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Tuesday Jul 22, 2014

Like Father, Like Son: How I Raised a (Future) Family Physician

Like many small-town family physicians, I've volunteered over the years as a team doctor for our local school's athletic teams. On Friday nights, I often found myself on the sidelines, watching football and cheering on the local team (which often included many of my patients). More often than not, my son Brett would tag along, soaking up anything there was to learn.

On one particular fall evening, one of our players was badly injured, and I hurried onto the field to evaluate his condition. In retrospect, I probably should have paused just long enough to tell my son, who was about 7, to stay put.

Last weekend I represented the AAFP at the Nebraska AFP's board meeting. My son Brett, left, is a student member of our state chapter's board of directors.

As I kneeled next to the injured young athlete, I heard a small voice from behind me say, "Dad, there's blood."

That's Brett. Always eager to experience and learn something new. It wasn't the last time he got an up-close view of his dad trying to help someone who needed it. We've lived in a few small Nebraska towns that lack urgent care facilities and hospitals. So when people needed help in a hurry, they often call me directly. If Brett was with me I got one of those calls, he often came along to the office.

I remember one day when Brett was about 10, a young girl fell and needed stitches in her chin. Brett and I were out running errands when I got the call, so we went straight to my office to meet the girl and her parents. With the permission of the patient and her parents, Brett watched me clean the wound and stitch it closed.

Through these types of encounters, Brett learned not only about medicine but about the importance of building relationships with patients, families and the community.

As a high-school student, he participated in a medical interest group and expressed interest in becoming a family physician. He followed up on that by shadowing other family physicians in our area.

When he enrolled in a college halfway across the country, I thought he might come back with plans to become a subspecialist because although Brett has seen all the positive things that family medicine has to offer, he is aware of the payment issues and other challenges we face, as well.

He also knows the time demands of being a family physician. One year, Brett and I signed up for a father-son basketball camp. The night they were taking photos of the sons with their fathers, I got tied up at work and was late. The other kids got a nice memento to remember the fun experience they shared with their dads, and Brett got a photo of himself. Alone.

But Brett has stayed the course. Now in his fourth year at the University of Nebraska Medical Center, he is a student member of the Nebraska AFP Board of Directors. This past weekend, I represented the AAFP at the Nebraska AFP's annual meeting, and my son was there as a member of our state chapter's board. It was a proud moment, and Brett has given me plenty of those.

He's served as president of the Student Alliance for Global Health and in the student senate at UNMC. But the point of this post isn't just for me to say how proud I am of my son. It's to point out the importance of mentoring. Brett obviously got an early start, but if we expose students -- in high school or college -- to the broad scope of family medicine and show them the relationships we develop with our patients, they will understand and value what we do.

And some, no doubt, will follow.

Robert Wergin, M.D., is president-elect of the AAFP.

Thursday Jul 17, 2014

Is Anybody Out There? Tell Us What You Think

It has been nearly three years since the AAFP launched the Leader Voices Blog with the goal of improving communication between Academy leaders and members.

During that time, we've posted more than 200 blogs on a wide range of topics affecting family medicine. We've let you know about Academy meetings with legislators and meetings with payers. We've talked about the challenges facing small practices and a host of clinical issues.

AAFP directors -- who come from small private practices, big group practices, academia and everywhere in between -- have shared deeply personal stories about where they practice and why. We also have shared stories of our own personal health crises.

And we've seen spirited debate on some controversial topics, such as gun violence.

Although this blog's readership numbers have been steady, the online conversation has grown quiet. We missed a few opportunities to respond to comments earlier this year, but we're committed to doing better going forward. Some of you, no doubt, grew frustrated with a technical issue we experienced this spring with our comments field. That problem has been resolved.

To paraphrase past AAFP President Glen Stream, M.D., M.B.I. -- who had the vision to use this tool to create a two-way conversation between leaders and the members we are elected to serve -- we're listening. And we value your feedback.

The landscape in medicine remains quite active and rapidly changing, and your Academy remains engaged on your behalf. This blog is an opportunity for all members to not only hear what the AAFP is doing, but to be heard by sharing your opinions in the comments field. Tell us what you think -- good or bad -- about the issues we face and how the Academy is addressing those issues.

Start today. We’re listening.

Michael Munger, M.D., is a member of the AAFP Board of Directors.

Wednesday Jul 16, 2014

Women's Health: Do You See the Big Picture?

I had a new patient come to me last year, a woman in her 60s, complaining of back pain. Over the course of several months and multiple visits, and after indicated tests and imaging, we worked together to formulate and execute a pain management plan. Her acute condition improved, but I found myself wondering: Had I done a thorough job? Or had I let myself get caught up in dealing with one specific problem and had failed to see the bigger picture? Had I offered this patient all of the other tests and screenings -- such as colonoscopy -- that were recommended for her age group?

Patients often, and understandably, focus on the problem that is bothering them right now. But back pain isn't what is going to eventually kill that patient. Cancer, heart disease and other factors are much more likely to cause serious, long-term problems. As physicians, it's our job to stress the importance of doing all the other things that can help keep patients healthier longer.

So how are we doing?

A CDC study published this month in JAMA Internal Medicine indicates that when it comes to women's health, we could do better -- possibly much better. Researchers looked at data from more than 60 million preventive health visits to OB/Gyns and primary care physicians and compared what services were being offered by the two types of physicians.

Perhaps not surprisingly, OB/Gyns were more than twice as likely as primary care physicians to offer screenings for breast cancer and cervical cancer and almost twice as likely to test for chlamydia. However, women who saw a primary care physician were likely to receive a much broader range of services.

For example, 34.5 percent of women 45 or older received cholesterol screenings from their primary care physicians compared to only 5.4 percent of those who saw an OB/Gyn. Women who saw a primary care physician were four times more likely to be tested for diabetes.

But both OB/Gyns and primary care physicians have room for improvement. Colon cancer is the third-leading cause of cancer-related death in women. But the study found that among women ages 50-75, a total of only 6.1 percent were screened -- 7.2 percent of women who saw a primary care physician and 3.9 percent of those who saw an OB/Gyn.

The study also examined whether women received counseling about four key health issues: diet, exercise, obesity and tobacco use. Researchers found that 81.5 percent of women who saw an OB/Gyn and 73.5 percent of women who saw a primary care physician did not receive counseling on any of those important topics. Although not all patients need counseling on these issues, the numbers seem shockingly high given that more than one-third of U.S. adults are obese and nearly one-fifth smoke.

Despite the low overall numbers, primary care physicians fared better than OB/Gyns in all four areas. A little more than 19 percent of primary care visits involved counseling for diet compared to 12.4 percent of visits with OB/Gyns, 14.3 percent of primary care physicians offered counseling about exercise compared to 9.9 percent of OB/Gyns, 7.5 percent offered counseling for obesity compared to 4.2 percent of OB/Gyns, and 3.4 percent offered counseling for tobacco compared to 2.6 percent of OB/Gyns.

Time is obviously a factor. There's only so much ground we can cover in a 15-minute appointment, and patients often come with their own questions and concerns that have to be addressed. But taking a few seconds to show a patient where he or she stands stand on the BMI chart can be powerful, eye-opening and the first step in pointing that patient in a new direction. Patients who want to stop smoking can be referred to quitlines. We also can schedule a follow-up for patients who need more time to address their issues.

Communication likely is another factor. We need to let our patients know what tests and screenings are recommended and appropriate for their age. For our patients who see both an FP and an OB/Gyn, we also may need to do a better job communicating with our OB/Gyn colleagues to ensure that someone is taking responsibility for offering the appropriate services.

It's worth noting that the study's data were drawn from visits during 2007-2010 -- before the Patient Protection and Affordable Care Act mandated that health plans cover a wide range of preventive services. If this issue is re-examined in a few years, it will be interesting to see how much our numbers improve.

How does your practice use electronic health records, patient registries or other tools to ensure that patients receive recommended tests or screenings?

Kisha Davis, M.D., M.P.H., is the new physician member of the AAFP Board of Directors.

Monday Jul 07, 2014

Inside the Affordable Care Act: One Patient's Story

Whether folks thought it was a good piece of legislation or not, the Patient Protection and Affordable Care Act (ACA) is the law of the land. And recent polls show that roughly two-thirds of Americans favor retaining and, perhaps, modifying the health care reform law rather than repealing or replacing it.

A Bloomberg National News poll published in June found that 66 percent of respondents favored letting the law stand or retaining it with modifications. A month earlier, a Kaiser Health poll found similar results with 59 percent favoring keeping and improving the law.

By far, most people who responded to the Kaiser poll (60 percent) said the law had no direct impact on them, while 24 percent said the law had hurt them, and 14 percent said it had helped them. Nearly one-third said they knew a previously uninsured person who was able to get insurance because of the ACA, while less than one-quarter said they knew someone who had lost coverage.

I'd like to share the story of one of my patients -- we'll call him John -- who was helped greatly by the ACA.

John was a healthy child growing up in my hometown in Nebraska before he contracted polio at age 3 in 1952 (three years before the polio vaccine was introduced). The disease left him temporarily paralyzed from the neck down, and his parents were told that he would never walk again.

John proved the physicians wrong, and he did walk. But he has suffered for decades from an array of complications, including severe scoliosis, muscle wasting and restrictive lung disease.

As an adult, John could easily have qualified for disability, but he learned a trade, opened his own business and raised a family. His health insurance costs were high, but manageable, and he looked forward to saving more money for his retirement once his children were grown and out of the house. But John's health care insurance costs increased dramatically in the 1990s, and he suffered the consequences, at times, of not being able to afford coverage. In the past 20 years, John has paid more than $200,000 in premiums alone.

Before the health insurance exchanges opened this year, his deductible was $6,000, and his premium was more than $1,300 a month. When the exchanges opened, John went online and found a plan that cost him $32 a month. His deductible dropped to $450.

"It completely changed my life," he told me.

John's new plan was through CoOpportunity Health, one of nearly two dozen Consumer Operated and Oriented Plans set up nationwide under the ACA; this particular health care cooperative started in Iowa and Nebraska with funding provided through HHS. The Iowa AFP and Nebraska AFP were instrumental in securing that funding and making the plan available through the health care exchange.

The new plan lowered John's costs for medications and treatments, including the oxygen he uses at night. In addition to me, John has a respiratory specialist in another town. His out-of-pocket cost to see that physician had soared to $400 per visit on his old plan, so John hadn't seen that subspecialist in years. After he enrolled in the new plan, John made a long-overdue (and affordable) visit to that doctor and found out about new tips to help his breathing that he could have learned a lot sooner if he'd had ready access to affordable care.

The ACA may be far from perfect, but this one example shows its potential. The Academy is working to support the provisions of the act that help family physicians and their patients and is continuing to advocate for change where it's needed.

As for John, he's in his 60s and still running his business, but the money he is saving on insurance will allow him to finally start saving, in earnest, for a well-deserved retirement. John tells me that he feels as though a huge burden has been lifted from him, and the new insurance plan is literally helping him breathe easier.

Robert Wergin, M.D.,  is president-elect of the AAFP.

Tuesday Jul 01, 2014

Teamwork: AAFP, PA Groups Find Common Ground

I recently represented the AAFP at meetings with leaders from the American Academy of Physician Assistants (AAPA) and the Association of Family Medicine Physician Assistants (AFMPA), and I was honored to be an invited guest to the AAPA meeting in Boston a few weeks ago. The leadership of the AAFP and the AAPA have previously attended each other's board meetings to review proposed legislation at state and national levels. This is a critical interaction that allows our organizations to identify areas in which we can work together.

For example, in Boston, I learned about a proposal in Missouri regarding so-called assistant physicians, who are not PAs but medical school graduates who have not completed residency training. Not only does this proposed measure create potential confusion because of the title of these would-be health care providers, it also would create significant challenges in terms of how unlicensed providers should be designated, regulated and utilized.

I recently met with leaders from the American Academy of Physician Assistants, including (from left) President John McGinnity, PA-C; President-elect Jeffrey Katz, PA-C; CEO Jenna Dorn; and Board Chair Lawrence Herman, PA-C.

This issue was directly addressed by the AMA House of Delegates at its annual meeting last month. The AAFP delegation coordinated with our PA colleagues and testified about concerns raised by this issue. A resolution opposing the use of medical school graduates as assistant physicians was adopted with wide support.

Our common interests with the PA groups aren't limited to advocacy. PAs are trained in the medical model of care involving diagnosis and treatment, as are physicians, and they follow rigorous and standardized educational, certification and licensing processes. Last fall, we reached a unique arrangement with the AAPA, which was working to identify activities that would fulfill the performance improvement requirements for its new certification of maintenance program. The AAPA came to us seeking a collaborative agreement through which the AAPA could offer the Academy's four METRIC (Measuring, Evaluating and Translating Research Into Care) performance improvement modules within the AAPA's own learning management system.

METRIC is the AAFP's flagship performance improvement product line and is critical for lifelong learning and maintaining certification. This agreement has been finalized, and PAs may now purchase and access the AAFP's METRIC modules directly from the AAPA, which coordinates marketing and accreditation of the modules. This joint venture represents an important way to share resources and not reinvent educational wheels as we move toward quality improvement in continuing education. Moreover, this relationship reinforces the value that others see in our educational offerings.

This is all worth noting, in part, because 40 percent of AAFP members work with PAs, who assist us in ensuring that we provide effective care and improve our patient outcomes. Team-based care is important to meeting the goals of the quadruple aim -- improving patient outcomes, improving patient and provider satisfaction with the system, and doing so at lower cost.

Family physicians and PAs are working together not only at the practice level but also at the national level, and I look forward to further discussions and collaborations with these groups. Together we are making progress in providing better, more effective care for our patients.

Reid Blackwelder, M.D., is president of the AAFP.

Wednesday Jun 25, 2014

Follow the North Star: Global Health Is Focus of New Wonca Group

A growing number of medical students, family medicine residents and new physicians are interested in pursuing global health experiences. In fact, more than 30 percent of U.S. medical students completed a global health rotation in each of the past four years.

Polaris, the new and future physicians movement for Wonca North America, was one of the topics discussed when I attended the winter meeting of the College of Family Physicians of Canada's Section of Residents. 

In the United States, we are fortunate to have structured, well-developed clinical rotations and residency programs for our family physicians-in-training, but in many other countries, recent medical school graduates are often faced with the prospect of building their own family medicine experience. To address this need, the Europe region of the World Organization of Family Doctors, or Wonca, formed the first new physicians organization -- referred to as a young doctors' movement -- in 2005 to focus on networking and providing a platform to connect physicians across borders. Other Wonca regions have since followed this example -- all except the North America region.

The 2013 Wonca World Conference in Prague triggered renewed discussions about establishing a new and future physician movement in North America. Members of the AAFP, the College of Family Physicians of Canada and the Caribbean College of Family Physicians have worked together to establish the movement's framework, including its charter, name, logo and a governance structure. On May 19 -- World Family Doctor Day -- Wonca North America announced the creation of its new and future physicians movement, Polaris, to provide an avenue for the exchange of ideas and actual observational experiences in different countries.

Polaris is not simply a platform for launching medical mission work. Rather, it is a comprehensive forum for global health. In many of the discussions leading up to its formation, the difference between mission work and global health was emphasized, and organizers envisioned one possible goal of the program to be changing the perspective that medical missions are global health to the reality that medical missions are only a small part of global health.

Although mission work is often how physicians gain global health experience, family doctors practice in all parts of the globe, and the vast differences that exist among medical systems, available resources, patient populations and disease processes offer amazing learning opportunities that can enhance physicians' work in their own communities and offices.

A global view of patient care is becoming more necessary as both our demographics change and our health systems adapt, and family medicine is the natural home for that viewpoint. Two-thirds of family medicine residency programs now offer international rotations or electives, and even those without formal programs teach the skills and population management competencies needed to work in any community, which produces physicians who have interests and/or abilities well-suited for global health delivery.

Aside from skills development, simply connecting with family doctors in other countries provides a perspective that often helps open our eyes to new solutions and processes we can then use in our own programs and offices. For example, I was fortunate to be invited to attend the winter meeting of the College of Family Physicians of Canada's Section of Residents, where each residency program in Canada is represented. Polaris was simply a glimmer of an idea at that point, but the collaborative effort it represented was well-received.

Canada's postgraduate medical education system is much like that in the United States, but even so, these residents shared our interest in developing a more comprehensive patient approach. Canadians have rural patient populations that make some of our rural sites in the United States appear metropolitan. Not surprisingly, their medical education curriculum includes impressive didactic and skills sessions to meet the needs of students and residents who plan to work in remote settings. I came back to my residency program with ideas for improving our own training based simply on talking with Canadian residents. Imagine the progress we could make in our training if we were able to experience the many cultural variations and nuances that characterize family medicine across continents.

WONCA's young doctors' movements have already established exchange programs to enable their members to participate in observational experiences. Polaris could provide an infrastructure for setting up exchanges to and from North America.

      Polaris is still being developed, and much remains to be decided. So if you are a family physician who is interested in global health -- whether you're a seasoned veteran or someone looking for a first global health experience -- take advantage of the many upcoming opportunities to be part of the discussion

  • At the National Conference of Family Medicine Residents and Medical Students, Polaris will be discussed during the global health networking session, which is scheduled for Aug. 8 in Kansas City, Mo.
  • Attendees at the Family Medicine Global Health Workshop scheduled for Sept. 11-13 in San Diego, can see a presentation by representatives of the Vasco da Gama Movement, which is the European group for new and future family physicians. The event also will feature a networking session where Polaris will be a topic of discussion.
  • An international networking session also will be held during this year's AAFP Assembly, which is scheduled for Oct. 21-25 in Washington.

Kimberly Becher, M.D., is the resident member of the AAFP Board of Directors.

Wednesday Jun 18, 2014

Implementation Begins on Family Medicine for America's Health

Throughout the year, we have been using this space to provide updates on the Family Medicine for America's Health: Future of Family Medicine 2.0 project. I'm pleased to share that the planning portion of the project is now complete, and we are moving forward with implementation. Our Academy's Board of Directors recently pledged $12 million over the next five years to support implementation of both the strategic and communication plans.

In this latest update, you'll find an announcement of the members serving on the Implementation Committee, the naming of the new chair (former AAFP President Glen Stream, M.D., M.B.I.) and a summary of both the strategic and communication plans. Additional updates will be shared here as the project unfolds. Exciting times for Family Medicine!

Family Medicine for America’s Health: Future of Family Medicine 2.0

Organizational Update No. 7

June 2014

We are pleased to report that the planning phase of the Family Medicine for America’s Health initiative has been completed. As a reminder, the purpose of this effort was to develop a multi-year strategic plan and communications program to address the role of family medicine in the changing health care landscape. To read earlier updates from Family Medicine for America's Health: Future of Family Medicine 2.0, please visit the project Web page.

 The Boards of Directors of each of the seven original sponsoring organizations, plus the American College of Osteopathic Family Physicians (ACOFP), have approved both the strategic and communications plans. The eight organizations have pledged more than $20 million over the next five years to implement both plans, which are described in further detail below.

Moving forward, this effort will be known simply as Family Medicine for America’s Health. An Implementation Committee has been formed that will drive the next phase of this work. Representatives include:

  • Glen Stream, M.D., M.B.I. – Chair (AAFP)
  • Tom Campbell, M.D. (ADFM)
  • Jerry Kruse, M.D., M.S.P.H. (STFM)
  • Paul Martin, D.O. (ACOFP)
  • Norman Oliver, M.D. (NAPCRG)
  • Bob Phillips, M.D. (ABFM)
  • Mike Tuggy, M.D. (AFMRD)
  • Jane Weida, M.D. (AAFP Foundation)

Four additional members are being recruited for the Implementation Committee, representing the following stakeholder categories:

  • Family physician in full-time practice (practice size of five physicians or fewer)
  • Young physician leader in family medicine (five to seven years post-residency)
  • Patient advocate
  • AAFP chapter executive

Strategic Plan

Strategic planning consulting firm CFAR developed the strategy in an intensive eight-month effort that included:

  • A strategy survey (taken by hundreds of family physicians, as well as by other primary care health professionals).
  • Current state analysis of family medicine today and the role family medicine plays in the current health care environment.
  • Identification of scenarios depicting possible futures for family medicine that were tested at a multi-stakeholder retreat attended by family physicians, other primary care health professionals, public and mental health stakeholders, policymakers and employers.

The framework of the strategic plan is organized according to a few guiding principles:

  • Put the patient and family at the center – always.
  • Now is the time for family medicine to take up a leadership role in primary care, including reforming payment in ways that make it possible for family physicians to offer patients and their families the highest quality primary care.
  • Family medicine must clearly state its vision for the next five to seven years and pursue actions specifically linked to strategies in six critical areas: practice, payment, workforce education, technology, research and engagement.
  • Family medicine can’t prove the value of primary care alone. Family medicine leaders must take a leadership role in building partnerships and alliances with a variety of stakeholders in the wider health care system – with patients, other primary care health professions and national policy organizations, among others.

The complete strategic plan will be published in an article in the Annals of Family Medicine later this year.

Communications Plan

Communications consulting firm APCO Worldwide conducted extensive quantitative and qualitative research to develop an evidence-based communications program to demonstrate that family physicians are leaders in the new and evolving health care environment and advocates for patient health. (Detailed findings of the research are provided in earlier editions of the monthly reports.) The plan outlined the following goals:

  • Position family physicians as leaders and central to the delivery of quality care for patients.
  • Increase patient understanding of the value of primary care and of receiving primary care through a family physician.
  • Improve patient engagement in prevention and health care management.
  • Attract the best and brightest students to the practice of family medicine.
  • Shift the payment model to support comprehensive payment reform.

Stakeholder perceptions of family physicians are favorable and higher than those of almost every other medical specialty. With these favorable perceptions come high expectations. The research showed that patients want and need a primary care physician – particularly a family physician – to be at the center of their health care.

A number of concepts and themes were tested for this effort. The winning theme will be launched in October at the AAFP Assembly in Washington, D.C.

This campaign will be used as an advocacy platform to communicate with consumers about their critical role in creating a strong primary care system that improves health. Research examined an exhaustive list of areas where stakeholders believe family medicine must focus. The four focus areas that emerged as most relevant and needed were: prevention and health promotion, health disparities, patient education and engagement, and chronic and complex disease management.

The communications strategy will drive broad, long-term social goals, while strengthening family medicine’s identity, cohesion and capacity to deliver on the triple aim (improving patient care and outcomes and lowering costs). The campaign will use integrated communications and will include policymaker outreach, workplace outreach, paid media, earned media placements, stakeholder engagement, corporate and organizational partnerships, and a strong online presence.

Next Steps

We will continue to provide regular updates on the implementation of this important effort. Watch these reports for opportunities to learn more and weigh in on the process.

Jeff Cain, M.D., is board Chair of the AAFP.

Wednesday Jun 11, 2014

It Takes a Village: Become a Breastfeeding Advocate

Over the years, the Academy of Breastfeeding Medicine (ABM) has received significant leadership contributions from AAFP members, including past ABM officers Anne Montgomery, M.D., Julie Wood, M.D., and Tim Tobolic, M.D. AAFP member Anne Eglash, M.D., in fact, was a founding member of the ABM. But no AAFP officer had ever been invited to participate in the ABM's Annual Summit on Breastfeeding, even though our colleagues from the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics have routinely attended.

But this year, for the first time in the event's six-year history, all the specialties that care for newborns and mothers were represented at the recent two-day summit in Washington.

Family physicians, including president-elect Julie Taylor, M.D., M.Sc., (right) have played an important role in the Academy of Breastfeeding Medicine. I met with her at the recent Annual Summit on Breastfeeding.

This breakthrough represented an important opportunity for the AAFP because attendees at this event included not only representatives of the medical professional organizations noted above, but also leaders from CMS, HHS and other governmental agencies; federal legislators; representatives from such diverse stakeholder groups as the W.K. Kellogg Foundation, Kaiser Permanente and the March of Dimes, as well as academics, state health officials and others.

Unfortunately, many of these groups have not coordinated their efforts with one another and were not aware of other groups' activities. In particular, these other stakeholders were not familiar with the important work the AAFP has done in the areas of breastfeeding support, advocacy and policy. Therefore, I saw at least part of my role in attending the event as helping to break down existing silos.

I found it encouraging that everyone present seemed to readily recognize this need. We forged new relationships, connecting to the right people to improve our collaboration. In between agenda sessions, people were talking, exchanging cards, and sharing resources and links. I felt a great deal of enthusiasm and energy throughout the entire event.

Best of all, this summit provided me another opportunity to help other groups understand who family physicians are and what we do. I was able to point to our unique role in taking care of these special patients, noting that because we are the only specialty that truly does cradle-to-grave care, we have multiple opportunities to talk not only about breastfeeding, but also the many diverse issues relating to rearing children.

An especially important message for attendees to hear was about our ability to educate not just the mother, but also the father and, perhaps even more essential, the maternal grandmother! Family physicians are truly the medical specialists who can pull everything together after the blessed event, because we see both mother and baby together at subsequent visits. With this kind of postpartum follow-up, we can directly impact the sad decrease in breastfeeding rates that occurs after women go home from the hospital. At the time of discharge, about 75 percent of U.S. women are breastfeeding, but that rate drops to roughly 28 percent within a few weeks of going home.

Family physicians can take the lead in addressing this critical public health issue because we understand that breastfeeding is really a family matter, not just a personal one. We witness the powerful role of relationships within families and with our practices every day, with every patient.

The ABM has a number of resources to support breastfeeding, just as the AAFP does. One of our resources, the Academy's breastfeeding position paper, is even now being updated as part of a regular evidence review by our Breastfeeding Advisory Committee. That update likely will be published in the fall and will be accompanied by an education campaign aimed at helping to create breastfeeding-friendly family physician offices.

Other resources family physicians may find helpful include the Baby-Friendly USA initiative and its 10 steps to creating breastfeeding-friendly hospitals. Even for family physicians who don't work in hospitals or provide obstetric care, it's still important to advocate on patients' behalf to ensure that that the first exposure during and after delivery reflects strong support for "the first food" and not formula.

It's also worth noting that 28 percent of all medical students in this country are members of the AAFP, so we have a unique opportunity to begin emphasizing breastfeeding benefits early on regardless of what specialty each student eventually selects. Moreover, our residencies are working to become breastfeeding-friendly for our trainees. This new policy is the result of resolutions passed by the 2013 Congress of Delegates that initially were brought forward by our students and residents.

Finally, I was able to share the critical need for all of us to network better with each other. Even in this meeting that focused on an issue of common ground, I still saw evidence of our fragmented health care system. Different groups don't always share as well as they could. This is one of our challenges in these days of advanced communications technology -- we can forget the power of face-to-face discussions. That is one reason I am so eager to say "Yes!" to these kinds of invitations. Nothing can beat actually talking with people in person.

That said, we need to recognize that the mothers and families of today are different, and I challenged everyone at the meeting to get comfortable with social media because it's one more avenue to increase awareness about breastfeeding.

One final note: Just as family physicians were critical to the founding of the ABM, so we are to its leadership now. The current president of the ABM is Wendy Broadribb, M.B.B.S., a family physician from Australia. Julie Taylor, M.D., M.Sc., a family physician on faculty at Brown University, will be taking over next year. I look forward to future opportunities for the Academy to interact and grow together with other stakeholders on this important issue.

Reid Blackwelder, M.D., is president of the AAFP.

Friday Jun 06, 2014

Measles and Mumps and MERS, Oh my…

It's not hard for me to remember that it's that time of the year again because my daughters are frequently singing Olaf's song from the Disney movie "Frozen." "When life gets rough, I like to hold on to my dream, of relaxing in the summer sun, just lettin' off steam … in summer."

My family is heading to Hawaii for our summer vacation, and we won't be alone. After a harsh winter in many parts of the country, a busy summer travel season is expected. The American Automobile Association (AAA) estimated that nearly 32 million Americans traveled at least 50 miles by automobile during the Memorial Day holiday alone, and another 2.6 million traveled by plane. It marked the second-highest travel volume for the holiday in more than a decade.


Airlines for America, an industry lobbying organization, projects summer air travel will rise to its highest level in six years. Roughly 210 million passengers are expected to fly U.S.-based airlines from June through August, including a record 30 million passengers traveling internationally on U.S. carriers.

With that summer fun comes some potential risks. Measles remains common in many parts of the world, including areas of Europe, Africa, Asia and the Pacific. For example, the Philippines had more than 31,000 suspected cases of the disease (and 70 deaths) through May 20 of this year.

In an average year, only about 60 cases of measles are reported in the United States. Unfortunately, international travelers are bringing home more than just souvenir T-shirts. This year, the United States has had more than 300 cases of measles -- including 15 outbreaks covering 18 states -- reported since Jan. 1. That's the highest total since public health officials declared the disease eliminated here in 2000. According to the CDC, the vast majority of reported cases (97 percent) have been associated with either foreign visitors or U.S. travelers returning home from international trips.

Meanwhile, the CDC also reports that from Jan. 1 to May 2, 464 cases of mumps have been reported. That total already is higher than all the mumps cases reported last year.

Although nearly half of the measles importations have been linked to the Philippines, other cases imported into the United States have been associated with travel to other countries in Southeast Asia, Europe and what the World Health Organization refers to as the Western Pacific region and the Eastern Mediterranean region.

Measles isn't the only health issue for travelers and their physicians to think about. With new reports of infection caused by the novel Middle East respiratory syndrome coronavirus (MERS-CoV), many of my patients are now concerned about what they otherwise would have thought of as simply a mild cough or seasonal allergies. I, too, have found myself being more diligent in asking about travel history when confronted with patients who present with fever or upper respiratory symptoms.

Although few of us may remember seeing -- much less treating -- measles, even fewer have experience managing suspected cases of MERS-CoV infection. I remember the hypervigilance of our health care community in 2003 after the World Health Organization issued a global alert regarding the severe acute respiratory syndrome (SARS) outbreak, how we masked every patient who presented with cough, how there was a run on local pharmacy supplies of N-95 masks, and how every traveler returning from Asia was screened via infrared cameras on their entry into the United States.

The general public may be lulled into a false sense of security when infectious diseases such as measles, smallpox or polio are eliminated domestically or when a particular outbreak "dies out," as SARS did. It is our responsibility as trusted physicians to remain vigilant about global trends in communicable diseases and outbreaks. It is our role as patient advocates to ensure that our patients are protected from preventable illnesses in this global community. And it is our role as public health defenders to convince those who are reluctant to get vaccinated that it really is in their own best interests -- and the best interests of those around them -- to do so.

But one of the most difficult challenges in my daily practice is to know what advice to give when patients travel to locales unfamiliar to me. So when I ask my patients' their about summer travel plans, I breathe a sigh of relief if they mention some place like Japan or Cancun. But how about a honeymoon trip to Tahiti, the annual Hajj pilgrimage to Mecca, or a medical mission to Haiti?

Well, I recommend a quick search on the CDC's Travelers' Health Web page, which provides the latest information and advisories about communicable disease outbreaks around the world. It also has information -- searchable by country -- for both clinicians and lay travelers about vaccination requirements and other recommendations. You also can find travel tips for patients heading abroad (including the fact that they should be vaccinated at least six weeks before leaving home) on FamilyDoctor.org

Armed with these invaluable resources, I can confidently advise my patients and protect my community from the latest outbreak of polio in Syria, dengue in Brazil and Ebola in Liberia.

So, when you see your patients this summer, don't forget to ask them about their travel plans.

Jack Chou, M.D., is a member of the AAFP Board of Directors.

Monday Jun 02, 2014

White House Invitation Shows Importance, Recognition of Family Medicine

In our advocacy efforts, we often talk about the importance of being "at the table" when important discussions are taking place. The Academy is getting a good seat at that proverbial table more and more often.

Last week, I had the opportunity to represent the AAFP at a White House event for the second time in less than 18 months. This most recent trip was prompted by an invitation to attend the president's Healthy Kids and Safe Sports Concussion Summit, which brought together select medical experts and representatives from collegiate and professional sports organizations to address this serious problem.

I attended the Healthy Kids and Safe Sports Concussion Summit May 29 at the White House.

My previous White House invitation stemmed from the first lady's request that an AAFP representative attend a meeting about Joining Forces (a national initiative to support military service members and their families) along with the representatives from the Department of Defense, the Department of Veterans Affairs and other stakeholders. At that meeting, we addressed the challenges of providing care to special groups within our armed services, including service women and veterans needing mental health services.

I'm pleased that the administration is demonstrating an increasing recognition of the critical, foundational role that family physicians play in our health care system. Concussions, traumatic brain injury, mental health and women's health needs are significant health issues. Unfortunately, it is common for legislators and administrators to view these issues strictly in terms of subspecialty services, which can easily lead to fragmented care.

Family medicine is the only specialty that doesn't limit itself based on organ systems, disease groups, specific problems or age of patients. Instead, we are on the frontlines of managing all of these issues in our patients every day. One of the Academy's goals is to help those in leadership positions better understand who family physicians are and what we can provide. The fact that the AAFP is repeatedly being invited to meetings like these indicates our message is getting through.

During his remarks at the concussion summit, the president mentioned that although U.S. emergency rooms see roughly 250,000 children each year for head injuries, that doesn't include the number of children who are taken to see their "family doctor." I appreciate his recognition that family physicians are instrumental in the care being provided to children for such health issues. We are able to address the acute issues of affected children and the appropriate concerns of their families. We can educate these families and discuss how to prevent these injuries.

Perhaps even more important are our relationships within our communities. Family physicians provide numerous community services in many different venues, and 40 percent of our members provide some sports medicine services. Many are right there on the sidelines to educate coaches and teams.

Moreover, the direct connection we have with patients allows us to be there for the challenges created when someone has a severe concussion and its sequelae -- such as post-concussion symptoms and even career- or life-changing events. We are the only physicians with the combination of comprehensive education, extensive training and skills to handle complexity that allows us to care for all of our patients’ needs and help manage the impact on their families.

One of the promises that our officers and Board made to all Academy members was to continue to advocate that we be at the table and, thus, off the menu for such keenly important health care issues. I think we are well on our way in this regard. Our invitation to, and attendance at, these high-level meetings allow us to continue to educate those in health and government administration not only about the need for family physicians to be right at the frontlines, which we already are, but also to be respected in that critical role.

Thank you for all of your service and for all that you do. More and more people are recognizing the important work family physicians have always done, and they are starting to value those contributions appropriately.

Reid Blackwelder, M.D., is president of the AAFP.

Wednesday May 28, 2014

Patient Portals: Useful Resource But Expensive Mandate

To spend money on a patient portal, or not to spend money on a patient portal right now: That is my dilemma.

I am in a three-physician family medicine practice. We have no physician assistants or nurse practitioners. Our small practice held off on buying an electronic health record (EHR) system, waiting for the Veterans Administration to release VistA (Veterans Health Information Systems and Technology Architecture) to the public domain. That system initially won many awards when fully supported, but licensing of proprietary modules is required for it to function correctly. Thus, we were forced into the commercial marketplace. 

Our path took us to the EHR system that we have used for the past eight years. These have been expensive and emotionally taxing years. Our original trainer, sent by the vendor prior to implementation, gave us some bad information and advice. (Although the company eventually fired him, they still charged us for all the time he spent "helping" us.)

Last year, our server was hacked, causing it to crash. Three weeks and tens of thousands of dollars later, we were back up and running.

We have worked hard and diligently to do the right things. Before the words “meaningful use” even entered our lexicon, we participated with our local Medicare Quality Improvement Organization on a project involving colonoscopy, Pneumovax administration, mammography and flu vaccinations in our patient population. We finished either first or second among the practices for meeting goals set by Medicare.

Meaningful use stage one was our next project, and we successfully fulfilled that government mandate. Meaningful use stages two and three, as well as National Committee for Quality Assurance recognition for transforming to a patient-centered medical home, will be our next projects. All three require upgraded hardware and software, which we acquired after our server crash pushed us in that direction.

We also are considering the addition of a patient portal, which is a requirement of meaningful use stage two. I understand the importance of fluid patient communication, but the cost of complying with this requirement seems steep.

Initially, our vendor was going to charge $5,000 per physician, plus training and a per-use fee. A "use" could include an email, an appointment or a payment received through the portal, and there would be no way for us to limit a patient from inundating us at our expense. That price -- before the server crash, at least -- seemed unfathomable.

The vendor later decreased its asking price by roughly $8,000 to initiate, but the per-use fee and training costs still remain.

What to do? Could we run a parallel program on a free EHR with a free patient portal? Should we spend the kind of money that the vendor is charging? A patient portal has the potential to reduce the number of phone calls we handle, but it also could result in more electronic messages that require responses. Can we, and should we, charge our patients for electronic access to help defer the cost?

What is the return on investment of implementing a patient portal? A Kaiser Permanente study showed that outcomes for patients with diabetes and/or hypertension improved within two months with the use of secure patient-physician email. Another study involving Kaiser patients showed that those who enroll in a patient portal that allows secure messaging with physicians, access to clinical data and self-service transactions are more than two times more likely to stay with a practice than patients who do not use such online resources.

A study in JAMA: The Journal of the American Medical Association found that patients with online access to their medical records increase their use of clinical services.

Still, I'd like to hear from my fellow small-practice physicians on this issue. I'd like to hear about your experiences in this brave new world of constant access and costs associated with electronic data. I look forward to learning people’s thoughts and, hopefully, coming to peace with a definitive decision.

Have patient portals helped your practice, and have they been worth the expense?

Rebecca Jaffe, M.D., M.P.H., is a member of the AAFP Board of Directors.

Friday May 23, 2014

Agents of Change: ACOs Can Reduce Costs, Improve Care, Increase Income

Editor's note: During the AAFP's Scientific Assembly in San Diego, a panel discussion on practice transformation generated far more questions than the panelists could answer in the time allotted. This is the sixth post in an occasional series that will attempt to address the issues members raised -- including questions regarding accountable care organizations -- during the panel.

I recently attended a payment forum where family physicians expressed their frustrations with the existing health care system, as well as their hopes for the future. We discussed the need to repeal and replace the sustainable growth rate formula, payment for telemedicine and much more.

For every success story these FPs shared, there were others who talked about the challenges we face in primary care. It was a mix of dreams of the future and realities of the present.

One of those realities was the potential for change posed by accountable care organizations (ACOs). One physician grabbed the audience's attention by talking about his ACO, a group of about 40 physicians in Austin, Texas, that has negotiated a 5 percent positive payment differential with BlueCross and BlueShield.

Several physicians, in fact, talked of positive experiences with ACOs, which allow family physicians and other health care professionals to band together to pool data, develop best practices and make policy decisions that improve quality and reduce costs, and, ultimately allow them to negotiate contracts with the power of a larger group.

They didn't need to convince me. I'm the medical director and board chair of a fledgling ACO that received its charter from CMS in December. So far, we have nearly three dozen practices and about 50 physicians (mostly family physicians) on board.

CMS is encouraging ACO development by offering shared savings bonuses to participating practices. Those short-term incentives can invigorate and strengthen family medicine practices. But in the long run, ACOs will need to look beyond Medicare to thrive.

My ACO has already signed a three-year contract with Aetna that will pay fee-for-service, plus incentives for quality outcomes and cost savings as well as fees to cover the cost of administering the ACO. We're also in talks with two other large private payers with the goal of negotiating similar deals.

A representative of one of those payers told me his company sees itself transitioning from a traditional insurance model to a business based more on health maintenance. That revolutionary statement indicates that payers understand that fee-for-service is not the concept our future will be based on. Are we finally are on the verge of payment reform in this country?

We grew up with a health care system that had hospitals at the center of our medical communities, but that paradigm is about to shift radically, with primary care becoming the center of the health care delivery universe and hospitals becoming the satellites that orbit medical homes.

People resist change, especially when it doesn't benefit them. Health care and payment reform stand to benefit both primary care physicians and our patients. The need to change has been obvious for decades, but progress previously had been checked by political roadblocks. For the first time in my career, this shift is realistically achievable, and I'm doing my best to make the ACO model work.

So how does a family physician become the head of an ACO? There's no class or training that I'm aware of, so I did a lot of reading and networking and attended relevant conferences.

Maybe you don't want to run an ACO but you're interested in joining one and aren't sure how to get started. I was fortunate that in 2000, my small, rural practice joined an independent practice association, which became the basis of our ACO. Given that my experience might be the exception rather than the rule, I would suggest you look for a physician-owned and -operated ACO. If there are none in your area, look for an ACO that has primary care-led governance built into its operations. If other parties are in positions of authority, that ACO might not share your goals or want the kind of change you hope to be part of.

The patient-centered medical home (PCMH) was another topic discussed at the payment forum, and it's a vital part of the plans for our ACO. Our goal is for all the participating practices to achieve National Committee for Quality Assurance (NCQA) PCMH recognition within the next 12 months.

There has been a lot of concern from small practices about the cost and time needed to achieve PCMH recognition, but it can be done. My two-physician practice achieved Level 2 recognition by working together with other small practices in my area, and we have submitted paperwork for Level 3. Blue Cross and Blue Shield has pledged to provide a 5 percent positive payment differential for practices in our group that achieve Level 3 recognition.

There seems to be little question that fee-for-service is going to become a smaller and smaller part of how primary care physicians get paid in the future. We need to look at all the options available -- whether that be an ACO, direct primary care or something else -- and choose the best opportunity for our individual practices.

Finally, if you are interested in learning more about ACOs, or connecting with AAFP members who are participating in -- or leading -- ACO initiatives, you will be pleased to know that there are a number of family physicians interested in forming an ACO member interest group. At our most recent meeting, the AAFP Board of Directors approved the formation of member interest groups as a way to define, recognize and engage groups of AAFP active members who have shared professional interests. These groups will provide a forum for such members to have a voice in the development of Academy development.

If you are interested in participating in the formation of an ACO member interest group, contact AAFP delivery systems strategist Joe Grundy.

Lloyd Van Winkle, M.D., is a member of the AAFP Board of Directors.

Tuesday May 20, 2014

Turn the Page: Saying Goodbye Not Easy for Graduating Resident, Patients

My residency is almost over. By this point in our careers, all graduating family medicine residents have spent four years in college, four in medical school and at least three years (sometimes four) in residency. You might think there would only be elation, joy and relief on the cusp of completing this grueling, 11-year process.

It has been years of 80-hour (or more) workweeks, cafeteria food (if you even have time to go there), missing your kids' school events, missing your spouse's birthday, being that relative who misses weddings, funerals and Mother's Day -- all while struggling to pay the bills. By this time in some other industries, we might have made a fortune by working such long hours, but instead we are in serious debt. Most of us owe more in student loans than we do on our mortgages.

The bond a patient can develop with his or her family physician is amazing. Here I am with a patient who is interested in following me to my new practice -- more than two hours away.

So why would anyone sign up for the not-so-enticing path I just described?

Three words: the patient relationship.

As a medical student, you get limited exposure to continuity of care because rotations are usually eight weeks long, at most, so the number of repeated contacts with a specific patient or family is limited. Family medicine residency, however, focuses on relationships and caring for a patient across all settings, whether that be at the physician's office, a nursing home, the patient's home, a hospital or a hospice facility.

I've delivered babies and handed them off in the delivery room to a grandmother who is also my patient. Moments like that give you more enthusiasm and energy than a venti coffee ever could.

What I'm realizing as I near the end of my training is that patients get more than quality medical care from our interactions. They develop a bond with us that has far-reaching implications. My patients feel like they know me as a person, not just as a diagnostician. We have conversations about their priorities and how their financial and logistical realities relate to treatment. We grow to understand each other.

I don't think most patients in a residency training program realize how much we appreciate them. They quite literally provide the foundation for our specialty training. Most of us can remember our first patient in the office, our first well-child visit and our first reading of a patient's obituary. We remember the cards and notes patients send us, but most importantly, we remember how they humbled us with their complex medical cases.

I recently added a little spiel to each patient encounter I have about how I will be leaving the program and transitioning them to another resident in July. This conversation fails to get any easier with repetition.

I have had multiple patients cry. Several have stood up and hugged me, and a lot have asked for directions to where I am going next.

Through this process, I have noticed a difference between two groups of patients. Those who I inherited from a former resident (or from generations of residents in my program) smile and say I better pick a good physician to take my place. In contrast, the patients I acquired from the emergency room or hospital and brought to this practice during my residency -- many of whom had never had a family doctor before -- tend to enter a brief panic. I explain that the same attending physicians who have been joining our visits occasionally are still going to be here to precept the residents, that the incoming class of residents is wonderful, and that the same nurses will answer their phone calls. Some of those patients say that they don't want a new doctor, and they will drive the 2 1/2 hours to my new office to see me.

I've heard over and over, 'I've never found a doctor like you,' 'You listen to me,' 'You know my whole family.' They say they like being able to come with their kids to one big, long appointment for everyone. They like to see a face they know if they get admitted to the hospital. And women have told me they want to have the same doctor take care of them during and after their pregnancy and see their new babies.

To all of these cares and concerns, there's really only one reply I can give, and it's a reassuring one: That's family medicine. I am a family doctor, and they will get the same care and have the same opportunities across generations with their next family doctor. I am nothing special within family medicine; it's family medicine that is special.

There are more than 3,000 family medicine residents who will be graduating soon. What tips do you have for other third-year residents who are preparing to say goodbye to their patients? If you've had a particularly gratifying goodbye, please share your story in the comments field below.

Kimberly Becher, M.D., is the resident member of the AAFP Board of Directors.

Wednesday May 14, 2014

Ask the Question: Screening for Alcohol Misuse Can Save Lives

I recently returned home from an incredibly inspiring weekend at the AAFP's Annual Leadership Forum and National Conference of Special Constituencies in Kansas City, Mo., but my good mood quickly faded when I found the local Chicago news filled with stories of yet another accident caused by drinking and driving.

A man driving an SUV entered the northbound lanes of Lake Shore Drive headed south and struck a taxi head-on. According to police reports, the man’s blood-alcohol content was more than twice the legal limit.

A young law student who was riding in the taxi died in the crash. She was reported to be an accomplished and big-hearted leader among students, was on schedule to graduate next month and had already received and accepted a job offer.

Sadly, she won't be graduating with her classmates or celebrating her accomplishments with her family. And her story, tragically, is just one of many.

In fact, the World Health Organization (WHO) said in a report released this week that alcohol contributed to 3.3 million deaths -- or 6 percent of all deaths -- worldwide in 2012. That staggering total means that roughly every 10 seconds, someone dies an alcohol-related death. Accidents, including car crashes, accounted for 17 percent of all alcohol-related deaths.

Here in the United States, excessive alcohol use is the third-leading preventable cause of death,  claiming roughly 80,000 lives annually. Alcoholic liver disease is the second-leading indication for transplantation in the United States.

So what are we doing about it in our practices?

"Do you drink?" is a question we are trained to ask in medical school, but are enough of us actually asking it? According to the CDC, only one in six U.S. adults have ever talked to a health care professional about alcohol use. That's unfortunate because, according to the agency, alcohol screening and brief counseling can reduce the amount excessive drinkers consume by as much as 25 percent.

Of course, there are reasons why a primary care physician might hesitate to ask the question. Some physicians tend to shy away from questions about substance abuse. Not only can it be an uncomfortable topic, but some practices and communities lack adequate resources for treatment. It's also likely that some patients are less than forthcoming about their struggles.

Health care payers require us, and offer incentives, to ask every patient at every visit about certain other clinical issues, such as tobacco use, pain and asthma. In a health care environment where an office visit may be limited to 15 minutes or less, there are many issues to cover in a limited amount of time.

But considering that excessive alcohol use costs our country roughly $185 billion a year in health care costs, criminal justice expenses and lost productivity, wouldn't it make sense for alcohol use to be just as important a question as tobacco use when taking a patient's health history?

According to the WHO report, 7 percent of U.S. men and 2.6 percent of U.S. women are alcohol-dependent. More than 10 percent of men and more than 4 percent of women have an alcohol disorder, meaning either dependence or harmful use of alcohol. However, only 15 percent of people with such a disorder seek treatment, according to the National Institute on Alcohol Abuse and Alcoholism.

If none of those statistics grabbed your attention, consider that 10 percent of U.S. children live with an adult who has an alcohol problem. So what can we do to help patients and their families?

It's really very simple: We need to ask the question. The AAFP recommends that physicians screen adults for alcohol misuse and provide patients engaged in risky or hazardous drinking with brief behavioral counseling interventions.

American Family Physician has compiled an extensive collection of articles and other resources that cover screening, diagnosis, treatment and more. Patient information also is available online.

Although time certainly can be a barrier during an office visit, there are many simple screening tools that are easy and quick to use. For example, the CAGE questionnaire consists of just four questions. The WHO's Alcohol Use Disorders Identification Test can be completed in as little as two minutes.

Once we've asked that difficult first question, these tools can help us determine whether a patient needs counseling. If your practice isn't equipped to offer counseling, take the time to inform yourself about the resources that are available in your community.

The third-leading cause of preventable death in our country is an issue we can't continue to be silent about.

Javette Orgain, M.D., M.P.H., is vice speaker of the AAFP Congress of Delegates.

Tuesday May 06, 2014

Member Interest Groups to Provide Forum to Share Interests, Connection to Academy

I am really energized after attending the Annual Leadership Forum and the National Conference of Special Constituencies(NCSC) last week in Kansas City, Mo. These concurrent gatherings represent one of the most dynamic and innovative events the AAFP hosts.

The Annual Leadership Forum is a great opportunity for chapter-elected leaders, aspiring leaders and chapter staff from all over the country to attend practical and informative sessions and to network. It is one of the keys to helping our emerging leaders at the state level connect with each other and with the national Academy.

NCSC, originally the National Conference of Woman, Minorities and New Physicians, was created 24 years ago because certain member groups were underrepresented in Academy leadership. Over the years, constituencies for international medical graduates and physicians interested in gay, lesbian, bisexual and transgender issues were added.

Delegates write resolutions during the National Conference of Special Constituencies, held last week in Kansas City, Mo. During the event, the AAFP announced new opportunities for family physicians to form member interest groups.

In nearly 2 1/2 decades, NCSC delegates have written many resolutions that have challenged us as an Academy to creatively meet the needs of our members, as well as to improve the health of our patients. This year's conference was no different.

What is different, however, is the next stage in the evolution of this event. Prior to last year's Congress of Delegates, the Board of Directors convened a task force to explore the best way to create value -- including having a voice in the AAFP -- for all members. The task force made a series of recommendations to the Board last week. The Board approved all of the recommendations, and the Academy is moving forward with some exciting changes.

We have member groups with unique needs that are looking for ways their issues can be directly addressed, and a year ago, those members and the Congress challenged the AAFP to do a better job of recognizing the Academy's diverse membership.

The Academy has existing groups representing emergency medicine physicians and rural family physicians that have met for some time. However, our solo and small-practice physicians also are seeking a stronger voice, as are members who practice hospital medicine and those who are exploring direct primary care. There likely are many other groups, some of which we have yet to hear about.

So, here are some of the exciting changes we will see.

Next year -- the 25th anniversary of NCSC -- this annual meeting will again occur in Kansas City, Mo. However, it will be renamed the AAFP Leadership Conference for Current and Aspiring Leaders. The event will have two tracks, the Annual Chapter Leader Forum and the National Conference of Constituency Leaders. The groups will continue to meet in concert. Those of you who have attended in the past know that many of the leadership sessions presented during the forum have been scheduled at times when NCSC leaders also were able to attend. We'll continue this practice, which truly demonstrates our dedication to developing all of our leaders.

We anticipate that these member interest groups will become forums for our AAFP active members to share their mutual interests and address common concerns. We are setting in place a mechanism to begin requesting designation as a member interest group that will allow groups to really focus on what they hope to accomplish. They will be challenged to come up with a name for the interest group, first-year officers, at least 50 active members who support the application, interest group objectives, a description of how the interest group will further the AAFP's strategic priorities and a schedule of proposed first-year activities along with long-term goals.

Each member interest group will be connected with an Academy staff member and with the specific AAFP commission that seems most appropriate for that group.

The groups that presented resolutions 204 and 205 at last year's Congress -- which addressed the unique needs of family physicians in solo and small-group practices -- already have been given information on the application process for forming a member interest group, and we expect them to quickly move forward.

After one year, member interest groups have the option to petition the Board to transition to a member constituency.

Now, please bear in mind that because this is hot off the press, a link to the application is not yet posted online, but we will make an announcement in AAFP News when it becomes available.

Also important to note, a bylaws amendment from the Bylaws Work Group will be submitted to the Congress of Delegates that the member constituency seats to the Congress that currently exist be continued and not be reviewed by the Congress until 2020.

All of these recommendations build on the history of success and innovation that the Annual Leadership Forum and NCSC have always had. I look forward to seeing you in Kansas City next April for the 25th anniversary of this inspiring and energizing conference.

Reid Blackwelder, M.D., is president of the AAFP.

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