as strategies for family physicians to prepare for and adapt to upcoming changes including payment reform, digital integration, and practice transformation initiatives. Lastly, the panel will discuss the broader implications of the bill for the U.S. health care system.

You won’t want to miss this opening keynote or the rest of the CME schedule at Annual Session and Primary Care Summit, held November 14 – 16 in Addison, Texas. Check out the full schedule and register today.

  Register today

When Muhammad Ali Chaudhary, MD, arrived in Texas in 2024, he brought with him a career shaped by both global training and a deep commitment to community health. A graduate of Aga Khan University in Pakistan, he honed his expertise through a public health fellowship at Harvard, family medicine training in Pennsylvania, and a clinical fellowship in adolescent addiction at Boston Children’s Hospital. Now an assistant professor at UT Health San Antonio, Chaudhary is building an interdisciplinary adolescent addiction medicine program at the Be Well Institute, aiming to close gaps in care for young people struggling with substance use.

Who or what inspired you to become a family physician?
During medical school, I developed a strong interest in community health and the impact of socioeconomic factors on individual well-being. After graduation, I pursued a public health fellowship, where I gained a deeper understanding of systemic health care challenges. As I progressed through my training, I realized that the most effective way to address the issues I was passionate about—particularly health care disparities in the U.S.—was through family medicine. These disparities often stem from implicit provider biases, patient mistrust, and a breakdown in the doctor-patient relationship. As a family physician, I would be uniquely positioned as the first point of contact to bridge these gaps, build trust, and foster long-term, meaningful relationships with my patients.

Why do you choose to be a TAFP member?
I joined TAFP because I have always valued the role of AAFP chapters in supporting family physicians and advocating for the profession. Since my residency, I have been an active member of my local AAFP chapters, recognizing the tremendous value they provide in professional development, networking, and advocacy. Naturally, when I moved to San Antonio in late 2024, I wanted to continue my involvement and engagement with the family medicine community, making TAFP the ideal organization to join.

What has surprised you most about family medicine?
What has surprised me most about family medicine is the deep level of trust that patients place in their primary care physicians, even in this age of disinformation and widespread mistrust in health care. This trust is both humbling and a significant responsibility. As family physicians, we must honor it by staying up to date with medical knowledge, being mindful of societal realities and patient needs, and advocating for our patients both in the clinic and beyond.

Tell us about what led you to adolescent addiction.
My interest in addiction medicine began before my residency training, during my public health fellowship. I was particularly drawn to the opioid crisis, recognizing the immense preventable suffering caused by institutionalized stigma and outdated, non-evidence-based policies.

Training in family medicine and working as a primary care physician solidified this conviction and allowed me to care for a diverse patient population across all stages of life. During residency, I realized that while some progress had been made in addiction care, most advancements were focused on adults. However, with over 90% of substance use beginning before the age of 18, addiction is primarily an adolescent disorder that we are largely addressing only in adulthood.

This gap in care led me to pursue specialized training in adolescent addiction medicine and develop expertise in treating substance use disorders at their earliest stages.

What do you enjoy doing outside of medicine?
Outside of work, I enjoy reading nonfiction, and my favorite book recently has been Understanding Power by Noam Chomsky. I’m also an avid traveler with a particular interest in places rich in history. Some of my favorite destinations have been Andalusia, Spain, Jerusalem, and Palestine/Israel. My wife and two kids are my trusted companions on these adventures.

TAFP’s Member of the Month program highlights Texas family physicians in TAFP News Now and on the TAFP website. We feature a biography and a Q&A with a different TAFP member each month and his or her unique approach to family medicine. If you know an outstanding family physician colleague who you think should be featured as a Member of the Month or if you’d like to tell your own story, nominate yourself or your colleague by contacting TAFP by email at tafp@tafp.org or by phone at (512) 329-8666. 

Watch a summit recap

Before the summit officially began, 77 people from around the state met for the Family Medicine Leadership Collaborative facilitated by the Faculty Development Center as well as the Clerkship and Residency Coordinators Conference, both held all day Friday, August 22. These were attended by leaders of Texas family medicine educational organizations including department chairs, residency program directors, administrators, faculty, clerkship coordinators, and other family medicine champions. The groups spent the day sharing experiences and brainstorming ideas, discussing common challenges, and hearing from various speakers.

Friday ended with a camp-themed networking social, fondly referred to as CAMP TAFP, complete with the option to make camp-style crafts like friendship bracelets and keychains, appetizers supplied by the Texas Beef Council, and a packed house of around 75 people. Summit registrants were encouraged to arrive early and attend the social to network and receive their free CAMP TAFP T-shirts, sponsored by Concord Medical Group, TAFP, and the Texas Family Medicine Preceptorship Program.

The summit Saturday was split into two tracks, with breaks mixed in for attendees to visit the Residency and Career Fair. This year’s fair was bursting at the seams with exhibitors, including 27 Texas family medicine residency programs and nine companies hiring. The energy in the room was palpable as students met residency programs and residents chatted with possible employers. This year’s fair also included free headshots for students and residents as yet another resource provided at the summit.

The medical student track included speakers on school loans, the Match, career options in family medicine, and lifestyle and obesity medicine. The family medicine resident track included speakers on lessons and advice from new physicians, financial wellness for new physicians, fellowship opportunities, and physician contracts.

For an additional fee, 20 students and 20 residents also attended a contraceptives procedures workshop taught by educators from TAFP and Bayer. The day ended with a keynote address for all attendees on AI and the future of family medicine, given by Stanford University Clinical Assistant Professor Timothy Tsai, DO. Despite the long day, the keynote address was still very well attended.

Thank you to the TAFP student and resident officers, as well as other TAFP leaders and volunteers for helping to make sure the weekend ran smoothly. And thank you to the TAFP Foundation and its many donors for allowing so many students and residents to attend with the assistance of travel funding. This program also received a grant from the AAFP Foundation’s Family Medicine Chapter Alliance.

Between the large group in attendance and feedback received through a post-event survey, we’d say the second TAFP Student and Resident Summit was a huge success and will return once again in 2026. Thank you to everyone who attended.

The American Academy of Family Physicians is encouraged by proposed changes in the 2026 Medicare physician fee schedule that would help build a stronger, more sustainable health care system.

Notable updates proposed by CMS include:

• modernizing how medical services are valued,
• reducing barriers to patient-centered care and
• expanding support for behavioral health and at-home services through updated billing codes.

AAFP also welcomes proposed increases to the Medicare conversion factor — 3.8% for participants in qualifying alternative payment models and 3.6% for others — but notes that these are largely due to a one-year statutory increase. Without a long-term fix, practices continue to face renewed financial strain in 2027.

To ensure stability and continued access to care, AAFP urges Congress to enact a permanent annual inflationary adjustment to Medicare payments. Read our full statement.

AAFP shares recommendations on Medicare Advantage plans

Why it matters:

Family physicians care for patients across the lifespan, including older individuals and those with disabilities or other medical complexities. Many of them are enrolled in a Medicare Advantage plan. A 2023 AAFP survey among family medicine practices found that 18% of their patients were covered by MA plans. 

However, MA plans are consistently cited as one of the biggest sources of burden by family physicians. Some organizations administering MA plans subject physicians and patients to opaque, cumbersome prior authorization requirements and other tedious management processes that lack medical justification and delay necessary patient care.

What we're working on:

AAFP wrote to Congress urging it to hold MA organizations accountable and reform the program to better serve patients and alleviate the burden placed on physicians. Of note:

• AAFP is calling on Congress to finally enact the Improving Seniors’ Timely Access to Care Act to streamline prior authorizations and avoid care delays.
• We’re asking Congress to examine and explore guardrails to MA plans’ gaming of coding intensity and home health risk assessments.
• Congress should also take actions to prevent MA organizations from failing to invest in and support the provision of high-quality primary care.

Family physicians call on lawmakers to support family medicine during August recess

Why it matters:

In June, more than 300 family physicians from across the country convened in Washington, D.C., for the Family Medicine Advocacy Summit. Physicians from 44 states met with lawmakers and congressional staff to share stories and champion legislative policies that bolster family medicine. To build on these relationships, during August Recess AAFP is advocating for policy priorities that extend telehealth flexibilities for physicians, protect programs that grow the family physician workforce and support federal programs that invest in primary care.

What we’re working on:

• Make telehealth flexibilities permanent: During the COVID-19 pandemic, telehealth became a lifeline for patients, especially in rural and underserved communities. These flexibilities have improved access to care and decreased no-show rates. However, Medicare telehealth flexibilities expire on Sept. 30, and AAFP is urging Congress to make these flexibilities permanent to ensure care continuity.
• Bolster the primary care physician workforce: The U.S. continues to face a critical shortage of primary care physicians — up to 40,400 by 2036. Three key federal workforce programs are set to expire on Sept. 30, which would greatly restrict access to care without congressional action. AAFP is asking Congress to reauthorize and fully fund the Teaching Health Center Graduate Medical Education program, the National Health Service Corps and the Community Health Center fund.
• Protect and increase federal support for critical health care programs: The federal government is a key source of funding for essential health care services. AAFP is asking Congress to oppose proposed budget cuts that would severely reduce or eliminate programs that strengthen the physician workforce, undermine efforts to address the country’s mental health crisis, weaken public and population health outcomes, and diminish primary care research. 

Decision to pull mRNA vaccine funding alarms leading physician groups

Why it matters: 

Sustained research funding is essential to developing the next generation of tools that protect Americans from infectious disease. mRNA vaccines offer precise, targeted protection and can be produced more rapidly than traditional vaccines, making them a vital first line of defense against rapidly spreading diseases. Thanks to decades of rigorous science, testing and monitoring systems, mRNA vaccines used in the U.S. continue to be safe and effective and to save lives. 

What we’re working on: 

AAFP, alongside the American Academy of Pediatrics, the American College of Physicians, the American College of Obstetricians and Gynecologists and the American Osteopathic Association issued a joint statement expressing alarm and dismay at HHS’ decision to pull funding. We remain resolute in our support for investments in public health research and programs that prevent debilitating and fatal diseases and advance U.S. health care.

AAFP to CMS: Support family physicians in rural communities

AAFP and the Council of Academic Family Medicine supported key rural and primary care proposals that were recently finalized in the 2026 Inpatient Prospective Payment System rule. AAFP highlighted:

• Rural hospital support: We supported continued funding for small rural hospitals through the Low-Volume Hospital and Medicare-Dependent Hospital programs, which expire in 2025 unless Congress acts.
• Training rural physicians: AAFP flagged a payment gap that limits rural hospitals’ ability to host residency programs. CMS said it would consider it in future rulemaking.
• Interoperability improvements: CMS finalized all four proposed changes we supported to improve how hospitals use technology and share data.
• TEAM model changes: Wins for family physicians include:
• Reduced financial risk for rural and safety-net hospitals for the first three years.
• Better benchmarks and risk adjustment methods.
• Stronger discharge planning that continues to ensure patients are referred to the appropriate primary care physician for follow-up care.

Read our full comments here.  

AAFP weighs in on health IT certification rule

The Office of the National Coordinator for Health IT finalized several changes to its Health IT Certification Program. Here’s what stood out:

• Electronic prescribing:
• ONC decided to keep the requirement for systems to support access to a patient’s medication history, a win for family physicians.
• ONC will now require specific electronic prior authorization functions. While we support the overall move to electronic prior authorization, we urged the agency to hold off until those systems are proven to work well in real-world settings.
• We supported ONC’s phased rollout of new electronic prescribing standards.

Read our full comments here.

Family physicians crucial in providing maternity care in U.S.

Family physicians are an important segment of the maternity care workforce, particularly in rural areas. Researchers at AAFP’s Robert Graham Center explored the geographic distribution of family physicians providing maternity care and identified opportunities for family physicians to expand access to maternity care. While family physicians are providing maternity care in rural areas across the U.S., opportunities exist to expand their reach. Read the full study in Annals of Family Medicine.

What we're reading

AAFP President Jen Brull, MD, spoke to the Associated Press about the consequences of H.R. 1 on preventive care. 

AAFP EVP and CEO R. Shawn Martin discussed the Primary Care Enhancement Act and the importance of direct primary care with Axios.

AAFP president-elect Sarah Nosal, MD, spoke with Healio about how threats to physicians with medical student loan debt will impact access to primary care.

For the latest policy updates impacting family medicine, follow us at @aafp_advocacy.

This journal was built by and for the family physicians of Texas. We strive for our authors, readers, and editors to be medical students, residents, and medical school faculty as well as physicians. Our goal is not only to promote and disseminate family medicine research throughout Texas, but also to help guide authors with less research experience through the submission and publishing process. There is no subscription fee to read our journal, and the cost of manuscript submission is low when compared to similar journals.

If you are interested in submitting a manuscript to TFMRJ, please review our website’s author guidelines. We extend a special invitation to new authors, including community physicians, medical students, residents, and new faculty, with less research and publication experience by streamlining manuscript submission with an intuitive and responsive online process. We also publish case reports and editorials that may not fall into the traditional longer research timeline. Fundamentally, we emphasize topics relevant to family medicine in the state of Texas.

For any of our readers who would like to become reviewers or editors, please contact us at txfmrj@gmail.com. Sponsorship and advertising opportunities are also available. For ways to support our nonprofit journal, please see the corresponding section of our website.

Any questions about our mission, the upcoming inaugural issue, or the journal in general can be answered on our website or directed to our main email at txfmrj@gmail.com.

We look forward to having you be part of our journal community.

Cardiopulmonary risk is the risk of serious respiratory or cardiovascular events in patients with chronic obstructive pulmonary disease. These include, but are not limited to, COPD exacerbations, myocardial infarction, stroke, heart failure decompensation, arrhythmia, and death due to any of these events.

AstraZeneca, one of TAFP’s proud Partners in Health, released an infographic to be used as a resource on the topic.

TAFP’s Partners in Health program connects family physicians with organizations committed to supporting family medicine and promoting the health of all Texans. Our Partners provide patient education and high-value tools designed to help family physicians and their care teams deliver well-coordinated, comprehensive primary care. Go to Partners in Health to learn more.

Building a healthier Texas, one adolescent at a time

Before integrated behavioral health and narrative medicine were identified concepts, Celia Neavel, MD, began knitting together a unique and transformational system of care for adolescents and young adults in Central Texas that has changed countless lives. Meet the 2024-25 Texas Family Physician of the Year.

By Samantha White and Jonathan Nelson

Family medicine tallies significant victories for patients and communities in the 89th Texas Legislature

In a legislative session focused on education funding, property tax relief, water infrastructure, and banning THC, TAFP and its partners in health care delivery can celebrate the passage of a number of laws to increase access to care and protect patients.

By Jonathan Nelson

MEMBER VOICES: My journey through AAFP's well-being program

Jessica Glick, DO, new physician director on the TAFP Board of Directors, recently completed AAFP's Leading Physician Well-being Certificate Program. Learn about her experience in the program and why she thinks it makes family docs better leaders.

By Jessica Glick, DO

FOUNDATION FOCUS: 2024 TAFP Foundation Annual Report

RESEARCH: Familias contra diabetes — Group visits to teach self-management strategies to diabetic patients and their families

A family physician with fellowship training in adolescent medicine and developmental disorders, Neavel is the founding director of the Center for Adolescent Health at People’s, a full-spectrum clinic that has grown into one of the most robust youth-focused programs in Central Texas. Her commitment to equity, team-based care, and community-rooted innovation has earned her the title of TAFP’s Texas Family Physician of the Year.

Still, she’s not likely to mention the title herself. “When talking to Dr. Neavel, you would never know the extent of her body of work and accomplishments,” says Feba Thomas, MD, a former colleague at People’s and Neavel’s nominator. “She often will credit her teams and colleagues, and you would never know how she drives these projects or how much she has done.”

Neavel’s path to medicine began early. “I wanted to be a doctor starting in fourth grade,” she said. Raised in Baytown, Texas, she was influenced by a family steeped in both science and social justice. Her father was a research scientist at Exxon and her mother cared for the family at home. 

“Her side of the family,” Neavel says of her mother, “social justice was incredibly important.” Neavel’s maternal grandmother worked at Planned Parenthood in Cincinnati, and Celia would occasionally accompany her to work. “I didn’t understand what she did until I started working at People’s and was introduced to this whole concept of health educators…. She would talk to women about birth control.” 

She earned her undergraduate degree from the Plan II Honors Program at the University of Texas, a liberal arts track that fed her interest in narrative medicine. She then completed medical school at Baylor College of Medicine, followed by an internship in psychiatry and a family medicine residency at the University of Cincinnati, where she also completed a self-designed fellowship in adolescent and developmental medicine.

Along the way, she and her husband, pediatric urologist Joe Cortez, MD, raised three children: Beth, Elena, and Geordie. “My children have made me very brave,” she says. “I sometimes get their counsel as I’ve moved into areas that maybe weren’t comfortable for me.”

Building the Center for Adolescent Health

When Neavel created the Center for Adolescent Health in 1993 as part of People’s Community Clinic, she knew it would be a good fit for how she wanted to practice — holistically, compassionately, and with an eye toward systemic change.

“I was very clear about what my vision was,” she says. “I had this interdisciplinary model in mind from my fellowship.”

The Center for Adolescent Health is now a gold-certified youth-friendly program providing comprehensive care for adolescents and young adults ages 10 to 24. This includes behavioral health services, reproductive health care, LGBTQ+ affirming support, and developmental screenings.

A People’s colleague, Chief Medical Officer Louis Appel, MD, MPH, has worked with Neavel for more than 25 years. In his nomination letter, he wrote: “Long before the concepts were more broadly promoted, Dr. Neavel built a program that was and is team-based, holistic in its approach to care, and dedicated to the inherent value of youth and the importance of supporting youth to build a healthy future for themselves,” he wrote.

In 2005, Neavel launched the GOALS Program, Generating Outcomes and Liaisons for Students, to offer integrated care for children and youth with neurodevelopmental and behavioral concerns that interfere with learning. The collaborative program includes not only PCC physicians, but also social workers, psychiatrists, lawyers, and others.

“Dr. Neavel has exemplified compassionate care, visionary leadership, principled advocacy, heartfelt mentorship, and an unwavering dedication to the health of children, adolescents, young adults, and our community,” Appell wrote.

Advocacy and agency

Throughout her career, Neavel has balanced direct clinical care with relentless advocacy at the organizational, state, and national levels. She has testified before the Texas Legislature on reproductive health and vaccine access and played a key role in passing a law that allows teen parents to consent to their own vaccinations.

Neavel is active in the Texas Medical Association, where she helped create the LGBTQ Health Section and is active on the Committee on Behavioral Health and the Women Physicians Section, among other committees and task forces. She is also involved with the Texas Pediatric Society, the Society for Adolescent Health and Medicine, and the Travis County Medical Society.

Her belief in agency, especially as a physician, is foundational to her advocacy. “Being a physician, what I’ve learned is even if you’re not feeling it, it gives you a lot of power and platform. So, you need to leverage that for good,” Neavel says.

Mentorship as legacy

Neavel is quick to point out that her accomplishments are never hers alone. “It’s not really so much about me, it’s about what the team is able to do together. I couldn’t do any of this without them,” she says.

Still, her mentorship has shaped countless careers. She developed the Plan II scribe program at People’s, where UT undergraduates interested in medicine work in the clinic as paid scribes and interns, gaining direct exposure to trauma-informed, relationship-centered care.

“She has mentored medical students and residents, MAs who have gone on to become nurses and physicians, nurses who have gone on to become nurse practitioners, scribes who have gone on to become physicians, and others,” Appel wrote in his nomination letter.

Seeing the whole person

Neavel is known for her ability to bridge disciplines and see the whole picture. “Adolescents don’t segregate their psyche and their soma,” she says, referring to the interconnectedness of the mind and body. “It’s very challenging to bridge into an adolescent whose world is completely different from yours and find the right language and body language and really be able to connect.... You have to be on your game with adolescents. You can’t walk in and not be there, because they’ll know.”

Her approach — equal parts science, sociology, and storytelling — has helped create safe spaces for some of the region’s most vulnerable youth. “She has built trust with these patients who have been harmed by many systems and empowered them to improve their health,” Feba Thomas, MD, wrote in her letter nominating Neavel for the award. “Many times, her exam rooms and department were the only safe space for vulnerable patients.”

When the COVID-19 pandemic hit, Neavel led wellness groups for staff, modeling the same trauma-informed care for her colleagues that she had practiced with patients for years.

“She’s always there to listen or help offer suggestions and advocate,” Thomas wrote. “Watching how she navigated growing a vision of team-based, holistic care for the adolescent population to empower themselves from a dream to a reality has been truly inspirational.”

Centering adolescents, changing medicine

Neavel sees adolescents and patients up to age 24 now — a decision she made deliberately. “I did not start out doing that, but that was a very good move. They bring in their babies or their boyfriends or girlfriends or whatever. So, it feels very family oriented,” she says.

Her team handles everything from anemia to trauma to gender-affirming care. And she continues to push systems forward, developing partnerships with schools, expanding behavioral health integration, and leading research on suicide prevention and trust in youth health care.

“I never thought this job would be so politically important,” she says. “This work has become just critical.”

Neavel has always believed that care should adapt to people, not the other way around. It may not have been called full-spectrum family medicine, or population health, or holistic team-based care when she started her career as a physician, but the health care world has caught up to the work she’s been doing all along.

“The language that I have now didn’t exist to explain what I was doing when I started. I love that medicine has sort of caught up. It’s given me words to explain what I do.”

Narrative medicine is one of those terms for her. “Now I know that’s what I believe in. It ties in all my love of reading and language and writing and art.”

Narrative medicine is a comprehensive, holistic discipline in which a physician or other provider applies linguistic skills to better understand the language patients use when describing their state, or when telling their stories.

“When you hear these stories, they could overwhelm or drown you, but if you can look at them as stories and you can say, okay, they’re going to exist whether I’m here or not. What can I do to make them different?”

She employs this approach outside the clinic as well, saying her work in organized medicine, in academia, and in advocacy is to channel those stories into change.

A legacy of relationships

From her earliest days, Neavel has built programs the same way she built her career: relationship by relationship, conversation by conversation. Early in her career at People’s, she spent time developing relationships with local doctors and community partners to build residency opportunities and curricula. Now 30 years later, she continues building new partnerships and maintaining decades-old relationships to benefit the clinic, its clinicians and staff, and her patients.

“You have a deep responsibility as a leader to use whatever platform you have to effect positive change,” she says. “The other thing, of course that’s gotten me through all of this is all these relationships with nonprofits and staff and MPHs and advocates. It’s wonderful when you can build these bridges, and you really form a community, a community of people you enjoy being with.”

The persistence has paid off. She helped found the Manor Mustang Health Center, a school-based clinic serving Manor ISD. She has co-written policy for TMA and helped develop a youth-friendly certification model for clinics statewide. And she continues to publish research on topics ranging from integrated care models to adolescent trust in mental health screening.

“Her impact on generations of patients and physicians will continue to be felt for years to come,” Thomas wrote of Neavel. “Her vision has guided not just the People’s Community Clinic Center for Adolescent Health, but many organizations in Texas and across the nation. She embodies what it is to be a family physician.”

When expressing her appreciation to those gathered at the awards ceremony during the 2024 Annual Session and Primary Care Summit in November, Neavel said she felt the award recognizes how important taking care of adolescents and young adults is for our future. “I’m very proud of family physicians. I’m proud to be in this space where we can drill into what data and science can teach us and also integrate our story about being humans together…. This award validates that constant striving to be wiser and smarter and more present for our most challenging patients is important.”

Joaquin Villegas, MD, MPH, completed medical school and received his master’s degree in public health just in time to start his family medicine residency program not long before the COVID-19 pandemic began. He volunteered for ICU shifts during residency at UTHealth Houston, where he was grateful for the opportunity to learn procedures and realized a love for academic medicine. He is now medical director at the Outpatient Center Clinic with Harris Health in Houston, as well as an assistant professor at McGovern Medical School at UTHealth Houston, where he previously studied.

Who or what inspired you to become a family physician?
Both of my parents are originally from Mexico and worked in the health care field before transitioning into semi-retirement. While they never steered me toward a particular career, I’m sure they were proud when I developed an interest in medicine.

You recently attended a course held by the National Procedures Institute, which is owned by TAFP. What made you sign up?
I am currently associated with the McGovern Medical School at UTHealth Houston Family Medicine Residency Program, where I serve as assistant professor. Our program is committed to expanding learning opportunities for our residents, so when I saw that NPI was offering a POCUS course, I was eager to participate to gain formal training and bring those skills back to our learners. The course was very useful, particularly the hands-on sessions, which made the techniques more accessible and practical.

NPI offers a wide variety of courses, so I’m going through the offerings for the next few classes, and I’m really interested in the upcoming colonoscopy course.

You are active in TAFP business and will attend AAFP's Congress of Delegates later this year as a Member Constituency Delegate. What made you want to get involved in TAFP and organized medicine and why would you encourage others to do the same?
I really have to thank TAFP for helping me get involved on a larger scale. I was part of TAFP’s Family Medicine Leadership Experience soon after finishing residency, and it was a great source of information and resources in how to make a difference in a way that is meaningful to me as a physician and as an individual.

FMLE taught me how to reach out to our local representatives, how to interact with local media, and even how to write meaningful narratives that we can use to make more persuasive arguments to the elected leaders and the community at large. I’ll even go as far as to say that FMLE even helped me be a better physician, since I can better persuade my patients to stick to the plan we discuss together.

I would really encourage any physician who is interested in getting more involved to try out any opportunity at a local or regional organization and see where it takes you! Not all the opportunities will work out or you might find that it’s not what you expect, but it's all worth it when you find that one organization or role that really speaks to who you are or what you hope to accomplish.

How do you spend your time outside of medicine?
I enjoy exercising and recently completed a triathlon in a team with some of my residency classmates – I did the swimming and running! However, I really enjoy raising public health awareness and getting involved in organizations that help me achieve that.

I currently work with the Congressional Hispanic Caucus Institute where I serve as the Houston alumni’s chapter VP of programming. In this role, I help develop and implement educational programs for young professionals across various fields, with a focus on incorporating relevant health topics. Most recently, we had a program where we discussed women’s health and reproductive health which was very fun to be a part of.

TAFP’s Member of the Month program highlights Texas family physicians in TAFP News Now and on the TAFP website. We feature a biography and a Q&A with a different TAFP member each month and his or her unique approach to family medicine. If you know an outstanding family physician colleague who you think should be featured as a Member of the Month or if you’d like to tell your own story, nominate yourself or your colleague by contacting TAFP by email at tafp@tafp.org or by phone at (512) 329-8666. 

The American Academy of Family Physicians is encouraged by proposed changes in the 2026 Medicare physician fee schedule that would help build a stronger, more sustainable health care system.

Notable updates proposed by CMS include:

• modernizing how medical services are valued,
• reducing barriers to patient-centered care and
• expanding support for behavioral health and at-home services through updated billing codes.

AAFP also welcomes proposed increases to the Medicare conversion factor — 3.8% for participants in qualifying alternative payment models and 3.6% for others — but notes that these are largely due to a one-year statutory increase. Without a long-term fix, practices continue to face renewed financial strain in 2027.

To ensure stability and continued access to care, the AAFP urges Congress to enact a permanent annual inflationary adjustment to Medicare payments. Read our full statement.

CMS final rule brings changes to ACA Marketplace enrollment and coverage

Starting August 25, a new CMS rule makes several changes to ACA Marketplace coverage. While intended to improve oversight, the rule has sparked concern among health advocates, including AAFP, for its potential to limit access to care, especially for vulnerable patients.

Key changes include:

• ending monthly enrollment for low-income individuals,
• shortening open enrollment to end December 31,
• allowing insurers to deny coverage for unpaid premiums,
• removing automatic re-enrollment for some,
• defining certain gender-affirming procedures as not essential benefits, and
• excluding DACA recipients from ACA eligibility.

AAFP pushed back on these provisions warning they may harm patients and conflict with medical standards. We emphasized that care decisions should be guided by physicians, not regulations.

Some parts of the rule align with AAFP goals, including stronger broker oversight and keeping federal open enrollment open through year’s end. However, new flexibility for state and non-Marketplace insurers to set their own timelines starting in 2027 remains a concern.

AAFP and more than 100 health organizations urge protection of USPSTF

Why it matters:

The United States Preventive Services Task Force’s transparent, rigorous and scientifically independent process ensures that patients can benefit from trusted, evidence-based preventive care, and that physicians can make up-to-date recommendations. Recent actions by the Department of Health and Human Services have put that at risk.

What we’re working on:

AAFP joined more than 100 health organizations in a joint letter to Congress urging lawmakers to protect the integrity of the USPSTF. The Task Force makes recommendations for primary care and disease prevention through a rigorous, multistep process in collaboration with the public and medical experts. These include cancer screenings, mental health counseling, vision exams and much more.

More than 300 family physicians call on lawmakers to support family medicine

Last month, more than 300 family physicians from across the country convened in Washington, D.C., for the Family Medicine Advocacy Summit. Physicians from 44 states met with lawmakers and congressional staff to share stories and champion legislative policies that bolster family medicine, including:

• Preserving the Medicaid program. Medicaid is a critical safety net for millions of Americans — from routine checkups and maternal care to mental health and life-saving preventive services. Any funding cuts or restrictive reforms would put vulnerable patients at risk and increase costs across the system.
• Reforming Medicare physician payment. Our outdated Medicare payment system undervalues and underpays for primary care, threatening the stability of physician practices and their capacity to provide essential care. Sustainable, long-term payment reforms are urgently needed to support the viability of primary care.
• Protecting the Public Service Loan Forgiveness program, as well as other loan-repayment and scholarship programs. Family physicians often carry significant student debt, and many choose to serve in high-need areas where salaries may not reflect the critical work they do. PSLF is a lifeline — helping keep physicians in the communities that depend on them most. We urged lawmakers to protect and expand upon these programs, so that more physicians can afford to answer the call to service without being buried in debt.
• Urging Congress to protect public trust in vaccines and evidence-based care. Getting vaccinated helps protect vulnerable people, including newborns and people with weakened immune systems. It creates a community of immunity.
• AAFP president Jen Brull, MD, FAAFP, wrote about these critical topics in an op-ed in Medscape.

AAFP disappointed over passage of H.R. 1

As highlighted during the Family Medicine Advocacy Summit, family physicians repeatedly expressed deep concerns with several provisions in H.R. 1 , which was signed by President Trump on July 4. Sweeping and draconian cuts across the health care system will leave as many as 16 million individuals without health care coverage over the next 10 years. 

AAFP will continue to advocate for policies that protect Medicaid and put patients first. 

AAFP submits feedback on NIH’s proposed AI strategy

AAFP has weighed in on the National Institutes of Health’s forthcoming artificial intelligence strategy. The letter emphasizes the unique role of family medicine in delivering comprehensive, person-centered care, as well as the need for AI tools to support, not disrupt, that experience.

AAFP urges NIH to adopt a principles-first approach, anchored by transparency, equity, trustworthiness and accountability. We also call on NIH to embed practicing physicians throughout the AI lifecycle — from design to evaluation — to ensure that tools are practical, effective and aligned with real-world care delivery.

AAFP’s recommendations highlight the importance of rigorous evaluation, workforce readiness and cross-agency alignment, while advocating for AI solutions that reduce administrative burdens and advance health equity.

Read the full letter.

What we're reading

Amid rising measles cases, AAFP President Jen Brull, MD, spoke to CNN about the urgent need for Americans to get vaccinated.

AAFP President-elect Sarah Nosal, MD, conveyed to Bloomberg the risk of disappearing federal data.

Dr. Nosal also spoke to Medscape about how doctors can help patients who lose insurance under federal budget cuts.

AAFP Board Director Shannon Dowler, MD, appeared on the New York Times’ The Daily podcast to talk about how cuts to Medicaid will harm rural communities.

For the latest policy updates impacting family medicine, follow us at @aafp_advocacy.

A member of TAFP’s advocacy team, Helen Kent Davis has written an extensive overview of the session from the perspective of family medicine and public health entitled “The 89th Texas Legislature: A Summary from the Texas Academy of Family Physicians.” The document contains a bonus section on the predicted effects of Congress’s passage of H.R. 1, the so-called “One Big Beautiful Bill Act,” on the health care industry.

Here are some highlights from the session.

The budget

Unlike some recent legislative sessions, lawmakers convened in January with a sizeable budget surplus and a rosy fiscal forecast. They passed a $338 billion budget including state and federal funds for the next two years, $5 billion more than the current biennial budget. Some of that new funding will go to upgrade the state’s aging eligibility system for Medicaid, the Children’s Health Insurance Program, and the Supplemental Nutrition Assistance Program. About $160 million in new spending will go to support programs to improve rural health, including much-needed help for rural hospitals.

Women’s health program funding remained stable as lawmakers maintained spending levels for the Healthy Texas Women program, the Breast and Cervical Cancer Screening Program, and the Family Planning Program. As a steering committee member of the Texas Women’s Healthcare Coalition, TAFP fought for programs and initiatives designed to address Texas’ maternal mortality and morbidity crisis, and to increase access to maternity care.

Family medicine obstetrics fellowships

In what amounts to a major win for rural communities across the state, budget writers included $5 million to “support the development or expansion and administration of family medicine obstetrics postgraduate training grant programs and to support the salaries and benefits of the training physicians.” The Texas Higher Education Coordinating Board will administer the funds and establish rules to guide institutions in the creation and expansion of the fellowships.

After participating in the publication of the “2025 Rural Texas Maternal Health Rescue Plan” last fall, TAFP began calling for the creation of obstetrics fellowships for family doctors to increase access to maternity care in rural Texas. According to the March of Dimes, 47% of Texas counties are “maternity care deserts” — meaning they lack obstetrical services entirely — compared to 33% of counties nationally. The Robert Graham Center says family physicians deliver babies in more than 40% of U.S. counties, and they are the sole maternity care clinicians in 16% of maternity care deserts across the country.

TAFP believes family doctors can play an important role in increasing access to maternity care for rural Texans, but more training opportunities are needed. For family physician residents seeking additional maternity and women’s health care training, there are only five FMOB fellowships available in Texas and only 48 fellowships in the country. By establishing the new Family Medicine Obstetrics Postgraduate Training Grant Program, the Legislature has given family medicine the opportunity to help struggling communities.

Primary care and rural physician workforce funding

The Legislature opted to stay the course on a raft of programs designed to recruit and train primary care physicians and to encourage more to practice in rural and underserved communities. Funding for these five programs remained unchanged from the current biennium.

The Family Practice Residency Program

The FPRP is a strategy in the budget under the Texas Higher Education Coordinating Board designed to increase access to primary care by providing direct funding to family medicine residency programs. The program, which has suffered from inconsistent funding in past sessions, maintained funding at $16.5 million for the coming biennium.

The Physician Education Loan Repayment Program

The PELRP pays up to $180,000 of student loans for physicians who agree to practice in a Health Professional Shortage Area in Texas for four consecutive years. The program will receive $35.5 million for the biennium.

The Texas Primary Care Preceptorship Program

The TPCPP aims to increase student interest in primary care by placing first- and second-year medical students in primary care practices for two- to four-week rotations. Its funding will stay at $4.85 million for the biennium.

The Rural Resident Physician Grant Program

The RRPGP awards grants for the creation of new graduate medical education positions in rural and nonmetropolitan areas. The program was established in 2024 and will get $3 million for its second biennium.

The Joint Admission Medical Program

JAMP seeks to recruit economically disadvantaged undergraduate and high school students to pursue careers in medicine by offering scholarships, internships, mentorship, and other support. Its funding held steady at $11.7 million for the biennium.

Other key legislation

Expansion of value-based primary care

House Bill 2254, which reforms outdated insurance laws that block value-based care models in many employer-based health plans, made it through the session and is awaiting the governor’s signature. TAFP and a coalition of health plans, business and employer groups, and primary care organizations worked to bring this issue to the Legislature. H.B. 2254 allows employers and primary care physicians to enter value-based contracts with innovative payment models like advanced primary care and direct primary care that could improve patient outcomes and lower health care costs.

The Life of the Mother Act

Lawmakers in both houses passed Senate Bill 31, the so-called Life of the Mother Act, with broad majorities. The bill should provide pregnant women, physicians, and hospitals a common understanding of what constitutes a medically necessary exception to Texas’ abortion ban, allowing physicians to perform the procedure when needed to save a mother’s life or prevent serious medical harm.

Scope of practice

As expected, the house of medicine faced numerous attempts by nonphysician providers to expand their scope of practice. Once again, TAFP and other physician organizations succeeded in defeating the measures. This session’s biggest threat was S.B. 3055, which would have given advanced practice registered nurses, or APRNs, independent authority to diagnose and treat patients — which is by definition the practice of medicine — without collaborating with physicians.

In written testimony to the Senate State Affairs Committee, TAFP President Lindsay Botsford, MD, MBA, laid out the Academy’s concerns with the legislation. “Rather than another debate regarding physician versus nurse credentials, the Academy urges lawmakers to consider ways to strengthen the entire primary care network, including APRNs, by redoubling efforts to promote team-based care — the only model that can achieve our mutual goals to increase access, improve health outcomes, and constrain health care costs,” she concluded. The bill did not make it out of committee.

Stay tuned …

The current 30-day special session called by Gov. Abbott is focused on legislation in response to the recent floods in Central Texas, regulation of THC products, the redrawing of the state’s congressional districts, and a number of conservative-backed proposals that failed to pass during the regular session. Of interest to family physicians, lawmakers will likely consider legislation to restrict the manufacturing and distribution of abortion medications. TAFP will continue to advocate for family doctors, their practices, and their patients, and as always, keep an eye on your inbox for the latest news in TAFP News Now.

Your Academy extends a huge “thank you” to all members who participated this session, either by testifying, or writing and calling your representatives, or by serving as Physician of the Day. Your effort, your voices, and your membership led to TAFP’s successful advocacy.

Though originally from California, Rachelle Hamblin, MD, now considers herself a Texan after training for and beginning her family medicine career here. She earned her medical degree and Master of Public Health at UT Health San Antonio, completed her family medicine residency at CHRISTUS Westover Hills, and is now an attending at Health By Design, the retiree police and firefighter clinic in San Antonio.

Who or what inspired you to become a family physician?
On my fourteenth birthday, while playing soccer, I tore a ligament in my foot and I was told I would not play sports or possibly even walk without pain again. One year, two surgeries, and an amazing medical team later, I was able to do all of those and more, including getting recruited for college ball. Dr. Mann and my amazing medical team gave me my life and my passions back and sparked that passion for medicine. In medical school on my third year rotation, CHRISTUS and their fantastic team of doctors inspired me to go into family medicine – a unique field where I could listen to peoples’ stories, truly get to know and take care of my patients and their families throughout their lives and engage in holistic prevention. For all those who helped me, I am blessed to be able to do the same for my patients as a family medicine physician.

What led to you wanting to work with firefighters and police?
I'm so blessed to be able to intertwine family medicine and my MPH with my love for my fire service and my firefighters. Not only do I get to be a family doc for retired firefighters at Health by Design, a retiree police and firefighter clinic, but I also get to help take care of active duty firefighters as well.

Since 2019, I have been volunteering with the San Antonio Fire Department as part of their Occupational Cancer Committee. It all started with an EMS ride out at Station 13 in medical school where I asked, how can I better help you as a physician? The resounding answer was cancer care and prevention as their friends were getting cancer and dying. I thought, "I'm getting my MD/MPH. I can do that." Since then, I've been fortunate to help them work on extinguishing cancer by collaborating on firefighter cancer prevention research with local, national, and international partners; teaching at the fire training academy; advocating for occupational cancer prevention and treatment at local, state, and national levels; assisting with cancer screenings; educating physicians, medical students, and firefighters on occupational cancer; and riding out with SAFD.

Some really neat things we have been able to do are create our SAFD Wellness and Cancer Prevention Fair in 2023, helping to screen over 1,500 firefighters for occupational cancer, and form a Memorandum of Understanding with Mays Cancer Center, UT Health, University of Miami, Sylvester Cancer Center, and SAFD in late 2024 to collaborate and help improve prevention, treatment, survivorship, education, and research of occupational cancer in our firefighters. I was also very fortunate and honored to be a speaker at this year's International Fire Service Cancer Symposium, speaking about our academic and community partnerships.

Walking in their shoes, training with them, and participating in the Citizen's Fire Training Academy – which included learning how to fight fires – I've gained a lot of understanding and respect for what firefighters do. They have become my reason, and I'm blessed to say a number of those same firefighters have become some of my closest friends and even came to my wedding.

Why do you choose to be a TAFP member?

My residency introduced me to TAFP and since then I've continued to be an active member.

I'm very lucky TAFP found me and grateful my CHRISTUS residency introduced me. TAFP has been an integral member of my career which is the reason why I choose to remain a TAFP member (it's a no-brainer).

My mentor in residency, Laura Nietfeld, MD, showed me the range of opportunities at TAFP. I was fortunate to go to D.C. and represent Texas at AAFP’s Family Medicine Advocacy Summit where I got to advocate for family medicine and my patients at the House and Senate. In 2024, I was also fortunate to attend AAFP’s National Conference of Constituency Leaders and helped author, promote, and testify on a new resolution which was passed (Resolution 2007: Improving Awareness and Training for Family Medicine Physicians Serving First Responders).

Beyond these incredible opportunities, I'm blessed to also work with TAFP as part of the AAFP Residency Ambassador Program and the Texas Family Medicine Preceptorship Program. TAFP offers a wealth of information, and I have met incredible mentors, colleagues, and friends who inspire lifelong learning and personal and professional development. I can't imagine not having TAFP as part of my medical community, support, and growth.

What do you enjoy doing outside of medicine?
Outside of medicine, I love spending time with my husband (who is completing an emergency medicine residency at BAMC!). I also love cooking, working out, and spending time with my family, friends, and firefighters. We are building our home gym complete with a punching bag (to continue Krav Maga) and Olympic weight set.

TAFP’s Member of the Month program highlights Texas family physicians in TAFP News Now and on the TAFP website. We feature a biography and a Q&A with a different TAFP member each month and his or her unique approach to family medicine. If you know an outstanding family physician colleague who you think should be featured as a Member of the Month or if you’d like to tell your own story, nominate yourself or your colleague by contacting TAFP by email at tafp@tafp.org or by phone at (512) 329-8666. 

In 2023 the American Thoracic Society called for the use of race-neutral equations in spirometry. The charge represents an evolution in thought supported by recent evidence. 

AstraZeneca, one of TAFP’s proud Partners in Health, released an infographic to be used as a resource on the topic.

TAFP’s Partners in Health program connects family physicians with organizations committed to supporting family medicine and promoting the health of all Texans. Our Partners provide patient education and high-value tools designed to help family physicians and their care teams deliver well-coordinated, comprehensive primary care. Go to Partners in Health to learn more.