Students, Young Physicians Provide Insights for Future of Family Medicine 2.0
Have you offered your opinion on the Future of Family Medicine?
Your opinion matters, and now is the time.
In our first update on Family Medicine for America's Health: Future of Family Medicine 2.0, you had a chance to learn about our initiative that aims to define the role of the 21st century
family physician, including scope of practice and our role within the health
In our December update below, we address some of the important questions being considered by the work group and introduce the young physicians, residents and medical students who have been selected to help answer those questions.
You can share your thoughts directly with us at FutureFM@AAFP.org. And you can be sure we will continue to share updates on our progress.
Family Medicine for America's Health
(Future of Family Medicine 2.0)
The Family Medicine for America's Health (Future of Family Medicine 2.0) initiative is moving forward according to schedule. The purpose of this effort is to develop a multiyear strategic plan and communications program to address the role of family medicine in the changing health care landscape.
The Core Team held two meetings in November. The meetings focused on CFAR's "current state" analysis and APCO's opinion research. The current state analysis is designed to create a foundation on which to build an implementable strategic plan that identifies risks to take, investments required to do so, and a realistic understanding of what it will take to bridge the gap between the current state and the desired future we want to create. During the meetings, there has been significant discussion about scope of practice, compensation and the impact of technology on the specialty.
To address some of the key questions and ensure broad input in the process, the CFAR team is focused on organizing two "Insight Groups" designed to engage and elicit feedback on the future of family medicine. The first group includes medical students and residents. The second group includes young leaders who are in their early years of practice. Each of the seven family medicine organizations nominated two participants to each of the groups. Please see below for names of the 28 individuals who were nominated.
Discussions with these Insight Groups are being facilitated by Bob Graham, M.D.; Larry Green, M.D.; and Jim Martin, M.D. Members will contribute their perspective throughout the FFM 2.0 process. This will include
- participating in discussions about the future of family medicine with their facilitators;
- reviewing and reacting to the work produced by the Core Team and the Steering Committee; and
- meeting in person with the Core Team, Steering Committee, and a variety of stakeholders within and outside of family medicine at a strategic planning retreat in February.
APCO, which is leading the communications strategy element of the project, has completed a series of in-depth interviews with policy experts, payers, employers and specialists outside of family medicine. APCO's interviews will inform the quantitative element of their research, which includes a survey of a wide group of family medicine stakeholders. The results of that survey are expected in January.
We strongly encourage input from family physicians. Since our first report on this initiative, we have received more than 100 comments to FutureFM@aafp.org.
Following are several of the key questions the Core Team is considering as CFAR develops the current state analysis. We welcome input on these questions or general comments via FutureFM@AAFP.org.
- Is the patient-centered medical home (PCMH) the model of the future?
- How will the PCMH model need to evolve to meet the demands of the Triple Aim?
- Is population health a key part of family medicine? How should family medicine integrate with public health?
- How will disruptive technology alter the practice of family medicine?
- What changes are needed in the current payment structure to support the future of family medicine?
- What data is available/needed to support changes in payment structure?
- How does a narrowing scope in maternity and children's care impact the practice of family medicine?
- The Core Team and Steering Committee will meet on Dec. 8. We will continue to provide monthly updates throughout this process.
Insight Group Members
Young Leaders (with nominating organizations)
- Michael Coffey, M.D., Somerville, Mass. (AAFP)
- Christina Kelly, M.D., Harker Heights, Texas (AAFP)
- Brooke Sciuto, M.D., Sacramento, Calif. (AAFP Foundation)
- Gretchen Dickson, M.D., M.B.A., Wichita, Kan. (AAFP Foundation)
- Kurt Lindberg, M.D., Holland, Mich. (ABFM)
- Amy McIntyre, M.D., M.P.H., Butte, Mont. (ABFM)
- Melissa Nothnagle, M.D., M.Sc., Pawtucket, R.I. (ADFM)
- Jill Endres, M.D., Iowa City, Iowa (ADFM)
- Carl Covey, M.D., Las Vegas (AFMRD)
- Carla Ainsworth, M.D., M.P.H., Seattle (AFMRD)
- Lauren Hughes, M.D., M.P.H., Ann Arbor, Mich. (NAPCRG)
- Rebecca Etz, Ph.D., Richmond, Va. (NAPCRG)
- Alisahah Cole, M.D., Charlotte, N.C. (STFM)
- Brett White, M.D., San Diego (STFM)
Students and Residents (with nominating organizations)
- Tate Hinkle, Brownsboro, Ala. (AAFP)
- Kimberly Becher, M.D., Huntington, W.V. (AAFP)
- Nathaniel Lepp, M.P.H., New York (AAFP Foundation)
- Jessica Johnson, M.D., Portland, Ore. (AAFP Foundation)
- Charles Salmen, Brisbane, Calif. (ABFM)
- Kathleen Barnes, M.D., M.P.H., Seattle (ABFM)
- Jason Valadao, Wauwatosa, Wis. (ADFM)
- Jillian Fickenscher, M.D., Omaha, Neb. (ADFM)
- Natasha Bhuyan, M.D., Phoenix (AFMRD)
- Kari Sears, M.D., South Bend, Ind. (AFMRD)
- Vanessa Stagliano, Sagamore Hills, Ohio (NAPCRG)
- Richard Bruno, M.D., Baltimore (NAPCRG)
- Rebecca Mullen, Overland Park, Kan. (STFM)
- Nicholas Cohen, M.D., Cleveland (STFM)
Jeff Cain, M.D., is Board Chair of the AAFP.
FPs Doing Good Work in House of Medicine
recently represented our members at the AMA Interim Meeting in National Harbor,
Md. The AMA obviously is a very different organization than ours, but it
provides family physicians with another opportunity to lead and advocate at the
state and national levels. I was truly impressed by the tremendous
contributions being made by family physicians across the country.
Many of our members may not realize how involved some of their family physician colleagues are in the AMA, but we do everything we can -- anywhere we can -- to take our messages forward. I want to share my praise for a number of hard working FPs who represent our specialty and their patients through their work in the AMA.
The AAFP's delegation to the AMA is an outstanding group of dedicated individuals. Many of them have spent a decade or more involved in the AMA, and several are in positions of leadership. Our delegation is chaired by Joseph Zebley, M.D., of Baltimore and his co-chair Daniel Heinemann, M.D., of Sioux Falls, S.D.
Other members of the AAFP delegation are
- Neil Brooks, M.D., of Vernon Rockville, Conn.;
- Aaron George, D.O., of Durham, N.C..;
- Ajoy Kumar, M.D., of Saint Petersburg, Fla.
- Glenn Loomis, M.D., of Crestview Hills, Ky.;
- Frederick Ridge, M.D., of Linton, Ind.;
- Hugh Taylor, M.D., of South Hamilton, Mass.;
- Colette Willins, M.D., of Westlake, Ohio; and
Worthington, M.D., of Des Moines, Iowa.
Two of those delegation members -- Willins and Loomis -- serve on AMA councils.
David Swee, M.D., of Piscataway, N.J., is the alternate delegate. AAFP staff members Doug Henley, M.D.; Stan Kozakowski, M.D.; Perry Pugno, M.D., M.P.H.; and Julie Wood, M.D., also play important roles.
We also have critical representation from new physicians Janet West, M.D., of Pensacola, Fla., and Lindsay Bosford, M.D., M.B.A., of Sugarland, Texas; residents Charles Thompson, M.D., of Huntsville, Ala., and Messalina Jordan, D.O., of Brownsboro, Ala.; and students Jerry Abraham of San Antonio and Samuel Mathis of Galveston, Texas.
You might remember that Brooks is a former AAFP President. He is demonstrating a lifelong commitment to our specialty and is moving things forward in every avenue that he can find.
AAFP officers -- Board Chair Jeff Cain, M.D., (pictured with me above) President-elect Robert Wergin, M.D., and myself -- also serve as delegates. Each of us testifies during reference committees, as well as on the floor of the House of Delegates.
We also maintain connections with our state delegations and have many opportunities to talk about the priorities of family medicine in the context of the state chapters and their issues.
It's also worth noting that five members of the AMA Board of Trustees are family physicians, including the chair, David Barbe, M.D., of Mountain Grove, Mo.
Other family physicians on the AMA board are
- Gerald Harmon, M.D., of Pawleys Island, S.C.;
- William Kobler, M.D., of Rockford, Ill.;
- Albert Osbahr, M.D., of Hickory, N.C.; and
Permut, M.D., of Philadelphia.
All five of these men are AAFP members who understand the importance of family medicine. Each of them has the opportunity to be the AMA President-elect in the near future.
At each AMA event, we hold a dynamic meeting that is called a lunch but is actually more of a caucus. AAFP members from AMA leadership positions and state medical societies are invited to attend. We had more than 100 family physicians present at the most recent lunch as we reviewed AAFP priorities and policies, networked, created connections, talked about ways of engaging, and shared ideas and concerns. This is an important opportunity to communicate with members who may not come to our state chapter or national meetings.
It is exciting to be a part of this dedicated group of family physicians. As I have been saying, the answer to our country's health care needs is team-based care. The AMA meeting allowed us to reconnect with critical segments of our membership team to work to ensure policies that come out of the AMA are in line with the needs of our members. Ultimately, family physicians are on the front lines of organized medicine, working to improve outcomes for patients, increase their satisfaction with their care and decrease the cost of that care. Together we are stronger.
Reid Blackwelder, M.D., is President of the AAFP.
Giving Thanks for Work-Life Balance -- and the Dog
With the hectic schedules that we keep and the daily challenges we face, Thanksgiving presents a wonderful opportunity to pause and reflect on the things that are important.
One of the most important aspects of this holiday is that even if families are spread across the country, it is a time to gather, share a meal and give thanks. If face-to-face visits aren't possible, people often call or connect in other ways. And those connections are so important for recharging ourselves.
I find myself remembering that one of the main areas
of focus during our Scientific Assembly was finding balance in our lives. This
is an excellent theme to remember during Thanksgiving, so here is a story I'd
like to share.
My wife, Alex, and I have always had large dogs as part of our family. Sadly, we lost our last big black lab, Little Bear, in April. This left us with a 17-year old cat and the world’s largest Yorkie. Given the demands of an AAFP officer’s travel schedule, we decided that we wouldn't get a new puppy until my time on the Academy's Board of Directors ends in 2015.
Of course, you know what they say about best-laid plans. During a trip to the New Mexico AFP's chapter meeting, Alex and I fell in love with a malamute mix puppy and brought him home to Tennessee. He was able to fit in the pet carrier on Delta for just this one plane trip. He has since grown to 60 pounds at just 5 months of age.
New puppies bring additional responsibilities and even stress -- disrupted sleep schedule, need for frequent walks, lots of sudden play time, training, puppy class, socialization and so on. Not surprisingly, all of these things rather abruptly put into focus for me the critical need for balance.
Despite all of the above, which is certainly disruptive and even exhausting at times, our puppy, named Chashush (which is Apache for Big Bear) has actually helped create some balance for me. Alex and I have made important and healthy changes in our lives at a time we thought we might be too stressed to do so. We are outside getting exercise again with walks in our beautiful neighborhood, seeing the wildlife -- such as deer, raccoons and turkeys -- that are out early in the morning and late in the evening in our area. I am learning to recognize I can’t work 24/7, even though -- as Alex would tell you -- I still try.
Given his size, we committed to socializing Chashush early and regularly. Addressing this need has led to spending more time with friends because we often have puppy play dates that involve dinner and catching up with those friends. The dog also has been a wonderful focus for the grandkids, who are getting to know another member of our extended family and helping teach him how to interact with children.
We were not looking for a dog, and had, in fact, agreed not to get a new one during this hectic time in our lives. But it is remarkable what can happen when you hear a knock at the door and open it. I hope each of you will find time to open those doors that present opportunities to you, connect with friends and family (however you define them) who are important to you, and make them a part of your lives. This is definitely the time of year to do that on many levels.
Alex and I wish you and your family a happy, powerful and recharging Thanksgiving.
For news about the Academy and family medicine (and occasional updates about the dog) follow me on the AAFP President Facebook page.
Reid Blackwelder, M.D., is President of the AAFP.
AAFP Takes SGR Message to Capitol Hill
After spending a week at the AMA Interim Meeting in National Harbor, Md., AAFP leaders met with members of Congress and congressional staff Nov. 19-20 in Washington to discuss the repeal and replacement of the sustainable growth rate (SGR) formula and other issues of importance to family medicine. AAFP President Reid Blackwelder, M.D., offers an update on the Academy's advocacy efforts in the video below.
Reid Blackwelder, M.D., is President of the AAFP.
Patient Encounter Offers Reminder About Finding Work-Life Balance
As family physicians, we spend a significant portion of our days telling patients what they should or should not eat, how often and how rigorously they should exercise, and how much they should sleep, as well as offering tips related to bad habits they should stop.
But how often do we take our own advice?
recently saw a patient, a woman in her early 50s, who we'll call Janice. Janice
was struggling with short-term memory problems, forgetting things like paying
her bills on time. That costly error led to late fees and additional stress for
a woman with an executive-level job, two kids and ailing, older parents.
I completed a thorough evaluation to rule out any physical or mental issues. In the end, Janice simply had too much on her plate, and the stress was getting to her. I suggested that she clear time on her schedule for herself and manage her time better. Sometimes, I said, our own well-being has to move to the top of the priority list, or all the other things on that list will suffer.
After she left, I thought, "That was pretty good advice. I should take it."
Physicians, especially physicians with children, often struggle with being pulled in multiple directions. In addition to the demands of a time-intensive job, we have commitments to family, friends and others. How do we find balance?
We deliver important messages to our patients every day, but these encounters also can serve as needed wake-up calls for ourselves. Someone who has completed college, medical school, residency and a master's degree in public health shouldn't have to be told to exercise, rest and eat well, but there I was in need of a simple reminder to take better care of myself.
Less than a year ago, I joined a brand new practice dealing with the typical challenges that new practices face: implementing an electronic health record system, recruiting a health care team and attracting patients. Throw in a family that includes 3-year-old and 6-year-old boys (pictured above), and life can be pretty crazy sometimes.
So now when I need to do something for myself, even little things like finding time to exercise, I put it on my calendar so that important time is reserved for me. If you think, "I'll go for a jog after I take care of X, Y and Z," you can count on A, B and C waiting for you the minute you're finished with Z.
The holidays are fast approaching, and although this time of year can be stressful, it also is a good time to stop and take a look at what we're doing and how we're doing it. In the coming weeks, I'll be asking my patients, "How did things go for you this year? What negative things are you going to leave behind in 2013, and what positives will you take with you into 2014?"
Those are questions we should ask ourselves as well.
M.D., M.P.H., is the new physician member of the AAFP Board of
Center Provides Important Lesson on Where We Came From
"History is who we are and why we are the way we are." -- Author and historian David McCullough
A placard bearing that quote from McCullough, a two-time Pulitzer Prize winner, caught my eye during my first trip to the Center for the History of Family Medicine. I recently attended my first meeting of the Center's Board of Curators as a liaison from the AAFP Board of Directors. Although I have been actively engaged in our Academy for nearly 30 years, I am sorry to admit that I was not aware of the wonderful resources available through the Center.
I am proud of our specialty and our heritage, and the Center is home to thousands of books, articles and artifacts that track our history. This wonderful combination of library, archives and museum is available as a resource for members wishing to learn more about our roots.
Some of our more experienced members might find the Center's
resources interesting because those books, articles and artifacts document
something they experienced. For our younger members, the Center offers insight into
where we came from.
Our specialty is a relatively new one. Family medicine officially became a medical specialty in 1969 (not long after this photo from the Center's archives was taken at the 1968 Congress of Delegates). At the time, the number of physicians entering what had been regarded as general practice was dwindling rapidly. Specialization, on the other hand, was viewed as important and valuable.
Our leaders understood the role of specialists, but they also believed in the importance of primary care, building relationships with patients and tying it all together rather than having a system of highly fragmented care. Family medicine leaders were courageous and worked for what they believed in, despite opposition from many in the medical establishment who opposed the idea of family medicine as a specialty.
Today, the mentality to speak out for our patients, practices and family medicine continues to be important in the face of new -- and old -- challenges in health care. It's something in the DNA of our specialty and something we can't afford to lose.
I encourage you to become more acquainted with our history, and you can do this easily by exploring the Center's online resources. In particular, I suggest you look through the Classics of Family Medicine, a list of seminal articles from the medical literature that have helped shape our specialty. Likewise, I suggest you explore our online exhibits, where, among other exhibits, you will find the "Distinguished Dozen: Twelve Books That Shaped the Face of Family Medicine."
For those interested in spending time in the Center to perform research leading to a publishable article or book, there is an annual fellowship available from the AAFP Foundation.
Remembering where we came from can help us find our way in the future. As McCullough said, "History is a guide to navigation in perilous times."
Clif Knight, M.D., is a member of the AAFP Board of Directors.
The Good, the Bad and the Ugly … A Tale of Three Bills
Congratulations to our Louisiana, Ohio and Pennsylvania chapters for winning Leadership in State Government Advocacy Awards at the AAFP's State Legislative Conference, Nov. 1-2 in Broomfield, Colo. Our national and state legislative leaders spent that weekend discussing issues related to scope of practice, the Patient Protection and Affordable Care Act, opioid abuse and rural workforce. This annual event presented a great forum for knowledge sharing and cross pollination of legislative strategies across the states.
If you have spent any time at your state legislature, you know that actions are worth more than words, and that legislators -- despite good intentions -- may craft bills that are good, bad or just plain ugly when it comes to public health and the practice of medicine.
My state legislature is no exception. In California, we just ended the first of a two-year legislative session, which meant that all bills were chartered, killed or pushed onto a second year session for more work. This year, we saw three scope-of-practice expansion bills: one for pharmacists, one for nurse practitioners and one for optometrists.
Here is the low down on each of these bills.
The first in this triad of bills became law, allowing pharmacists to furnish self-administered hormonal contraceptives, nicotine replacement products, and prescription medications not requiring a diagnosis that are recommended for international travelers. In addition, they will be allowed to order and interpret tests for the purpose of monitoring and managing the efficacy and toxicity of drug therapies in coordination with the patient's primary care physician, including by faxing or entering results in patients' medical records. And finally, they are allowed to initiate and administer routine vaccinations recommended by the CDC's Advisory Committee on Immunization Practices.
Why, you ask, is this expansion good for family physicians? The house of medicine initially opposed the bill. However, after several thoughtful discussions with pharmacists, the bill was amended to bring pharmacists into a patient-centered medical home model, which allows them to become a part of the health care delivery team in their area of expertise. This will result in more coordination between a patient's primary care physician and pharmacist, and it will decrease the barriers our patients may face in obtaining certain treatments.
It is always good when each member of the health care team is participating to the maximum that their training allows.
In stark contrast to the pharmacists, the nurse practitioner scope bill exemplified how bills should not be worked through the legislature. After years of working with physician organizations -- including by supporting several prior bills that were passed to allow increased scope of practice for nurse practitioners within a collaborative agreement structure -- nurse practitioners tried to pull a fast one on the legislature this year. Nurse practitioners argued that they can fill in primary care shortage gaps where family physicians cannot or are not willing to do so.
However, physician organizations successfully argued to the legislature that independent nurse practitioners would not improve quality and may adversely affect patient safety. This argument was further augmented by data provided by the California AFP showing that independent nurse practitioners would not improve primary care misdistribution in our state.
To their credit, state legislators heeded our message, and the bill failed to pass out of committee. By focusing on obtaining independence, nurse practitioners sought to further fragment the health care delivery system and to further undermine the cornerstone of health care reform by putting their financial self-interest above coordinated, patient-centered care. The nurse practitioner bill simply highlighted deficiencies in our fragmented health delivery system without providing a workable solution to the primary care workforce shortage.
The last of the three scope bills would have allowed optometrists to diagnose and treat all conditions presenting with ocular manifestations. It would not only allow them to initiate treatment of chronic diseases -- such as diabetes and hypertension -- but also complex conditions such as systemic infections and autoimmune diseases.
Needless to say, the house of medicine was strongly opposed to this bill. Yet, the author, an optometrist himself, would not take on any amendments to his bill. He was able to move this bill out of the committee that he chaired. But facing a high likelihood of defeat on the floor, he pulled the bill for further work next year.
I had an opportunity last week to participate in a community chronic disease forum hosted by the author of this trio of scope bills. After some careful repartee sitting around a small table, I came to realize that he, like many, if not all, legislators, drafts bills with the best of intentions. In this vein, it would be in our best interest as family physicians to keep close tabs on all our legislators and develop relationships with them. Successful advocacy takes good will and influence to bring about change.
So, what can you do? You can join the thousands of family physicians who have signed up to become key contacts for advocacy. Key contacts receive regular updates from the Academy's government relations staff on issues important to family medicine, and they occasionally are asked to reach out to their legislators by phone or e-mail to tell their stories and let lawmakers know how issues are affecting family physicians and our patients.
For those who aren't able to get directly involved with advocating for family medicine, you can still make a difference by supporting FamMedPAC, the Academy's federal political action committee. FamMedPAC enhances AAFP advocacy efforts by making direct, nonpartisan contributions to candidates for the U.S. House of Representatives and the U.S. Senate. FamMedPAC provides AAFP members with an easy way to get involved in the political process and to support candidates who support family medicine.
With mid-term elections approaching, you'll be helping to improve the delivery of health care in this country, and helping put family physicians on equal footing with the powerful insurance companies and trial lawyers. It's one way to ensure our voice is heard on Capitol Hill.
Jack Chou, M.D., is a member of the AAFP Board of Directors.
The Challenge of Working With Health Plans
Every year, AAFP leaders and staff members meet with several of the nation's largest health insurance companies to discuss payment and other issues important to family medicine. Last week at the Academy's headquarters in Leawood, Kan., we met with UnitedHealthcare (UHC), and it provided us with an opportunity to express our concern regarding UHC's recent move to make significant cuts to its Medicare Advantage provider network just a few weeks before Medicare open enrollment.
UHC representatives told us they made the decision because in some markets their networks were significantly larger than their competitors, who already have taken similar steps to reduce the size of their networks. They felt they needed to “optimize” those networks to align with their competitors. A narrower network, UHC's representatives said, will allow the company to invest more in certain practices through incentive payment programs and also will eliminate unwanted variations in care.
Regardless of whether UHC's business decision was good for the insurer, it was poorly timed, catching physicians and patients off guard during a critical time of year. We stated again that decisions that affect such a significant number of patients and physicians -- up to 18 percent of primary care physicians who contract with UHC in some markets -- should be communicated to the Academy in advance so we can alert our chapters and prepare our members.
According to UHC, the company did not remove patients from coverage altogether. Instead, it is working to move them to other practices in their network. As we told them, however, cutting large numbers of physicians could create capacity and access issues in some markets because many of our members do not have the ability to significantly increase their patient panels.
Despite the above matter, we were able to find common ground on some important issues. For example, United agreed that we need a more continuous dialogue at the staff level, and we identified a few issues that we will be actively engaged in with UHC moving forward.
UHC representatives also said they want to work with the Academy -- as well as other payers -- to standardize and align quality measures, which would vastly reduce the reporting burden physicians face. They also want to hear more about the new evaluation and management codes for primary care physicians that the Academy has recommended to CMS.
Care management fees are another issue we will be discussing with UHC, which has publicly stated that it plans to have at least 50 percent of its provider network working under value-based contracts, rather than strictly fee-for services arrangements, by 2015.
Fee schedules that pay less than Medicare in some regions also were a topic of discussion. We emphasized that other payers in these areas do pay above Medicare rates, and to be viable, family medicine must be valued appropriately.
Working with health plans can be challenging, but we can build on common issues that keep the patient's best interest as our primary focus. We will stay engaged and continue to promote the value of family medicine.
Robert Wergin, M.D., is President-elect of the AAFP.
Getting Health Care Right, Even as We Change It
If there's one thing that's constant about health care in the United States these days, it's change. Health care reform swept a wave of new ideas out of theory and into practice, from insurance exchanges to accountable care. Advances in medical research mean that physicians have more treatments to help our patients than ever before. As a country, we're coming to terms with how complex health care is and how much change is still on the horizon.
Amidst all the change and complexity, though, the importance of the physician-patient relationship has stayed exactly the same. As I reviewed this month's workforce issue of Health Affairs, I was reminded of the more than 20,000 hours of training and education I completed, learning to provide the right care to patients despite a wide array of variables. Complexity is what physicians train for throughout our careers. As physicians, we have the education, expertise and experience necessary to ensure the highest quality of care for patients.
Being a primary care physician has never been more challenging or interesting, and fortunately, there are more of us than ever. The number of new primary care physicians increases every year, and by 2016, more than 3,000 new physicians will complete their training annually.
I can't imagine doing my job without the full breadth of training and education I received when becoming a family physician. Our patients' health challenges are growing increasingly complex. More members of our local communities -- whose families we often have cared for during the course of many years -- are developing multiple complex conditions that require advanced training and a keen insight into what might be causing overlapping health problems. According to the CDC, 45 percent of adults have two or more of the most common chronic conditions, and with an increasingly sedentary lifestyle and persistently high childhood obesity, future generations are likely to face significant overlapping health challenges, as well.
Because of our training and our presence in virtually every community across the country, family physicians are uniquely able to mediate change and complexity in a way that helps make health care work better for patients. The relationships we have with patients, combined with our training and expertise, are key to our ability to ensure our patients get the right care at the right time. There's a reason that people with chronic conditions -- from Parkinson's disease to hypertension -- see primary care physicians at higher rates than they see subspecialists.
Ultimately, that's what patients want. When they come to see us, our patients want to see a trusted partner in health who is expert enough to diagnose their problem, develop a comprehensive treatment plan, advise them and lead their care. We offer our patients exactly that because we devote more years to the study of medicine than any non-physician health care provider.
There's a lot that's changing with health care, but the core of why we became family physicians is our relationship with our patients, their families and their communities. Even as health care changes and evolves around us, we remain steadfastly committed to our patients. In that commitment, some things never change.
Reid Blackwelder, M.D., is President of the AAFP.
Shaping the Future of Family Medicine
A few months ago, the Family Medicine Working Party launched an initiative to examine the challenges and opportunities facing our specialty and define a path forward in a rapidly changing health care system.
Family Medicine for America's Health: Future of Family Medicine 2.0 is specifically designed to define the role of the 21st century family physician, including key attributes, practice scope and role within the health care system, and to ensure family medicine can deliver the workforce to perform this role via medical school/residency training and re-engaging existing family physicians, among other things.
When this project launched, we promised to share regular updates on its progress. Here is the latest information.
Family Medicine for America’s Health:
Future of Family Medicine 2.0
Organizational Update #2
As many of you know, the Family Medicine for America’s Health: Future of Family Medicine 2.0 initiative launched in late August. The purpose of this effort is to develop a multiyear strategic plan and communications program to address the role of family medicine in the changing health care landscape.
As a reminder, the Family Medicine Working Party identified a set of key principles that will underpin this effort:
- deliver on the triple aim: improving the health of the population, enhancing the patient experience of care (including quality, access and reliability), and reducing, or at least controlling, the per capita cost of care;
- focus on the needs of residents and medical students, as well as practicing family physicians; and
- manage the tension between addressing the needs of family medicine as a specialty and needed changes to the health care system of which it is a part.
The first of seven Core Team meetings was held on Oct. 15 in Chicago. The consultants retained for this project -- CFAR and APCO Worldwide -- have begun the research phases of their respective plans. CFAR conducted a series of interviews with family medicine stakeholders. Interviewees included family physicians practicing and teaching in a variety of settings, public health and mental health teachers and practitioners, osteopaths, physician assistants, nurse practitioners, and other specialists. The insights gleaned from the interviews will be used to inform CFAR's Strategic Options Survey, which launched during the week of Oct. 21 and will remain open for two weeks. CFAR also will begin gathering and working with data from a range of sources to build a solid understanding of the current state of family medicine, its strengths and its challenges.
APCO is conducting in-depth interviews with health policy experts, payers, health plan purchasers, other primary care professionals and specialists to gather insights and recommendations related to how these external stakeholders view family physicians. These discussions will inform the quantitative element of their research, which includes surveys of a wide group of family medicine stakeholders. This research will be used to guide the development of a comprehensive communications plan.
At the meeting, CFAR and APCO briefed the Core Team on feedback from their interviews. Issues surrounding scope of practice and length of training emerged as significant themes, particularly in the CFAR interviews. Additional questions arose from both CFAR and APCO's discussions that will require further discussion and evaluation, including
- Are family physicians “specialists” or “comprehensivists” who provide longitudinal care?
- What is the “unifying theme” among the diverse archetypes of family physicians?
- How do family physicians approach the needs and wants of patients differently than do other physicians?
- Do family physicians believe they have a mandate to lead the patient-centered medical home effort or are they deferring to others?
- What impact will technology and big data have on the practice of family medicine?
Since our first report to members on this initiative, we have received more than 140 comments to FutureFM@aafp.org. We are pleased that family physicians are taking the time to provide input and would encourage others to share their views through this dedicated e-mail address. We are closely reviewing comments and are incorporating suggestions into the planning process.
The second meeting of the Core Team will be Nov. 13. We will continue to provide updates throughout this process. We strongly encourage input and feedback and invite you to share your thoughts and recommendations by email to FutureFM@aafp.org.
Following are members of the Steering Committee and the Core Team.
Samuel Jones, M.D. (ABFM) -- Committee Chair
Stacy Brungardt (STFM)
Ardis Davis (ADFM)
Frank deGruy, M.D. (NAPCRG)
Kevin Helm (AFMRD)
Douglas Henley, M.D. (AAFP)
Grant Hoekzema, M.D. (AFMRD)
Jason Marker, M.D. (AAFP Foundation)
James Puffer, M.D. (ABFM)
John Saultz, M.D. (STFM)
Kurt Stange, M.D., Ph.D. (NAPCRG)
Glen Stream, M.D., M.B.I. (AAFP)
Barbara Thompson, M.D. (ADFM)
Jane Weida, M.D. (AAFP Foundation)
Tom Campbell (ADFM)
Jennifer DeVoe, M.D., D.Phil. (NAPCRG)
Jerry Kruse, M.D. (STFM)
Bob Phillips, M.D. (ABFM)
Glen Stream, M.D., M.B.I. (AAFP)
Mike Tuggy, M.D. (AFMRD)
Mary Jo Welker, M.D. (AAFP Foundation)
Jeff Cain, M.D., is Board Chair of the AAFP.
U.S. GME Results Not Aligned With Need
The U.S. birth rate hit an all-time low in 2012, dropping to 63 babies per 1,000 women aged 15 to 44. That's a little more than half the birth rate the nation experienced at the tail end of the baby boom.
This recent news
from the CDC coincides with a new report from the AAFP's
Robert Graham Center for Policy Studies in Family Medicine and Primary Care showing how our
country’s graduate medical education (GME) system has not kept up with the
needs of our changing population. Despite the declining birth rate and an
increasing need for a larger adult primary care workforce, our nation's medical
schools and residency programs are producing general pediatricians at a much
higher rate than family physicians and general internal medicine physicians.
Our aging boomer population -- coupled with expanding access to health insurance -- poses a potential crisis. People are living longer with more chronic diseases, but who will provide their care?
We know that new medical schools are opening, and many
existing schools are expanding their class sizes. But our goal can't be to just
graduate more physicians. Our country's goal for medical education should be to
produce the types of physicians our health care system actually needs.
The Graham Center's one-pager illustrates an excellent example of how primary care research can help drive health care policy. It reinforces an August report from the Council on Graduate Medical Education (COGME) recommending that GME funding be prioritized to align the health care workforce with population and health delivery needs. Specifically, COGME said increases in GME funding should be directed to the following high-priority specialties:
- family medicine
- general internal medicine
- general surgery
- pediatric subspecialties and
The United States spends nearly $13 billion a year on GME funding, an investment made with our country's tax dollars. For this level of investment, we deserve a workforce that meets our country's needs.
Jeff Cain, M.D., is Board Chair of the AAFP.
Scientific Assembly Gets High Marks From FPs, But Can We Do Better?
It's an inspiring sight when nearly 5,000 family physicians get together in one place. That was the scene last month in San Diego at the AAFP's Scientific Assembly.
One of the goals for our flagship meeting this year was for members to head home feeling connected, inspired and better equipped to care for patients. So how did we do? In our survey of attendees, nearly 88 percent of respondents said they felt better equipped to care for their patients as a result of attending, and 78 percent said they were inspired by the event. More than 96 percent said they would recommend the Assembly to their colleagues.
numbers are pretty good, but can we do better?
The Scientific Assembly is the nation's largest gathering of family physicians because it offers an opportunity to choose from more than 320 CME courses and earn up to 40 AAFP Prescribed credits. We're always working to enhance the already first-rate CME, but we also want to provide an experience that isn't limited to sitting in a classroom for four days.
In San Diego, we got just a taste of what is to come at future events. In addition to CME, there were learning opportunities related to topics such as contract negotiations, direct primary care, financial planning, meaningful use and more. In other words, Assembly can teach us more than clinical topics; it can improve all aspects of our practices.
Assembly also offered new opportunities to meet, or reconnect, with colleagues who share similar practice models, backgrounds or other interests. We're evaluating how to do an even better job of connecting members next year.
For the first time, we offered three general sessions that were linked -- addressing the real issues that affect family physicians, hearing the real voices from our members and offering real answers. More than seven out of 10 attendees told us those sessions were helpful.
I was honored to open the Scientific Assembly, (photo above) and express my gratitude for the opportunity to be your president this year. I talked about the importance of finding balance and the critical nature of what some are calling the "quadruple aim." In addition to the triple aim of improving patients' outcomes, health and satisfaction at a lower cost, we have to do so while attending to our own health and satisfaction.
Glenna Salsbury, the keynote speaker for the opening session, drew especially high marks in our surveys. She talked about the importance of understanding our purpose in life and finding joy in it. We have an opportunity, at every moment, to decide whether to stay on a positive path, said Salsbury.
We also heard from speaker Sally Hogshead, who told us how each one of us has different ways of communicating with -- and fascinating -- people. If we understand and play to our strengths, she said, our patients will be more loyal, more trusting and more likely to adhere to instructions.
My hope is that everyone leaving San Diego felt energized and proud to be a family physician. Those are two of the goals we'll be focusing on for next year. We're already looking at ways we can make our 2014 Assembly -- scheduled for Oct. 21-25 in Washington -- a can't-miss event.
You can check back here for details. Registration will open in February.
If you attended Assembly last month in San Diego, please share your thoughts below on what you enjoyed and what the Academy can do to make the experience even more valuable to family physicians.
Reid Blackwelder, M.D., is President of the AAFP.
Residents Can Attest to Demand for FPs
I recently served as a panelist during National Primary Care Week activities at my alma mater, Marshall University's Joan C. Edwards School of Medicine. During our session, one of the medical school students asked me how family medicine might change in light of more mid-levels providing primary care. Specifically, the student wanted to know if demand for family physicians might fizzle.
Family physicians are in demand more than any other
specialty and have been for seven years running, according to Merritt Hawkins. The health care search and consulting firm
said in a report last month that the growing demand for family physicians stems
from the need for employed FPs in hospitals and health care systems.
The number of medical students choosing family medicine increased for the fourth straight year in the 2013 National Resident Matching Program, and more U.S. seniors matched to family medicine than in any year since 2002.
Despite those positive signs, the supply of family physicians is nowhere near balanced with the demand. Researchers estimate that the country needs 52,000 more primary care physicians by 2025.
The fact that family physicians are in demand should come as no surprise to family medicine residents. I receive solicitations daily from recruiters, despite the fact that I'm not looking for a job. I signed a contract more than a year ago for a position that will start in August 2014. Most residents don't sign that early, but I found exactly the kind of practice I wanted to join. The federally qualified health center is a patient-centered medical home with a physician friendly electronic health record. Its reimbursement model includes per-member, per-month fees.
The practice is continually pursuing, and receiving, innovation grants and trying new things, so I'm happy with my choice. I'm not circulating my resume. I don't even have a LinkedIn account. And yet, the calls, e-mails and snail mail keep coming at home and at work every day.
One of my fellow third-year residents -- who is looking for a family medicine job -- said she receives more than a dozen e-mails a day from recruiters.
So what did I tell that student during our panel discussion?
I said that nurse practitioners often specialize, so they can't necessarily improve access to primary care in areas of need.
I said family physicians should work to appropriately incorporate mid-levels into our practices because they can play a vital role on our health care teams.
And, I pointed out that many patients prefer to see a physician, and some will switch practices if they don't think they have proper access to their doctor.
We are in demand by patients and employers, and that isn't likely to change.
Kimberly Becher, M.D., is the resident member of the AAFP Board of Directors.
WIC One Example of How Shutdown Could Hurt Our Patients
On Monday, we told you how the government shutdown is affecting health care, as well as how it is affecting the Academy's advocacy efforts in Washington. Today, I offer one example of how the congressional stalemate could cause millions of our patients to suffer simply by affecting one vital, time-tested program.
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides supplemental foods, infant formula, breastfeeding support, health care resources and more to nearly 9 million mothers and young children who live near or below the poverty line. The WIC program has been essential in helping to improve health and nutrition for mothers and children and lowering health care costs.
But, the government shutdown has affected funding for this essential program. There was immediate speculation that state WIC programs would run out of money within a week or two, but state reserves and contingency funding from the U.S. Department of Agriculture are expected to keep programs running through the end of the month.
The question, however, is will Congress act before then? Faced with an Oct. 17 deadline to raise the federal debt limit, legislators and the White House have made no progress in preventing the country from defaulting on its debts, which could trigger a national -- and possibly global -- economic crisis and create chaos for the beneficiaries of government programs.
That's the big picture.
Practicing just outside the Beltway in Maryland, I'm thinking about my own patients. A national radio host made headlines last week when he said WIC wasn't "doing anybody any good." The four years I spent working in a community health center showed me otherwise. I've seen countless families who benefited from the program.
In the past week, I've been thinking a lot about one patient in particular, who we'll call Linda. She has six kids. Linda already was a mom when her birth control failed, leading to triplets. Linda and her husband both work full-time jobs, leaving them with significant daycare expenses for their four children who are not yet in school.
WIC not only helps people like Linda and their families make ends meet, it encourages healthy choices. You can't buy junk food through the WIC program, which means children are more likely to get fresh apples than french fries. If WIC funding isn't restored, unhealthy food will be a cheaper choice for the millions of moms who rely on the program.
Sequestration already will cut WIC funding by more than 7 percent, and a proposed House Budget Resolution would remove 1.7 million mothers and children from the program next year. (The House recently passed a bill that would fund WIC for two months, but the Senate and the National WIC Association deemed that stop-gap measure unacceptable.)
So how else is the shutdown affecting government nutrition programs?
The Supplemental Nutrition Assistance Program (SNAP), which provides food stamps to roughly 47 million Americans, is not affected by the shutdown. (As a side note, the House passed a bill in September that calls for $40 billion in cuts in the next 10 years.) However, the USDA school lunch program, which provides reduced-price and free meals to more than 30 million children, could run out of funds in a few weeks, according to USA Today. The USDA reimburses schools on a monthly basis, which means schools could be handed a tremendous challenge in November if the government remains gridlocked.
Millions of our patients rely on programs such as these to help them when times get tough. These nutrition programs determine how well people eat -- and sometimes whether or not they do eat. People shouldn't have to choose between paying their bills and putting food on the table.
Kisha Davis, M.D., M.P.H., is the new physician member of the AAFP Board of Directors.
When Congress Is Ready to Listen, We're Ready to Talk
What a week this could have been.
making my first visit to Washington as the AAFP's President-elect, but the
agenda is a little thin. My schedule for Tuesday and Wednesday shows a trip to
the White House, meetings with legislators and staff from both houses of
Congress -- and both political parties -- as well as discussions with leaders
from three federal agencies.
like most Americans, I'm waiting for federal employees to go back to work and
for members of Congress to stop pointing fingers and start solving problems. The
perpetual problem we had hoped to discuss with legislators -- one Congress
created -- is the sustainable growth rate (SGR) formula. For the first time,
Congress actually seemed to be taking clear steps toward replacing the flawed
Medicare formula before the government shutdown Oct. 1. In July, the House
Energy and Commerce Committee unanimously approved a Medicare physician payment
bill that would
abolish the SGR. The Senate Finance Committee is expected to release its own
version, or at least it was before things ground to a halt last week.
Without congressional intervention, the SGR will trigger a nearly 25 percent reduction in Medicare physician payments Jan. 1. Rest assured, we will reschedule our meetings with legislators and continue our advocacy efforts as soon as Congress stops is intransigence.
In addition to our meetings with legislators, Academy leaders were scheduled to meet this week with representatives from
- the Agency for Healthcare Research and Quality to discuss primary care research;
- the CMS Innovation Center to discuss studies related to the patient-centered medical home model; and
- the Office of the National Coordinator for Health Information Technology to discuss meaningful use regulations.
With roughly 800,000 federal workers furloughed, those meetings won't happen this week either.
I am disappointed but not discouraged. There will be another day to deliver family medicine's message.
How will the shutdown affect our patients and our practices? Will the prospect of resolving the SGR again be delayed by the process of resolving our budgetary crisis?
For now, there are a more questions than answers. In the past few days, taking care of a critically ill 2-year-old in my ER and seeing patients in my office has made the problems in Washington seem secondary, at least for a few precious moments. We are on the right path, creating access for our patients and providing high quality primary care one patient at a time.
We will get through this, and when Congress is ready to listen, we definitely will be ready to talk.
Robert Wergin, M.D., is President-elect of the AAFP.