Rebecca S. Etz, PhD

headshot of rebeccas s. etz

Home Institution: Virginia Commonwealth University

Fields:

Current Positions:

My Driving Question

How can primary care innovate to serve as a force for integration?

Visiting Visionary Project 

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.

Biography 

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
Selected Honors
  • 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.
Selected Publications

Developing safety, persistence, trust

Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Acquiring Resources

Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
    • “I think I kept trying to convince him I was crazy. And he kept saying, ‘No, you’re not crazy.’ […] You wouldn’t necessarily say a Vietnam Vet was crazy. You’d say they are responding like you’d expect to extraordinary circumstances.”
    • “I’m not the only one who have [sic] this problem. A lots, millions of people, you know. […] They don’t have nothing to do with that. I guess I have to live.”
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
    “You need a lot of energy and a lot of work … it takes a lot of work. It doesn’t just happen. It’s not like a magic wand.” This patient understood that they had to actively participate in the healing process.
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

Helping Relationships

“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad. When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.) “When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”

Healing

Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.” Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. Healing, in this sense, does not mean cured—none of the study participants were cured of their ailments—”but all developed a sense of integrity and wholeness despite ongoing pain or other symptoms.” In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” When we begin to heal, we find increased capacity for hope, renewed motivation to help others, and are more able to accept ourselves as we are.

Suffering

Suffering is the ongoing pain from wounding. There is debate about whether or not one actually needs to experience suffering on the path to healing.

Wounding

Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors. “The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”