Home Institution: Virginia Commonwealth University
My Driving Question
How can primary care innovate to serve as a force for integration?
Articulating a New Vision for Primary Care
The US healthcare system suffers from a poverty born of fragmentation. Primary care suffers the same distractions endemic to the health system in which it sits: an overemphasis on short term problem solving, solutions constrained by externally defined precedent rather than internally defined growth, and an increasing scarcity of resources. The ecology of individual and population health requires integrated and purposeful attention to the social and structural factors (the biological and the biographical) through which health is won and loss. Primary care can be a force for integration within the health care system but it currently fails in this role.
This is an auspicious moment for the conscious development and articulation of a clear vision for primary care. US health care sectors are demonstrating a willingness to experiment and improve the foundations of our health care system unlike anything we have seen in the last half-century. Federal think tanks and policymakers, insurers, and training institutions are experiencing a period of unprecedented and rapid change – redefining health care delivery and policy for a new generation. The National Academies of Science have called for two consensus studies to address these paradigm shifts – one specifically targeting primary care. There is great potential for primary care to assume a leadership role and to guide national conversations towards the realization of integrated care. Primary care is ideal for this role as it stands alone among the medical disciplines in being able to hold both the social and the scientific on equal footing. Yet the question remains: without a clearly articulated disciplinary center, how can we use primary care to elevate individual and population health – sustainably, affordably, and across health-related sectors?
Dr. Etz intends to grow and articulate the intellectual foundations and guiding principles for the next generation of primary care. This involves three carefully interwoven strategies:
Make visible the intellectual lineage upon which primary care is based to rediscover and pull forward the philosophical foundations that enable whole-person care.
Meet with national leaders in primary care practice, research, policy, and education to critically reflect on our beautiful mess: that which we can no longer survive and that which we cannot bear to lose. This is the heirloom seedbank upon which we will build.
Articulate a next-generation vision for primary care able to deliver on the promise we make to the American public 50 years ago: we will know you, we will be there for you when and where you need, we will hold in common and with equity the scientific and social frameworks by which health is won and lost, we will engage the full range of ways that you experience your health, integrating bodies of knowledge and care you receive across social and health sectors, and we will combat structural distractions that threaten to disrupt the healing communities we can create together.
Rebecca S. Etz is a cultural anthropologist at Virginia Commonwealth University with expertise in qualitative research methods and design, primary care measures, practice transformation, and engaging stakeholders. She has spent the last ten years dedicated to learning the heart and soul of primary care. Her career has been shaped by iterative research cycles that expose and reflect on the tacit norms and principles of primary care in which clinicians, thought leaders, and patients are equally invested.
Her work has three main lines of inquiry: 1) bridging the gap between the business of medicine and the lived experience of the human condition, 2) making visible the principles and mechanisms upon which the unique strength of primary care is based, and 3) exposing the unintended, often damaging consequences of policy and transformation efforts applied to primary care but not informed by primary care concepts.
As a member of the VCU Department of Family Medicine and Population Health, and previous co-director of the ACORN practice-based research network, Dr. Etz has been the Principal Investigator of several grants, contracts and pilots all directed towards making the pursuit of health a humane experience. Recent research activities have included studies in primary care measures, behavioral health, care coordination, preventive care delivery, simulation modeling, care team models, organizational change, community-based participatory research, the study of exemplars, and adaptive use of health technologies.
Education and Training
- Postdoctoral Fellowship – Ruth L. Kirschstein National Research Service Award
- PhD – Cultural Anthropology, Rutgers University, New Brunswick, NJ
- BA – Franklin and Marshall College, Lancaster, PA
- The Barbara Starfield Primary Care Leadership Award, The Primary Care Collaborative, Washington DC, 2020
- Primary Care Advocate of the Year Award, Society of Teachers of Family Medicine, 2021
- Levitt Lectureship guest, University of Colorado, Denver, CO, 2008 & 2019
- Innovator Abstract Award for Patient Reported Measure, National Quality Forum, Washington DC, 2019
- North American Primary Care Research Group Pearl Award, 2016 & 2018.
- Larry A Green Visiting Scholar, the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington DC, 2016 & 2018.
- President’s Faculty Excellence Award, Virginia Commonwealth University, Richmond, VA, 2011 – present.
- Simple Rules That Guide Generalist Care, Fam Med. 2021;53(8):697-700.
- Opportunities for Occupational Therapy on a Primary Care Team. Winship JM, Ivey CK, Etz RS. Am J Occup Ther. 2019 Sep/Oct73(5):1-10.
- Challenges and Successes in an Integrated Behavioral Complex Care Clinic. Ivey CK, Winship JM, Etz RS. Journal of Interprofessional Education & Practice. 2017 Dec;(9):39–40.
- A 60-Second Survey to Identify Patients’ Unmet Social Needs. Reves SR, O’Neal JP, Gonzalez MM, McHenry C, Favour M, Etz RS. Ann Fam Med. 2019 May;17(3):274.
- A New Comprehensive Measure of High-Value Aspects of Primary Care. Etz RS, Zyzanski SJ, Gonzalez MM, Reves SR, O’Neal JP, Stange KC. Ann Fam Med. 2019 May;17(3):221-230.
- Core Principles to Improve Primary Care Quality Management. Mutter JB, Liaw W, Moore MA, Etz RS, Howe A, Bazemore A. J Am Board Fam Med. 2018 Nov-Dec;31(6):931-940.
- Student Hotspotting: Teaching the Interprofessional Care of Complex Patients. Bedoya P, Neuhausen K, Dow AW, Brooks EM, Mautner D, Etz RS. Acad Med. 2018 Jan;93(1):56-59.
- Less AND More Are Needed to Assess Primary Care. Etz RS, Gonzalez MM, Brooks EM, Stange KC. J Am Board Fam Med. 2017 Jan 2;30(1):13-15.
- People Are Primary Etz RS. JABFM. 2016 Jul-Aug;29:S40-44.
- Practice-based innovations: More relevant and transportable than NIH-funded studies. Etz RS, Hahn KA, Gonzalez MM, Crabtree BF, Stange KC. J Am Board Fam Med. 2014 Nov-Dec;27(6):738-9.
- Metrics for assessing improvements in primary health care. Stange KC, Etz RS, Gullett H, Sweeney SA, Miller WL, Jaén CR, Crabtree BF, Nutting PA, Glasgow RE. Annu Rev Public Health. 2014;35:423-42.
- A re-emerging political space for linking person and community through primary health care. Sweeney SA, Bazemore A, Phillips RL Jr, Etz RS, Stange KC. Am J Prev Med. 2012 Jun;42(6 Suppl 2): S184-90. doi: 10.1
- Bridging primary care practices and communities to promote healthy behaviors. Etz RS, Cohen DJ, Woolf SH, Holtrop JS, Donahue KE, Isaacson NF, Stange KC, Ferrer RL, Olson AL. Am J Prev Med. 2008 Nov;35(5 Suppl): S390-7.
- See articles & papers on PubMed