Medical Students, We're Only Looking for the Best
For too long, medical students have heard from their mentors that they are "too smart" for primary care. Family medicine, they’re often told, is a solid safety choice, at best, if they fail to match into a residency program in the specialty they really want.
This misguided narrative, combined with the income gap between family physicians and our subspecialty colleagues, has fueled a worsening shortage of primary care physicians.
Photo courtesy of Pennsylvania AFP
Here I am with members of the Penn State University College of Medicine's family medicine interest group. I talked to medical students all over the country in the past year.
In my year as AAFP president-elect, I traveled the country to chapter meetings, media opportunities, Academy conferences and more. Wherever I went, I worked meetings with students into my schedule so I could give them my perspective on family medicine.
About one-fourth of the nation’s medical students are members of the AAFP, but that impressive statistic hasn’t translated into specialty choice often enough. I wanted to help students understand that family medicine is an exciting, viable career choice that will allow them to make a difference for patients and their families.
During a trip to North Carolina, I visited four medical schools in two days. I talked with students during chapter meetings in places like Arkansas, Kansas and Ohio. I would call med school faculty or chapter staff in advance and say, “I’m going to be in your area. Put me to work.”
Some meetings, however, happened on the fly. During the Family Medicine Congressional Conference in Washington, a family medicine interest group leader reached out and asked if I would come to his med school. So I made room in my schedule, he picked me up in his car, and off I went to spend my birthday with 40 medical students.
I was eager to share my insights about our specialty, but as our discussion got started it became clear to me that many of those students were disinterested and were there simply for a free lunch.
So I told them what I thought about using family medicine as a safety choice.
I said that if you aren’t passionate about your patients, we don’t want you in family medicine.
If you’re in medicine for the money, I said, we don’t want you.
If you won’t be an advocate for your patients, we don’t want you.
In short, I took the tale they’ve been told about family medicine and turned it on its ear. We want the best and brightest because family medicine is not a backup plan. This is a specialty for people who are willing to and capable of learning more than one body system and providing comprehensive care to entire families and, in some cases, entire communities. We deliver babies, provide end-of-life care and so much more in between, performing procedures, providing preventive care, managing chronic conditions and doing it all for both genders and all age groups.
We talked about the many opportunities in family medicine, highlighting that our members work not only in traditional family medicine practices but also in sports medicine, geriatrics, urgent care facilities, hospitals, academia and more.
I told them about my former resident Bruce Vanderhoff, M.D., a family physician who is a chief medical officer of OhioHealth, a system with more than a dozen hospitals, nine urgent cares, 30 rehabilitation centers and more than two dozen imaging centers.
I told them about family physicians like Richard Wender, M.D., the chief cancer control officer for the American Cancer Society, and about former Surgeon General Regina Benjamin, M.D.
Their stories resonate, and these students had never heard them before. We had a robust question-and-answer session, and by the end, even the students who had initially showed up only for the free food were engaged and asking questions.
In my trips to medical schools this year, I heard from students who thought family physicians earned less -- far less -- than $100,000 a year. They were pleasantly surprised when I directed them to a physician survey that showed family physicians earn, on average, more than $220,000 year. And family physician income is increasing at a faster rate than that of our subspecialty colleagues. We’re slowly closing the gap.
As the Health is Primary campaign is making clear, family physicians are the solution for what ails American health care. And we need many more of us.
Unfortunately, family physicians have a tendency to not toot our own horns -- even though we do much of the heavy lifting in our health care system. I appreciate humility, but it’s now my job to toot that horn -- or perhaps blare that horn -- not only to students but also to payers, legislators and federal agencies. People, students included, need to know what we do and why it’s important.
Wanda Filer, M.D., M.B.A., is president of the AAFP. Her term begins today.
Practice Perspective: Patient Stories Get Attention of Media, Policymakers
One of the most important roles of the AAFP president is spokesperson, and I’ve done a lot of speaking this year.
In the first few weeks of September -- my last month as president -- I talked to reporters about health care apps, ICD-10, meaningful use, vaccination rates, workforce issues and more. On one particularly busy day, I did seven interviews.
As I traveled around the country this year to roughly a dozen constituent chapter meetings, it was clear there is a perception by many of our members that AAFP directors aren’t practicing physicians. But that isn’t the case. Although I traveled about 200 days during my term, I’m still a practicing small-town doc with a solo practice in rural Nebraska. So when members say to me that I don’t know what it’s like dealing with the day-to-day issues of a family practice, I say, “Yes, I do. I do what you do.”
That in-the-trenches perspective has helped me in my role as spokesman and advocate. For example, I know how challenging meaningful use has been and how the many shortcomings of electronic health records are hampering our practices. I’ve talked about it not only with the media but also with Congress.
What I've found is that whether I’m speaking with reporters or legislators, being a practicing physician makes a difference because both groups want to know how health care issues affect patients (their readers and constituents, respectively).
“Do you have an example?” is a question I’m asked on a regular basis. Invariably, my answer is, “Yes, I do.” And I’ve noticed that when I provide journalists with a compelling patient story, it almost always makes it into their articles.
Sharing stories about how patients are affected by things such as access to care or how physicians are being affected by issues such as payment helps inform public debate and, ultimately, shape policy. There’s no better example from this past year than the repeal of the sustainable growth rate (SGR) formula. The AAFP and our members advocated relentlessly for years to have this flawed formula replaced. Thanks to your numerous letters, emails and phone calls, Congress voted overwhelmingly to replace the SGR and move forward with a new model for Medicare payment.
Thank you to everyone who joined us in this battle. Our voice and our stories are being heard and are a powerful force for changes in our health care system. The patient-centered medical home is mentioned in the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act, the legislation that repealed the SGR, largely because of our advocacy efforts.
Of course, our work is not done. We continue to communicate with Congress and federal agencies about many other challenges, including meaningful use.
Some vital programs that support and promote primary care -- including the Agency for Healthcare Research and Quality and the Health Resources and Services Administration -- have been targeted for cuts as Congress looks to reduce federal spending. But rest assured that the Academy is pushing back. You can follow the AAFP’s advocacy efforts on these issues (and others) and get involved in our grassroots movement on our advocacy Web page.
Sharing our stories is a powerful thing.
Robert Wergin, M.D., is president of the AAFP. He will transition to the role of Board chair on Sept. 30.
Building Relationships at Core of Family Medicine, Leadership
It's hard to believe that this will be the last blog I write as an AAFP officer. For me, the past six years on the AAFP Board of Directors have flown by. I have had an incredible journey full of once-in-a-lifetime experiences. However, one of the most important lessons I have learned is a basic one that is a core trait of being a family physician: It is all about relationships.
Although we say this routinely, it is such a profound truth that it can be overlooked in our busy lives. But when we embrace it, it is the fundamental approach to how we do what we do as family physicians.
| Here I am sharing a laugh with Academy members (clockwise from top) Kim Yu, M.D., Jennifer Bacani McKenney, M.D., and Kevin Wang, M.D., during an AAFP event. Building relationships is critical not only in our practices but also in leadership.
It is also the foundation on which health care reform must be built. One of the biggest dangers associated with the fragmented and siloed care many Americans still receive derives from a failure to respect this core principle. In all the discussions about primary care, providers, teams and the latest acronyms, we can lose sight of this basic truth: We care for individual people, and we must do so with teams of people who value the uniqueness of that person.
I have been able to travel the country and meet hundreds of AAFP members in their home states. This constantly reminded me to put our relationships into the right context. You are most "yourself" in your natural environment. As an AAFP Board member, and as an officer for the past three years, I needed to have the full understanding of who you are and how you are affected by all the changes that are happening in our health care system. Conversations, phone calls, meetings, notes, emails and social media interactions all helped teach me about you. This allowed me to better represent family physicians and to advocate more forcefully for our specialty.
My wife Alex and I have been welcomed into so many of your chapters, as well as into many people’s homes. We have broken bread together, enjoyed good drink, engaged in stimulating conversation, played music and sang songs, roasted marshmallows around bonfires, hiked incredible vistas, and enjoyed the peace of friendships all over the country. We have felt like a part of your families, and we thank you for that kindness and hospitality.
Life on the road can be challenging. AAFP officers travel more than 200 days a year. One of the things that keeps us going is the sense of connection and appreciation we feel at the many meetings and events we attend. This support makes it much easier to do the important work of engaging different groups outside of family medicine and making sure they know who we are, what we do and why it matters.
Of course, it helps to have a wonderful message. There is nothing better than seeing the light go on in the eyes of a congressional staffer, a legislator or a health care colleague when they finally "get it."
Although we each have our own perspectives, and our individual chapters may have slightly different challenges and priorities, we really are all singing the same song when it comes to the importance and value of family physicians. We are stronger together.
Accordingly, one of the challenges I'll leave each of you with is to make sure that you don't turn your back on the sacred nature of the relationships you create and nurture. It can be easy when you're frustrated by changes to allow that frustration to overtake the incredible joy that comes with answering the call to service. For those of you who are leaders within our national or state academies and in your communities, I challenge you to also seek out and nurture the relationships you create in those roles. It is critical that we truly represent those who depend on us to take their voices forward.
For those who would like to be more involved in leadership, the Academy offers many opportunities. For example, the deadline is fast approaching for state chapters to nominate members for AAFP commissions. I cannot emphasize enough how invigorating it is to move to the next level of involvement. Please jump in -- the water's fine!
My time on the AAFP Board will come to an end later this month when the Congress of Delegates convenes in Denver. Thank you for the tremendous honor of representing you. Although I will not be contributing in this particular forum any longer, you will continue to hear from me. I'm excited about my role on the Family Medicine for America's Health Board of Directors. I also will continue to serve as the Academy's liaison to the CMS Health Care Payment Learning and Action Network guiding committee.
My time on the AAFP Board has prepared me to take on these roles as we continue to navigate challenging waters ahead. I am confident we are moving in the right direction, and that others are seeing family medicine more clearly, listening to us more openly and believing in our message.
Thanks for being on this journey with me. Thanks for your support. And thanks for making me feel like a part of your family.
Reid Blackwelder, M.D., is the Board chair of the AAFP. His term ends Sept. 30.
Royal Pain: Team's Chickenpox Incident Offers Lesson for Patients
The Kansas City Royals have become a shining example of how to succeed in a small market in an era when baseball teams with the highest payrolls are often the biggest winners when it comes to the playoffs. After decades of futility, the reigning American League champions reversed their fortunes by pouring money into their scouting department and creating an elite team based on speed, defense and pitching.
Unfortunately, my hometown team recently became an example of what not to do, and it's a lesson family physicians can use when talking with patients and parents who have reservations about immunizations. After the Royals built a seemingly insurmountable lead in the American League's Central Division, a vaccine-preventable disease has done what few opponents have been able to do -- make this first-place team look vulnerable.
© Keith AllisonKelvin Herrera of the Kansas City Royals delivers a pitch. Herrera and teammate Alex Rios were recently diagnosed with chicken pox.
According to The Kansas City Star, the team's medical staff collects information from players about vaccinations and childhood illnesses every year during spring training. Apparently, that information wasn't reliable this time around, because in the thick of a pennant race, otherwise healthy young men have been sidelined by chickenpox, typically considered a childhood illness.
Kelvin Herrera is a 25-year-old All-Star pitcher who can throw a baseball 100 mph and is a key figure in the Royals' vaunted bullpen. Outfielder Alex Rios is a former All-Star and 12-year veteran. Both men are millionaires who have ready access to the team's medical staff and the means to afford excellent health care.
What they didn't have was immunity to the varicella-zoster virus. Now, Herrera and Rios are expected to miss about two weeks of playing time.
The incubation period for chickenpox can last up to three weeks, so it remains to be seen whether any more players will be affected. Sports teams can be a breeding ground for disease because athletes often spend time in tight quarters during games, in locker rooms and while traveling. It was less than a year ago that a mumps outbreak swept through the National Hockey League, affecting nearly two dozen players (including two-time MVP Sidney Crosby) from five teams, as well as two referees.
The take-home message for the general public is that if these strong, world-class athletes with access to quality health care, team doctors and excellent nutrition are susceptible to vaccine-preventable diseases, obviously, so is anyone else who has not been immunized, particularly children, the elderly and people with chronic conditions.
Patient registries and electronic health records can help us identify our patients who may be at risk. Those systems should be far more reliable than the Royals' method, which appears to have included asking athletes if they remember having chickenpox when they were toddlers.
In a study recently published in the Journal of the Pediatric Infectious Diseases Society, CDC researchers compared national health care claims data from 1994 (the year before the varicella vaccine was introduced) to 2012 data and found that outpatient visits for chickenpox fell 84 percent and hospitalizations fell 93 percent. The recommendation for a second dose of the vaccine was introduced in 2007, leading to accelerated declines in the need for both inpatient and outpatient treatment.
Before the vaccine was introduced, about 4 million Americans got chickenpox each year, leading to roughly 11,000 hospitalizations and 100 to 150 deaths, according to the CDC. Despite the efficacy of vaccines, outbreaks of vaccine-preventable diseases continue because of inadequate coverage.
The United States had 23 measles outbreaks last year, affecting more than 600 patients. This year, 188 cases in 24 states had been reported through Aug. 21, with the majority of illnesses stemming from the Disneyland outbreak that started in December.
In each of the past two years, more than 28,000 cases of pertussis have been reported in the United States. There were 48,277 reported illnesses and 20 pertussis-related deaths in 2012.
These sobering numbers should be shared with parents and patients who are resistant to immunizations. Sharing stories about famous athletes forced to sit at home because of the mumps or chickenpox couldn't hurt either.
Michael Munger, M.D., is a member of the AAFP Board of Directors who practices in Overland Park, Kan.
In an Emergency, Family Physicians Have it Covered
We were six hours into a transatlantic flight when the call came over the plane's intercom that a passenger needed medical assistance. I responded, as did another family physician and an emergency room doctor.
Fortunately, the plane was well stocked with oxygen, a pulse oximeter, a blood pressure cuff and more. We worked as a team to determine what was wrong with a woman who had collapsed on the floor. A few minutes in, another woman appeared, identified herself as an OB/Gyn and asked if she could help.
I replied, "Well, we're two family physicians and an emergency room doctor."
She said, "Oh, you've got it covered then."
So I suggested that this fourth physician try to calm down our patient's hysterical teenage daughter.
About 15 minutes later, yet another physician appeared, identified himself as an orthopedic surgeon and asked if we needed help. I repeated that we were two family physicians and an ER physician.
He said, "Oh, thank God, we have real doctors. My wife made me come up here."
I appreciated that he understood our level of expertise.
The flight crew was prepared to divert the plane for an emergency landing, but we were able to stabilize the patient and determine that her condition did not require urgent measures. She had a history of heart problems, had been sitting for hours, stood up too quickly and passed out.
The breadth of our training makes family physicians well-equipped to react to these types of situations, which is good because they seem to be happening to me with increasing frequency.
I was in the Denver airport last year en route to Boise for the Idaho AFP meeting. But I wasn't in the airport long because I had landed at Gate 6 and had about 10 minutes to run -- literally -- to Gate 70 to make my connection.
I made it on the plane, along with several other passengers who had made the 64-gate sprint. We were about 30 minutes into the flight when I heard someone say, "There's a pair of legs sticking out of the bathroom."
A woman had lost consciousness in the bathroom and had forced the bathroom door open when she fell. I volunteered to help the woman, who was ashen and diaphoretic. She had hypoglycemia and was in and out of consciousness, but I was able to deduce what had happened.
She was one of the passengers who had hurried through the airport to make the connection. She was diabetic, had taken insulin but had not had time to eat. Her condition was exacerbated by the plane's air conditioning, which was not working properly.
I asked the flight attendant to bring her orange juice with extra sugar in it, and we packed ice on the woman's neck and under her arms. Within 20 minutes, she was doing better. A little later, she was fully awake and able to eat.
A couple who had been watching this scene unfold asked if I was a paramedic. I said no, I'm a family physician. They then said they were looking for a new doctor and asked if they could come to my practice. They were disappointed to hear that my practice is in Pennsylvania, not Idaho.
Sometimes, we can get called into action before we even get on the plane. On another trip, I was on my way to the Vermont AFP meeting when I saw an elderly woman in the bathroom struggling to get out of a wheelchair. And more importantly, she was struggling to breathe.
I told her I was a family physician and asked if she needed help. She was a tough older lady, and although she acknowledged having heart disease and lung disease, she said she was fine. In reality, she was in respiratory distress. We talked for a bit, and it turned out that we not only were going to the same place, we also were on the same flight.
So I walked her to the gate, identified myself to the gate agent as a family physician and asked her to move my seat next to this woman's so I could keep an eye on her. The woman had some rough moments on the plane, but we made it to Burlington.
When we got off the plane, she wasn't interested in a ride or calling a family member. Instead she insisted on driving herself home. But first I made her promise that she would call her family physician the next day, and she gave me that physician's name.
At the Vermont chapter meeting, I got the contact information for the woman's FP, called the practice and suggested they follow up with their patient. That doctor did call her, and she was admitted to the hospital.
A month later, I received an email from the woman thanking me after she was at home recovering.
A New England Journal of Medicine study looked at nearly 12,000 in-flight medical emergencies and found that physician passengers were able to assist nearly half the time. I'd love to hear your stories of helping fellow travelers in the comments field below.
Wanda Filer, M.D., M.B.A., is president-elect of the AAFP.
Former 'Orphan' School Embraces Family Medicine to Drive Progress
When I was a student at Emory University School of Medicine, it was a so-called orphan school, meaning it did not have a family medicine department. In fact, I was one of the few students in my class who chose family medicine after graduation, but that is a story unto itself.
It was special, more than 30 years later, to be invited back to my alma mater recently to see what is happening in family medicine there and to be a part of the Atlanta school's new direction.
© 2015 Wilford Harewood/Emory UniversityAn Emory University medical student asks a question during a panel discussion about primary care. Emory launched its chapter of Primary Care Progress this month.
Emory recently launched a chapter of Primary Care Progress, an organization that seeks to not only promote primary care but also develop a new generation of leaders. My invitation to participate in a launch event came about, in part, because of the Academy's efforts to build student interest in family medicine. For example, during the recent AAFP National Conference of Family Medicine Residents and Medical Students, AAFP President-elect Wanda Filer, M.D., M.B.A., led a session about leadership in primary care with Andrew Morris-Singer, M.D., the president and founder of Primary Care Progress.
Reaching out to our students and residents and fostering relationships is vital to building our workforce pipeline. During National Conference, I happened to walk up to a group of students who turned out to be the contingency from Emory. These extremely passionate and engaging students were thrilled to be at the event and told me they were strongly considering family medicine residency.
It's also worth noting that Ambar Kulshreshtha, M.D., Ph.D. -- the resident representative to the AAFP's Commission on Quality and Practice -- was a chief resident at Emory last year and is now a member of the school's faculty. Our specialty is truly about family and relationships.
During my visit to Emory, I met many incredible folks dedicated to moving family medicine forward at this storied institution. I was introduced to an invigorated Department of Family and Preventive Medicine, and I spent a great deal of time with many in leadership who are involved with medical student and resident education. I gave a presentation about the patient-centered medical home that drew residents, faculty and staff, as well as some medical students. I was impressed by their energy and even more so by the demonstration of team-based care that was going on there. We had a chance to talk about steps for the future and finding practical approaches to tap into that energy.
I also participated in a panel discussion with primary care leaders from Emory. That event attracted more than 80 students. Immediately after the panel, I was able to give my "Practical Approach to Patient-Centered Medicine" talk. This was a fun and interactive opportunity to engage students about some things that they had not necessarily considered when they began their medical school path. The energy I felt afterward was inspiring.
Many students signed up immediately to receive more information about Primary Care Progress, and they already were talking to faculty about their interest in family medicine and what we do.
Overall, this was an awesome opportunity to talk about the opportunities that exist at Emory. I was able to emphasize team-based education within a large system that has many resources and ways of better integrating family medicine and primary care into the Emory health system. The school has everything in place to be an outstanding leader.
Perhaps one of the most important messages I tried to deliver is the power of cheerful persistence. Even though it was almost an aberrancy to find oneself in family medicine when I started at Emory, it has become an option that students are asking about proactively as they begin their training. I was excited and proud to see what was happening there.
In fact, my medical school classmate Chris Larsen, M.D., D.Phil., is now the school's dean. He attended the Primary Care Progress launch along with another classmate, Rick Agel, M.D. We reminisced about that special time we had together more than three decades ago when we each started on our journeys, and we reflected on where we find ourselves today, working to transform the health care system in this country.
It’s done one school at a time, one system at a time and one community at a time.
Reid Blackwelder, M.D., is Board chair of the AAFP.
America's Most Wanted: Family Physicians Again Top Search Firm's Wish List
We're No. 1.
For the ninth straight year, "family physician" was the most highly recruited role in U.S. health care, according to national health care search firm Merritt Hawkins.
© 2015 Tiffany Matson/AAFPResidency exhibitors talk with medical students during the 2015 National Conference of Family Medicine Residents and Medical Students. The recent event in Kansas City, Mo., attracted record-setting attendance, including more than 1,200 medical students and representatives from hundreds of family medicine residency programs.
Merritt Hawkins publishes a review each year of the more than 3,100 search and consulting assignments it conducts on behalf of its clients. In its 2015 report, the firm noted it sought to fill 734 openings in family medicine from April 1, 2014, to March 31, 2015. Internal medicine was a distant second at 237 openings. It was the ninth consecutive year that general internist ranked second behind family physician, a fact that highlights "the continued nationwide demand for primary care physicians as team-based care and the population health management model continue to proliferate," according to the report.
The report's authors noted that primary care physicians top the list of most-in-demand doctors in part because of the key role we play in patient management and care coordination. Specifically, they likened us to point guards on a basketball team. Patients need to see us first so we can coordinate their care appropriately. We can provide comprehensive care and refer patients to expensive subspecialist care only when needed. Like a point guard, family physicians see the big picture, not merely focusing on a single issue or area.
The report pointed out that primary care physicians are being rewarded for "the savings
they realize, the quality standards they achieve and for their managerial role" in newer models of care.
"That, at least, is the aspiration of these emerging models," said the report.
"In systems where volume/fee-for service still prevails," the report added, "primary care physicians remain the keys to patient referrals and revenue generation." In fact, a 2014 Merritt Hawkins survey found that family physicians generate, on average, more than $2 million a year for their affiliated hospitals.
I don't know about you, but I'd rather be a point guard who is looked to as the leader of a health care team than as a mere referral factory.
"Regardless of which model is in place (or a hybrid of the two) primary care physicians are the drivers of cost, quality and reimbursement and therefore remain in acute demand," the report said.
And that brings us to income.
For the jobs Merritt Hawkins sought to fill, family physicians had an average starting salary of $198,000. Overall, according to the firm, family physician income has increased more than 11 percent since its 2010-11 survey.
Meanwhile, a recent report by the Medical Group Management Association (MGMA) that was based on a survey of nearly 70,000 physicians reported a median salary of $227,883 for family physicians who provide maternity care and $221,419 for family physicians who do not. MGMA reported a median salary of $241,273 for primary care physicians, which was an increase of 3.56 percent compared with the previous year's figure. The same report found that median pay for subspecialists rose 2.39 percent to $411,852.
So although primary care physician income still lags behind that of our subspecialty colleagues, it is increasing at a faster rate. Since 2012, primary care physicians' income increased 9 percent, while subspecialist pay increased 3.9 percent during the same period, according to MGMA.
Part of the reason for the change is the shift to value-based contracts. According to MGMA, 11 percent of primary care payments came from value-based contracts in 2014, up from 3 percent in 2012. Halee Fischer-Wright, M.D., a pediatrician and MGMA’s chief executive officer, said in a recent interview with Forbes that the figure could grow to more than 30 percent within three years.
It's worth noting that Merritt Hawkins reported decreasing incomes for the positions it sought to fill in several subspecialties. Otolaryngology was down 10.2 percent, physiatry dropped 13.8 percent, urology lost 18.3 percent, and noninvasive cardiology declined a whopping 34.2 percent. OB/Gyn (-4.2 percent), general surgery (-4.2 percent), hematology (-7.2 percent) and pulmonology (-7.5 percent) also saw declines.
Our country has a critical need for primary care physicians. To convince more medical students to pick primary care, that payment gap will have to continue to shrink.
Emily Briggs, M.D., M.P.H., is the new physician member of the AAFP Board of Directors.
Shaping Our Future: Volunteer to Help Drive Specialty Forward
During my six years as an AAFP Board member, I have benefitted greatly from meeting hundreds -- if not thousands -- of family physicians at dozens of state chapter meetings, AAFP meetings and other primary care events across the country. The problems, solutions, suggestions and insights you have shared with me have helped shape the AAFP's positions on a myriad of issues. Your voice truly makes a difference. Thank you for eagerly sharing your ideas over the years.
Now more than ever we need your input, and here is an exciting opportunity for members to contribute to the future of our specialty in an even more direct manner.
Family Medicine for America’s Health, a collaboration of the AAFP and seven other national family medicine organizations, launched two years ago to drive improvement of the U.S. health care system and demonstrate the value of primary care. The initiative's
Health is Primary communications campaign is a three-year effort to advocate the values of family medicine, demonstrate the benefits of primary care and engage patients in our health care system.
I am honored to be able to continue to serve the AAFP and the specialty on the Family Medicine for America's Health Board of Directors after I complete my term as Academy Board chair. And you have the chance to join me in this work!
Family Medicine for America's Health is seeking volunteers to serve on tactic teams that will focus on six critical areas:
- engagement of stakeholders,
- practice transformation,
- technology, and
- workforce education and development.
Family physicians may participate on the tactic teams in one of three roles: project team members, advisory group members or communicators.
Each team will be working from 2015 through 2019 and will complete a number of projects each year. There are three ways family physicians can serve as project team members:
- Experts -- Physicians with a specific type of knowledge, experience or expertise who can help accomplish a task or achieve an objective.
- Influencers -- Physicians who think work on a particular project is vital and sign on to help influence others about its importance, especially as objectives of the work are achieved and consequences for action become clear.
- Mobilizers -- People who have passion and interest in working on a project whether or not they have specific experience or expertise in the subject matter.
Advisory group members will be asked to lend their perspectives on issues through online discussions, surveys and other channels.
We realize that not everyone who is interested in participating on a tactic team will be able to commit the time needed to serve as a project team member or an advisory group member. That's where the communicators come in. They will be kept informed of tactic team activities through regular updates and will have opportunities to participate when their schedules permit.
Additionally, we will ask communicators to tell people who might be interested about opportunities to engage with Family Medicine for America's Health.
If you would like to participate on a tactic team in one of these roles, please let us know by completing this questionnaire. You'll find more information about the tactic teams -- including the projected time commitment for various roles and a frequently asked questions document -- in the survey.
You have a unique opportunity to help shape the future for family medicine, family physicians, our patients and our communities. Thank you for considering these positions, and I look forward to working with you!
Reid Blackwelder, M.D., is Board chair of the AAFP and the Academy's representative to the Family Medicine for America's Health Board of Directors.
Students, Residents Show Their Passion for Family Medicine
You have to admire the passion and dedication that students and residents showed last week during the AAFP's National Conference of Family Medicine Residents and Medical Students.
That passion was evident in the debates about public health, education and other issues heard during the student and resident congresses. And it was evident in the expo hall where students, looking for the next stop in their training, met family medicine residency program representatives who made the case for why their programs stood out from the hundreds of other programs represented in that same expo hall.
But you also could see the passion and dedication simply in the lengths that some attendees made in getting to -- or trying to get to -- Kansas City, Mo.
Photo courtesy of Warren Yamashita
Warren Yamashita, a student at the University of Southern
California's Keck School of Medicine, presents his research poster at Los
Angeles International Airport after his flight was delayed. Yamashita was
bumped from three other flights and could not make it to the AAFP's National
Conference of Family Medicine Residents and Medical Students.
Take, for example, Courtney Hudson, D.O., M.B.A., a second-year resident at the Crozer-Keystone Family Medicine Residency Program in my home state of Pennsylvania. Courtney was participating in the new Family Medicine Leads Emerging Leader Institute, so she had to be in Kansas City early Wednesday morning. Her work schedule was jammed in the days before leaving. On Monday, she worked a cardiac outpatient clinic in the morning before moving on to the primary care outpatient clinic in the afternoon. She then worked the overnight shift -- with five admissions -- at the hospital before attending lectures Tuesday morning. Her 30-hour shift finally ended with a trek to the airport, and she made it into Kansas City late Tuesday night.
In addition to the Emerging Leader program, Courtney worked her residency program's booth in the expo hall and served as an alternate delegate in the National Congress of Family Medicine Residents. She made it home late Sunday night -- just hours before heading back to work on Monday.
I asked Courtney if the trip was worth the effort, and she said she wouldn't have traded it for anything. She also said that immersing yourself in the event is the best way to get the most out of it.
Poor Warren Yamashita wasn't as lucky. Warren, a student at the University of Southern California's Keck School of Medicine scheduled to present his research poster in the expo hall at the conference, saw his flight from Los Angeles delayed. He was subsequently bumped from three alternative flights and could not make it to Kansas City. Waiting overnight at the airport for the city's buses to resume running, Warren engaged in a long conversation with some airline employees and others about families, economics and health care.
Although Warren was unable to present his poster at National Conference, that didn't stop him from presenting it at 2 a.m. in the terminal at the Los Angeles airport. During the past two years at USC, Warren has worked to increase health care access by training interdisciplinary health professional students to act as insurance educators who provide consultations regarding Medi-Cal, Covered California and My Health LA to consumers at community health fairs. His poster chronicled those efforts.
Warren, who won a scholarship from the California AFP to attend the conference, asked AAFP staff to post an email about his experience and photos of his impromptu airport poster presentation because he wanted to contribute "to the spirit of the conference" even if he couldn't be there in person.
These are just two stories out of the thousands that could be told by students and residents who worked National Conference into their hectic clinic and lecture schedules. Total attendance last week was more than 4,200, and the event continues to grow each year.
I came to my first National Conference four years ago. I had just finished my first year of medical school, and although I was pretty sure family medicine was what I wanted to do, I told myself I was going to keep an open mind. Then I arrived at the convention center, and I was blown away by the atmosphere and inspired by the speakers. I felt connected, like I had found my people.
I keep coming back because the passion for family medicine that the students, residents and faculty share at this event is inspiring and energizing. Every year I take home something new because the conference's workshops -- and the issues debated in the congresses -- change to reflect the issues that are important to students and residents.
Warren said he hopes to make it to National Conference next summer.
Kristina Zimmerman, M.D., is the student member of the AAFP Board of Directors.
Physician Burnout: The AAFP Is Winning Battles For You
I have long been concerned about the impact of physician burnout on the health of our colleagues, our profession and ultimately our patients. Most of us realize that the issues of physician burnout are complex and involve factors related to personal resiliency (which can be addressed at the individual level), practice management (which must be addressed at the system level) and regulatory burdens (which must be addressed at the legislative level).
We all know burnout is a huge problem at a time when primary care physicians already are in short supply. Earlier this year, I wrote a blog noting that more than 40 percent of U.S. physicians experience at least one symptom of burnout (loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment). In that post, I wrote about the importance of managing stress, seeking support and removing the stigma associated with burnout.
Since then, additional blogs and editorials published by AAFP News have addressed personal resiliency. One blog post discussed the need to provide residents with resources to recognize, treat and prevent burnout. And we also have confronted the issue of physician suicide.
| AAFP President Robert Wergin, M.D., testifies about electronic health records during a Senate Health, Education, Labor and Pensions Committee hearing.
Although I am glad to see the increased awareness of burnout, I remain dismayed that many of the conversations about issues related to burnout reflect a sense of hopelessness. It is disheartening to realize the sense of frustration of some members who think the Academy isn’t willing or able to help. That being said, I can appreciate that our members on the front lines of primary care may be so busy in practice that they are unaware of all the activities that the AAFP is undertaking on our behalf.
The Academy is, in fact, working to change many of the drivers that lead to burnout, including payment reform and administrative burdens. Here's a look at the progress we've made on some critical issues this year.
The AAFP repeatedly called on CMS to ease the administrative burden associated with meaningful use. In April, CMS included two changes the AAFP advocated for in a proposed rule regarding stage 2 -- shortening the attestation period to 90 days and making requirements related to secure messaging with patients more attainable.
In March, the agency published it proposed rules for stage 3. The Academy pushed back, arguing that implementation should be delayed. Last week, the Senate Health, Education, Labor and Pensions (HELP) Committee agreed, and its chairman, Sen. Lamar Alexander, R-Tenn., called for a delay in enforcement of stage 3 requirements, which are scheduled to take effect in 2017.
The HELP committee has heard from both AAFP President Robert Wergin, M.D., and family physician David Kibbe, M.D., M.B.A., in recent months. Wergin spoke about the burden of electronic health records and the need for interoperability at a March hearing, and Kibbe spoke this month about business practices that impede information sharing.
The Academy also has seized opportunities for public comment and written letters to federal agencies in recent months regarding meaningful use stages 2 and 3 and the Office of the National Coordinator for Health Information Technology's interoperability roadmap. All of this correspondence has stressed the need for improvements in interoperability.
Finally, the Academy's Alliance of eHealth Innovation is conducting a study on the benefit and burden associated with meaningful use and is expanding its work on improving health IT usability and implementation.
For years, family physicians fought for the repeal of the Medicare sustainable growth rate (SGR), the faulty formula that repeatedly threatened to cut physician payments. On April 14, Congress finally passed the Medicare Access and CHIP Reauthorization Act, repealing the SGR formula. The law will provide needed payment stability in the Medicare program with several years of modest payment increases for physicians. The law also funds for two years the Children's Health Insurance Program, the National Health Service Corps, the Teaching Health Center Graduate Medical Education program and the federal community health centers programs.
The Academy will continue to communicate with HHS and CMS as they develop new payment models.
CMS announced this month that it will provide greater flexibility -- a one-year grace period from claims denials and audits -- during the transition to ICD-10 billing codes. The AAFP was one of numerous medical organizations that had written to CMS in March, urging further testing and risk mitigation.
Advance care planning
CMS recently released its proposed 2016 Medicare physician fee schedule. It discusses the establishment of advance care planning codes -- which the Academy has advocated for -- that would pay physicians for our expertise and time in assisting patients and their families with advance care planning services.
The Department of Veterans Affairs (VA) announced in March that roughly twice as many military veterans will be eligible to see a physician who is not affiliated with the VA under a new standard for measuring the distance from a veteran's home to the nearest VA facility. The AAFP pushed for that change while also expressing continued concerns about VA payment rates being less than Medicare rates.
This spring, CMS proposed -- at the Academy's behest -- covering HPV testing in conjunction with a Pap smear test (once every five years for asymptomatic Medicare beneficiaries 30 to 65 years old who wish to extend the screening interval).
I know many challenges and frustrations remain. The increasing complexity and administrative burdens being placed on family medicine have been piling up for years. The Academy is committed to stopping this landslide.
The AAFP is continually communicating with Congress and federal agencies to ensure they know about these important issues. Legislators and policy makers must understand that transforming health care will require a strong family physician workforce, which in turn requires improving the health and wellness of our colleagues, and our practices, by decreasing the regulatory and system burdens that cause physician burnout.
Lynne Lillie, M.D., is a member of the AAFP Board of Directors.
California's Vaccine Victory Holds Lessons for Other States
In politics and culture, California does not often align with Mississippi and West Virginia, but I feel proud to stand with those states in declaring solidarity on eliminating nonmedical vaccine exemptions.
Even before an extensive measles outbreak erupted from the so-called Happiest Place on Earth earlier this year, many states sought to tackle the issue of vaccination exemptions, and those attempts have only intensified since then. In California -- the epicenter of that outbreak -- the battle over S.B. 277 culminated in a victory for public health advocates over a small but vocal anti-vaccine contingent, including some noted celebrity opposition.
In California and everywhere else these battles have been waged, childhood vaccination should have been a motherhood-and-apple-pie issue, yet debate about requiring vaccines and removing personal and religious exemptions elicited visceral reactions from both sides of the ideological divide.
Surely, such heated discourse couldn't be focused solely on refuting the science and evidence behind immunizations. Even Jenny McCarthy has backpedaled somewhat from her earlier anti-vaccine statements that, arguably, set childhood immunization efforts back a decade. No, what this debate really boiled down to was the notion of preserving individual rights at the cost of placing others in harm's way.
Throughout its history and in virtually all areas of public discourse, our country has tried to carefully balance the needs of individuals against the greater societal good. Nowhere has this been more evident than in our protection of individuals' religious freedom. In this case, one of the primary arguments to remove religious exemptions to vaccines is completely consistent with this goal. After all, no major religion in the world (we're not talking about Scientology here) is against vaccination; we can rely on our pastors and priests, rabbis and imams to agree on this point.
So, we're back to personal freedom. The crux of anti-vaccine supporters' argument against removing the personal/philosophical exemption stems from a fear that the government is dictating -- and, thus, overruling parental control of -- children's health care matters. But consider this perspective: The California law allows an exception to the vaccine mandate for home-schooled children, which, in essence, preserves parents' right to decide whether their children will participate in a community-sponsored benefit or opt out of that process.
Moreover, this law continues to allow medical exemptions as determined by a physician, so we can and will continue to discuss this important issue with our patients. In fact, Gov. Jerry Brown cited the continuation of the medical exemption as the sole reason he signed this bill into law. To some, this clause may appear to allow a loophole for vaccine-hesitant parents to go doctor-shopping. And, no doubt, there still will be some physicians ready to cast doubt on the science of vaccines, but they will continue to be in the minority. Ultimately, the decision will be in the hands of the physician and the child's parents after an evidence-based discussion that takes place behind exam room doors.
One last thought: Perhaps sensing the inevitability of passing this legislation, opponents of the California bill vilified its primary author, Sen. Richard Pan, M.D., a practicing pediatrician -- and good friend -- who represents the state's 6th District. Fortunately, Dr. Pan wisely built a coalition of citizen groups and medical organizations -- including the California AFP -- that worked together to overcome this opposition. For those of you familiar with Sen. Pan, you know he has been a stalwart champion of primary care and public health, even winning CAFP's Champion of Family Medicine award in 2013
My challenge to you, my fellow family physicians, is to take up this public health banner and run with it: no personal exemptions, no religious exemptions. Three states down, 47 to go.
Jack Chou, M.D., is a member of the AAFP Board of Directors.
Are You the Leader We're Looking for?
Before the end of the year, nearly two dozen family physician volunteers will be selected to serve on AAFP commissions, providing invaluable input regarding issues related to continuing professional development, education, finance and insurance, governmental advocacy, health of the public and science, membership and member services, and quality and practice.
If you've ever wanted to get involved, make a difference or make your voice heard, this could be your chance. The Academy sent a letter to its constituent chapters today seeking nominations for 23 commission slots that will be vacated in December. Interested members should contact their chapters before the Oct. 15 deadline for nominations. To be considered, your chapter must provide a
- letter of nomination,
- typed nomination form,
- passport photo, and
- completed online conflict-of-interest form.
Commission members serve four-year terms and participate in biannual meetings, conference calls, project work and other activities. Commission work can be a stepping stone to leadership in our organization. More importantly, it is an opportunity to influence the direction of the Academy and our specialty.
Photo courtesy of Kim Yu, M.D.
More than 100 Academy members volunteer their time each year and provide input to the AAFP's seven commissions, including the Commission on Membership and Member Services.
As an example of how the commission process works, I visited AAFP headquarters in Leawood, Kan., twice this spring to attend meetings of the Commission on Finance and Insurance that took place during budgeting for the new fiscal year. I was impressed by the diligence with which the organization prepares the annual operating budget and the thoughtful questions that were asked by the 10 family physicians volunteers before they forwarded that budget to the Board of Directors for approval. There is a commitment by all involved to spend your dues money wisely.
It's an intense, time-consuming process. Each Academy division director was given 30 minutes to explain who they are and what they do, explain items of note in the budget related to their division and discuss goals and hiring needs for their areas. Commission members listen and ask questions.
Given the scope and breadth of the Academy (more than 120,000 members and more than 400 employees) and the immense number of activities the AAFP is involved with in advocacy, education, practice advancement and public health, one commission member likened the budget process to drinking from a fire hose. The Commission on Finance and Insurance is tasked with striking a balance between being a good steward of Academy funds while also advancing needed products and services to members.
For example, one of the many projects discussed during budgeting was the recently launched Performance Navigator. The ambitious project combines live learning and online resources in a new tool that can help family physicians satisfy requirements for maintenance of certification parts II and IV, earn up to 113.5 AAFP Prescribed credits, and improve our practices while enhancing reimbursement potential. (Registration is now open for the Nov. 4-6 live course in Carlsbad, Calif.)
This commission's responsibility when considering such projects is to look at the big picture, understand what our resources are and make recommendations to the Board of Directors. The members of our other commissions perform similar tasks, reviewing emerging legislation and regulations for possible comment; lending their expertise in developing clinical policies and preventive services recommendations; providing feedback on proposed CME programs and activities; offering insights on new practice tools and processes; and more.
So here is your chance to make your mark and support our specialty. Contact your chapter. October will be here before you know it.
Wanda Filer, M.D., M.B.A., is president-elect of the AAFP.
AAFP Teams Up With NFL Foundation to Raise Concussion Awareness
More than 1.6 million concussions occur in sports and other recreational activities each year in the United States. Making matters worse, athletes, parents and coaches often are unaware of recommendations regarding returning to play and the need to seek medical attention.
A study published last year in JAMA Pediatrics found that 59 percent of female middle-school soccer players played with concussion symptoms, and more than half of the players reporting concussion symptoms were not evaluated by a physician. According to the Center for Injury Research and Policy, at least 40 percent of concussed high-school athletes return to play too soon. In fact, 16 percent of concussed football players returned to play the same day they were injured.
Concussions can occur even in sports that you don't necessarily associate with head injuries. For example, women's lacrosse is supposed to be a noncontact sport, but the ball travels at speeds in excess of 60 mph. At the recent AMA annual meeting, delegates voted to adopt a measure recommending helmets for girls and women playing that sport.
Like many family physicians, I treat sports-related injuries in my practice and also work as a team physician for the local high school. I often have to educate coaches and parents about the need to hold athletes out of practices and games while they recover. And we've also had to take helmets away from injured football players during games when they were far too eager to get right back into the action.
So how do we raise public awareness about the serious nature of concussions, their long-term effects and the fact that they often can be successfully managed? The AAFP has entered a partnership that will pair the evidence-based medical knowledge of the Academy with the influence of the National Football League Foundation. The initiative will produce three free webinars for family physicians, as well as patient education materials. The AAFP will have full control of all educational materials and will retain final editorial authority over the materials.
The Academy will be able to use the NFL's brand and logo on the patient education materials, which should help get the public's attention. NFL games reached more than 200 million unique viewers last season, when the league averaged 17.6 million viewers per game.
Here is a look at what to expect:
- Sports Concussions 101: The Current State of the Game, July 23, 8 p.m. CDT. This webinar will enable participants to define a concussion, and to identify the signs and symptoms of a concussion during an initial evaluation. The event will be presented by Stanley Herring, M.D., medical director of sports, spine and orthopedic health for University of Washington Medicine, co-medical director of the Sports Concussion Program, and a team physician for the Seattle Seahawks and Seattle Mariners; and family physician Matthew Silvis, M.D., associate professor in the departments of Family and Community Medicine, Orthopaedics, and Rehabilitation, and medical director of primary care sports medicine at Penn States's Hershey Medical Center.
- Sports Concussions 102: If You've Seen One Concussion, You've Seen One Concussion, Aug. 6, 8 p.m. CDT. Participants will be able to analyze the variability of the clinical presentation of concussion, construct an individualized, evidence-based treatment plan and recognize when to seek consultation or referral for a concussed athlete. The webinar will be presented by Jason Matuszak, M.D., the director of the Sports Concussion Center in Buffalo, N.Y., and Yvette Rooks, M.D., assistant professor of family and community medicine at the University of Maryland School of Medicine and a team physician for the University of Maryland Terrapins.
- Sports Concussions 103: Debates and Controversies, Aug. 20, 8 p.m. CDT. This webinar will cover long-term brain health in athletes; rule changes, practice and play modifications, and legislative efforts regarding sports concussions; limitations of protective equipment; and counseling parents about sports participation for young athletes. This webinar will be presented by Herring, Matuszak, Rooks and Silvis.
Patient education materials will be mailed to all active AAFP members in August and also will be posted on FamilyDoctor.org. These materials are intended to help patients understand the definition of concussion and its signs and symptoms, know when to seek medical evaluation, understand concerns about long-term brain health in athletes, and understand the limitations of protective equipment.
As part of the initiative, Family Medicine SmartBrief will publish a special report regarding concussions in August. You can sign up to receive SmartBrief, a daily wrap-up of news that affects family medicine.
Family physicians often are the first line of care for patients of all ages. We’re the first to spot these injuries, the first to treat them and the first to discuss the dangers of concussions with patients. This educational initiative will help family physicians and our patients by focusing on safety, the importance of reporting, evaluation of concussions and return-to-play protocol.
Concussions are a serious public health risk, and this educational initiative is the right thing to do.
Robert Wergin, M.D., is president of the AAFP.
What Patients Don't Know Can Hurt Them
It has been more than five years since the Patient Protection and Affordable Care Act (ACA) became law, but many consumers still remain unaware of one of the law's signature provisions: coverage of preventive services without cost-sharing.
A baby receives the rotavirus vaccine. Many Americans remain unaware that most health plans are now required to cover preventive services, including vaccinations, without cost-sharing.
The White House and HHS recently launched a joint Healthy Self campaign, which is designed to connect Americans to the health care they need and encourage them to take a more active role in their health. Fifty events will be held across the country in August to connect patients with care. The effort includes educating people -- particularly the newly insured -- about preventive services they are guaranteed under the ACA, which survived another Supreme Court challenge last week.
A Kaiser Family Foundation poll conducted shortly before last year's open enrollment deadline, showed that less than half of uninsured Americans were aware that the recommended preventive services most health plans are now required to cover must be provided with no cost-sharing. Those services include:
- blood pressure screening;
- breastfeeding support and supplies;
- depression screening;
- domestic violence screening and counseling;
- HIV screening;
- obesity screening and counseling;
- tobacco cessation interventions;
- well-child visits; and
- well-woman visits.
Considering that lack of awareness about these benefits, it's no surprise that half of the uninsured who were polled said they planned to stay uninsured.
However, more than 16 million people have gained health coverage under the ACA, according to the Healthy Self campaign announcement. That's significant because prevention is the key to true health care. Chronic diseases are responsible for 70 percent of U.S. deaths and 75 percent of our health care costs. Imagine the difference we can make simply by helping patients understand the services they have access to in our practices. If people delay preventive care because of cost concerns, they're more likely to eventually end up spending even more money at urgent care centers and ERs.
So what can we do as family physicians? We can use electronic health records to review what services patients haven't had. Our practices can use phones, email, portals and even social media to encourage patients to come in for preventive care. We also can use acute visits to identify preventive service gaps and schedule follow-up.
It's worth noting that CMS has launched a Web page with resources to help the newly insured understand their benefits and to connect them with primary care physicians who can provide preventive services.
Reid Blackwelder, M.D., is Board chair of the AAFP.
Father's Day Flashback: Lessons Learned From Dads
I have been blessed with many father figures in my life, and each one has shared valuable wisdom that has helped me become a better physician, a better leader and a better person. In honor of Father's Day, and fathers everywhere, I want to pay tribute to the special fathers in my life by sharing some of their wisdom.
My great grandfather, Charles Light, was a Mennonite minister. My first memories of him were of a gentle man who lived simply on a farm and enjoyed quilting. He was a member of the Hereford Dairy Project and sailed on that initiative's first trips that brought animals to those living in poverty so they would have sustainable means to provide food and income for their families. He showed me the wisdom of paying it forward.
My great grandpa Otto McBride was a carpenter. My first memories of him were of his wonderful smile, which extended over his entire face and into his eyes. He could create anything with his hands. I still have the cedar chest he built for my grandma to keep my mother’s baby clothes in. He showed me the wisdom of building your own future.
My other great grandpa, Thomas Lloyd, owned his own shoe store in Racine, Wis. My first memories of him were of playing with the hundreds of seashells that he would collect in Florida and bring back home in jars. He showed me the wisdom of appreciating the beauty in nature.
My grandpa Don Beckenbaugh was a salesman in the Midwest who retired and moved to southern California. Six months after his retirement, he was offered a job selling real estate. Six months after that he became a broker who managed a successful real estate business in Laguna Niguel for 20 years. He was also committed to keeping his large family connected, and every time we had a gathering, he would go around the table and make everyone stand up and give a short speech to share what was new in their life. (That was the old-fashioned version of Facebook). He showed me the wisdom of believing in yourself.
My other grandpa, Allen Light, was a salesman who lived his entire life in the Midwest, which allowed me to spend holidays and summer vacations at his home for more than 40 years. He had a great sense of humor and a sharp wit and was an avid gardener and winemaker. He had a strong faith in God and held the importance of family above all other things. He took care of me when I was a baby, and he helped take care of my babies when I became a mom. He always took an active interest in whatever I did in my personal and professional life. When he developed cancer at the end of his life, he taught me what is was like to be a patient. He showed me that the burden of disease cannot break your spirit, but also that it cannot exceed your capability to live with disease. He showed me the wisdom of allowing faith, hope and love to guide your life.
My dad, Bob Beckenbaugh, is a recently retired hand surgeon. He was the first one to introduce me to medicine and show me how physicians can make a difference in the life of others. Dad also taught me to appreciate the power of humor and the importance of having fun. He taught me to laugh and tell jokes and to swim, water ski and snow ski. He even tried to teach me to play golf, but he says I "hit the big ball (planet Earth) more than the little ball (the golf ball)." Most of all, my dad taught me that taking care of other people is the most important service you can do with your life, and that as a physician, patients should always be treated with courtesy and respect. My dad showed me the wisdom of keeping joy in your life and striving for excellence in caring for others.
For the past 36 years, I have been blessed with another dad, my father-in-law Ted Lillie Sr. He is a retired small business owner who cares deeply for his family and strives to help those who are less fortunate then himself. He taught my husband to be a wonderful father, and he has shown me the wisdom of perseverance in the face of adversity.
So this month, I say thank you to all my fathers, and thank you to fathers everywhere who take the time to make a difference in the lives of others.
Lynne Lillie, M.D., is a member of the AAFP Board of Directors.
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