Main | Next page »

Tuesday Nov 24, 2015

Tales From the Road: Giving Thanks for Family Medicine

In the eight weeks since I became AAFP president, I have visited nine states; Washington, D.C.; and Canada on Academy business. Along the way, I've met with governors, members of Congress, medical students, journalists and many, many family physicians.

Although these are trying times for family medicine, I've seen many things to be thankful for, and I want to share some of those bright spots.

During the recent interim meeting of the AMA House of Delegates in Atlanta, Neil Brooks, M.D., of Vernon, Conn., announced that he was participating in his last AMA meeting. That's significant because the former AAFP president has been representing family medicine in the House of Medicine for more than a quarter of a century, including the past 12 years as a member of the AAFP's delegation.

(Coincidentally, Rep. Joe Courtney, D-Conn., spoke highly of Neil and his wife, Sandi, during a recent meeting with AAFP leaders. Courtney is a co-founder of the new Primary Care Caucus, which seeks to advance public policy that establishes, promotes and preserves a well-trained primary care workforce and delivery system as the foundation of our health care system.)

When experienced physicians like Neil Brooks leave leadership roles, who will take their place? Well, for one, I was impressed by Allen Rodriguez, a second-year medical student from UCLA who was part of our AMA delegation. Student interest in family medicine is increasing, and I try to meet with medical students wherever I go. Students are excited by the idea of family medicine -- taking a holistic approach to caring for people in the context of their community, family and life rather than defining them by their disease state.

The students I have met with (most recently at Virginia Commonwealth) are passionate about addressing the social determinants of health, show great leadership skills and are committed to lifting the profile of family medicine. We recently saw students and residents at Columbia University and NewYork-Presbyterian Family Medicine Residency rally around their programs when those organizations announced misguided plans to divest from primary care. Columbia and NewYork-Presbyterian backpedaled from those plans after a fierce, and well-deserved, backlash.

And, of course, I'm thankful for the family physicians who are out there helping people every day. I've visited several state chapters in the past few years, and one of the things I look forward to on these trips is hearing the inspiring stories of each state's family physician of the year.

In Illinois, I heard about Elba Villavicencio, M.D., of Buffalo Grove, who was nominated by a patient who said "Dr. V" helped her quit using tobacco after 35 years of smoking and also helped her lose weight. Villavicencio trained in Ecuador and practiced in her home country and Colombia for several years before coming to the United States, a move that required not only additional training but learning a new language.

In Iowa, I heard about Mark Haganman, D.O., of Osage, who was praised not only for being a good doctor but also a good citizen. Haganman was humble about accepting the award, but others praised him for going above and beyond what any patient would normally expect from his or her physician. For example, Haganman mowed a patient's yard, not because the patient had asked but because help was needed after a surgery. Stories like that are inspiring, and we need to hear more of them.

Studies tell us that more than one-third of physicians are struggling with burnout. During my speech in Denver at the Family Medicine Experience, I said that we need to look out for each other. I was pleased recently when one of our members took me literally and asked me to call a colleague who was struggling. I made that call last week and offered a sympathetic ear and some mentoring. It's rough out there, and we need to continue to look out for each other.

We also need to continue to share the stories of our colleagues who are doing incredible things in their communities. Doing so helps inform the press, the public, payers and politicians about why primary care matters.

Happy Thanksgiving, and thank you for all that you do.

Wanda Filer, M.D., M.B.A., is president of the AAFP.

Tuesday Nov 17, 2015

Safeguard Your Sanity -- and Your Specialty -- With a Bold 'No!'

One day I walked into my home after a post-call clinic, having delivered a baby with dystocia and admitted a terminal cancer patient into hospice. It was a long, long call.

My daughter ran to my legs and hugged them, my son asked what was for dinner, and the newborn let it be known that she needed to nurse. I gave my husband a quick hug and kiss, thinking about how I was going to give my patients the quality care they need when my clinic has been paralyzed by our hospital's decision to implement a new electronic health records system without seeking input from physicians in its outpatient clinics.

This conundrum, I am sure, is common among physicians. We are conditioned to multitask, go the extra mile and do it without a grimace. As new physicians, we know all too well the pressures placed on us as medical students and residents to accept more work and excel. Despite working long hours with inadequate sleep, we are programmed to overachieve.

I am four years out of residency, working as a medical director of a rural health clinic, dealing with meaningful use and quality measures while also being a wife and mother of three, and I realize that without boundaries, I am at risk of burnout.

Think about it: In light of the changes occurring in our health care system, we new family doctors are groomed to be prime assets not only to our patients but also to our communities. We understand that, and we innately carry the responsibility of leadership. It is how we are made.

With that in mind, however, I find myself redefining leadership as a means to make a deliberate impact. For me, it has become a much more thoughtful process than it once was. For the first time in my career, I have the ability to tailor my experience and maximize my talents and gifts so that I can become the type of doctor that I once wrote about in my medical school essays.

With this new approach, I see that I must be willing to take a stand to make a difference. Most importantly, there is power in saying no.

Say no to things that do not feed your vision. Medicine, especially family medicine, is as much a calling as it is a job. Although not everyone is passionate on a national level, we each have an impact within our unique settings. But without vision, we can fall prey to spreading ourselves too thin, leading to burnout. With vision, it is easier to say no to demands made by insurers, employers, clinic managers and others.

Before entering medical school, I always envisioned myself working within the family unit and caring for people worldwide. I didn't know at that point that the image of medicine that motivated me to excel was that of a family doctor.

I thrive by providing quality care to all members of my community, not simply those who can afford it. Now, I take care to prioritize my work with my life's vision. The more that vision crystalizes, the more centered I become in life.

Say no to interactions that do not respect you for the asset that you are. We are valuable revenue builders for our health system, and without primary care physicians, the health system could not function. Although our self-worth goes much deeper than our bank accounts, given the years of both social and financial sacrifice we've made, the way we are compensated is an important reflection of respect.

I work as an independent contractor for a hospital-owned clinic, so I have had to develop confidence in my professional worth that I draw upon during contract negotiations. We women often are paid less than our male colleagues, but it is important to find a work environment that aligns with your value. I am no longer afraid to ask for fair compensation.

Beyond money, it is imperative that we guard our time, which is so valuable. It is no secret that family doctors are the backbone of the medical system. We need to be bold enough to say no when we are asked to do work that is not equitable compared to that our colleagues are asked to do. In contract negotiations, we need to be willing to walk away from a bad deal. We need to demand what we value -- money, time off, quality improvement, professional development or educational allowances.

We need to be bold enough to say no to outside sources that attempt to dictate how we practice medicine. We are bogged down by prior authorizations, Physician Quality Reporting System requirements, filing scripts for durable medical equipment and supplies, or even finding a specialist for our patients who lack insurance. It will only get worse if we as a collective don't take a stand against the administrative hassles that drag us away from our patients.

Part of our job as healers is to protect the sacred space between doctor and patient. The only way we can do that is by being a presence our local, state and national leaders know and respect. Until we are recognized for the immense role we play in health care, the pressures of the system will continue to fall on our backs.

When we are ready to hone in on our time, we gain the ability to say yes to more fulfillment. Let's say yes to less burnout. Let's say yes to fair compensation. Let's say yes to better quality of life. Let's say yes to better patient care. Let's say yes to the freedom and joy of serving in such a noble calling.

Marie-Elizabeth Ramas, M.D., is the new physician member of the AAFP Board of Directors.

Tuesday Nov 10, 2015

AAFP to Congress: Primary Care Plays Vital Role in Mental Health

It's no secret that among health care employers, family physicians have been the most highly sought-after type of physician in this country for the past decade. But what some may not know is that psychiatrists are close behind, ranking as the third-most highly recruited specialty.

The shortage of psychiatrists is so acute that nearly 4,000 places in this country have been designated as mental health care health professional shortage areas It would take more than 2,700 mental health professionals to adequately address the problem in these areas where, on average, only half of the need for mental health services is being met.

With a dearth of these subspecialists, primary care physicians provide the majority of mental health services in the United States. Unfortunately, payers and policymakers often are not attuned to this reality. That lack of awareness creates an additional barrier for patients who need help because of the difficulties primary care physicians face regarding payment for mental health services.

Last week, AAFP leaders were on Capitol Hill to speak with legislators and congressional staff about a number of issues concerning family physicians, including payment, meaningful use, funding for primary care programs, the newly created Primary Care Caucus and mental health reform. On Nov. 4, AAFP Board Chair Robert Wergin, M.D., and I met with Sen. Bill Cassidy, M.D., R-La. -- a gastroenterologist -- and Joe Dunn, the legislative assistant to Sen. Chris Murphy, D-Conn.

Sens. Murphy and Cassidy are the authors of S. 1945, the Mental Health Reform Act, which is one of two major mental health reform bills under consideration by Congress. The other, H.R. 2646, or the Helping Families in Mental Health Crisis Act, was introduced in the House by Rep. Tim Murphy, Ph.D., R-Penn., who is a clinical psychologist.

The AAFP has not yet endorsed either bill, but both include policies the Academy supports, including the integration of primary care and behavioral health. During our meetings with Cassidy and Dunn, we voiced our support for such integration while also emphasizing the important role family physicians play in mental health care and the need to eliminate barriers to care created by inadequate reimbursement in primary care settings.

Too often, payers have carved out mental health care as the purview of psychiatrists and psychologists despite the fact that nearly one-third of primary care visits by adults 75 and younger involve mental health issues.

Faced with payers who won't pay adequately -- if at all -- for mental health services, primary care physicians have been forced into creative billing. Rather than submit a code for depression that is likely to be rejected, primary care physicians often code for the symptoms of the disease instead and get paid for things such as treating insomnia or fatigue. Unfortunately, this scenario perpetuates the fallacy payers have bought into, because claims data thus indicate far less mental health care is provided in the primary care setting than is actually given.

Furthermore, the combination of inadequate reimbursement, physician shortages and other factors leads to shortcomings in both diagnosis and treatment. Mental Health America estimates that only 49 percent of patients with clinical depression and 52 percent of those with generalized anxiety disorder receive treatment.

The bill that Sens. Murphy and Cassidy are sponsoring would make an important change to Medicare and Medicaid, allowing patients to access mental health and primary care services at the same location on the same day. The bill also would allow for the creation of grants related to models of care, early intervention and more.

It remains to be seen what will transpire with either of these bills, but our recent meetings made it clear that the Academy plans to play an active role in the debate on this important issue.

John Meigs Jr., M.D., is the president-elect of the AAFP.

Monday Nov 02, 2015

Med Students, Schools Must Safeguard Peers' Mental Wellness

My friend was brilliant. He graduated valedictorian of his high-school class and was salutatorian of his undergraduate department. He had other gifts, too, including a phenomenal singing voice that would put Sam Smith to shame.

He also had bipolar disorder, which recently led him to take his own life.

For some students at our medical school, the news of his suicide was shocking. For those closer to him, it was almost understandable.

 Nearly one-fourth of medical students meet depression criteria.

Starting from day one, medical school students are constantly exposed to a host of new and stressful experiences. Support from family and friends can make a big difference, but this type of encouragement may be limited for those who are in a completely new environment far from home. Too often, we try to process these situations in isolation, or we may try to cope in potentially harmful ways, such as through excessive alcohol consumption.

According to a study on mental health in medical students published in JAMA: The Journal of the American Medical Association several years ago, 14 percent of students surveyed at the University of Michigan Medical School had moderate to severe depression, and another study suggested that nearly one-fourth of med students met depression criteria. More shocking, more than one in 10 students (11.2 percent) surveyed in a study assessing burnout reported experiencing suicidal ideation in the previous year. Third- and fourth-year medical students reported higher rates of suicidal ideation than did first- and second-year students. 

Although medical students are at particular risk for experiencing mental health issues, we’re unlikely to seek help. One commonly cited reason is stigma. Earlier in our lives, we were somehow molded to react uncomfortably to topics such as depression, schizophrenia, substance use or suicide. Medical school culture then builds high expectations in which weakness is not accepted. Some of us think that disclosing a mental health condition would lead us to be viewed as incompetent.

Even when students decide to seek help, we face additional barriers. Oftentimes, our busy class or clinical rotation schedules prevent us from scheduling needed appointments. And even if we do have free time, getting an appointment with a therapist may take weeks, and it may be a few months before a psychiatrist is available.

Another friend battling depression sought help and found that the institution’s student mental health resources had a three-week wait. She decided to go to the emergency department that day to contract for safety.

Addressing student wellness has become a priority for medical schools. Initially, most schools focused on increasing access to post hoc, therapy-oriented services for individuals who develop mental disorders or significant distress. But in recent years, comprehensive wellness programs are increasingly being implemented to counteract or balance the negative experiences students may face.

My institution established a college advisory program modeled after Vanderbilt University School of Medicine’s wellness program. Students are divided into four colleges (similar to the Hogwarts houses in the Harry Potter books). Within each college, we are further divided into "molecules" of five students with one faculty member who advises us on wellness and provides career counseling throughout medical school.

We meet with our faculty advisers after each clinical rotation to reflect on experiences from the past eight weeks. The most recent discussion focused on personal growth. A third-year student tearfully spoke about the insecurities he faced on his first rotation. He thought he constantly disappointed his team because he hadn’t met clinical expectations. He didn’t realize the expectations of writing complete progress notes on every patient before rounds and providing sign-out to the night team were beyond the scope of a medical student. Furthermore, his team regularly criticized his oral presentations. Hearing fellow third- and fourth-year classmates relate to his experience and offer advice on future rotations seemed to comfort the student, but the fact remains that he should have been supported earlier in his clerkship.

Additional measures taken to improve student wellness have included a dramatic move from assigning grades (honors, high pass, pass, fail) to using a simple pass/fail system. During the preclinical years, most lecture days end by noon. This provides students time to pursue extracurricular activities that range from conducting research to playing intramural sports to visiting family.

Yet even with these changes in place, my classmate struggled with his mental illness. He refused to seek mental health services and attempted to self-medicate. Ultimately, his strongest support was a small group of classmates who, despite his initial resistance, constantly reached out to him during both his highs and his lows. When he first expressed suicidal ideation, our classmates brought him to the emergency department. When he had his first manic episode, those classmates called police for help. They went through so much with him, and now that he has passed, they are the ones left hurting. Their mental health cannot go unaddressed, nor can the mental health of my classmate’s family and loved ones.

This sad experience offers a strong reminder that we future physicians are not invincible. It is acceptable for us to show weakness and to seek help. After all, if we cannot care for ourselves, how can we care for our patients?

Tiffany Ho, M.P.H., is the student member of the AAFP Board of Directors.

Tuesday Oct 27, 2015

Surrounded by Ghosts: Wisdom Gained From Patients Past

My exam rooms are full of ghosts, and sometimes it is standing room only.

My patients can't see them, of course, but the ghosts often are here giving advice and warning. Sometimes, when there is a particularly large crowd, the conversations are deafening.

I have worked in the same small town in Alaska for 21 years, caring for a community through all stages of life. During my time here -- as well as medical school and residency -- I have lost many people, and I freely admit that they come back to haunt me. This is not a bad thing. They are people who I liked or loved, and they still have much to offer. The hard part is translating their wisdom to those still living.

Particularly loud are the lost teenagers I hear when I talk with young patients during sports exams about not getting into a car with anyone who has been drinking. I have at least 10 ghosts in the room, all talking at once, when I have these conversations.

"Dude, listen to the doc."

"He told me the same thing."

The hardest to bear are the ghosts of infants and children when I am talking to parents about vaccinations. They don't say anything, but I still see their eyes, throats and backs because I trained in the era before the Haemophilus influenzae type b vaccine. Too much of my time on pediatric rotations in medical school and residency was spent performing lumbar punctures and taking care of periorbital cellulitis and epiglottitis.

The exam rooms are full of ghosts, I tell you. There are none, however, who died from complications of vaccines.

The ghosts are with me when I have to tell someone that they have cancer. I have been doing this long enough that they segregate depending on the type of cancer. They are also with me when I talk about the importance of quitting smoking or screening for colon, breast or cervical cancer.

The ghosts are especially present when I talk about end-of life-issues and the importance of maintaining quality of life -- even at the expense of life-sustaining measures -- and they advise me as I help patients and their families through this process.

The ghosts of those who died from alcohol and drug abuse are fatalistic and sad when I tell my patients that they must stop or they will die within the year. They nod and whisper among themselves that I told them the same thing. Sometimes I think that perhaps this particular group of patients can actually see the ghosts, but rarely is it enough to make them change their own lives.

The longer you practice as a physician, the more ghosts you have to keep you company. It's OK. They are good people. They fill the exam rooms and stand by your shoulder when you look at labs or X-rays. Sometimes they are so loud it is hard to believe that the patients can't hear them, but their voices and their stories are a gift you can give to your patients.

I admit that being haunted does take getting used to, but I would never dream of forgetting any of them.

John Cullen, M.D., is a member of the AAFP Board of Directors.

Friday Oct 23, 2015

'Stop the Bleed' Aims to Turn Bystanders into 'By-doers'

Imagine yourself standing on a corner when suddenly, a car strikes someone in the crosswalk. The pedestrian is severely injured, with a leg fracture and a profusely bleeding artery.

How would you -- or the average citizen -- react? It's an important question. In the event of a major arterial bleed, an injured person has about four minutes before survival becomes impossible.

© Aaron Tang

Bystanders assist victims in the aftermath of the 2013 Boston Marathon bombing. The Obama administration recently launched an initiative that aims to educate the public on how people can help save lives in an emergency situation.

This type of scenario is the focus of an initiative recently launched by the Obama administration and the Department of Homeland Security that is designed to reduce loss of life due to bleeding.

The 2013 Boston Marathon bombing, which killed three people and injured 264 others, was one of the incidents that prompted this effort. In the aftermath of that terrorist attack, every victim who reached a Boston-area trauma center alive survived. Injured people survived many potentially fatal injuries because of the prompt responses of bystanders who applied pressure and tourniquets to bleeding extremities until emergency personnel arrived.

I recently attended the White House launch of the Stop the Bleed initiative, which aims to educate Americans about how they can offer assistance in an emergency. Family physician Kevin O'Connor, D.O., physician to the vice president, said during the event that we must move more people from being "bystanders to 'by-doers.'"

Speakers also addressed the psychology of intervening in an emergency situation. The concept of diffused responsibility in a group means that the more bystanders there are at an event, the less likely any one of them is to intervene. A lone individual is more apt to take action.

The mindset in our culture has been for the general public to wait for emergency personnel, but with life-threatening bleeding -- even with a quick response time by paramedics -- survival is not likely without immediate action.

In military medicine, physicians have long referenced the importance of receiving care during the "golden hour" after an injury to improve survival. Quick action improves a wounded soldier's chances. In fact, the survival rate for soldiers who make it to a field hospital alive is more than 90 percent.

The U.S. military examined causes of death among the wounded who did not make it to field hospitals alive and found many died from extremity arterial bleeding and blood loss. This led to a change, and now every U.S. field soldier is equipped with a tourniquet and trained to use it. The prevalence of "field casualties" -- injured soldiers who die before reaching a hospital -- dropped dramatically.

Fast forward, and the administration now is implementing several efforts to educate the public about applying pressure or a tourniquet to life-threatening bleeding:

  • There will be an ad campaign with a logo that features a hand and a "Stop the Bleeding" message to remind people that odds of survival increase if direct pressure is applied over bleeding.
  • Bleeding control kits will be placed by defibrillators in public locations. 
  • The Red Cross is developing a "just in time" learning tool.
  • The Federal Emergency Management Agency has developed a short video that tells the story of how a neighbor's quick action saved a woman after a motorcycle accident.

We can share related resources with patients and our communities by posting them on our websites or social media. The bottom line? Don't be a bystander, be a by-doer.

Robert Wergin, M.D., is Board chair of the AAFP.

Monday Oct 19, 2015

Prescription for Pain? Important Questions Patients Should Ask

Earlier this year, I shared with you a story about being willing to take carefully considered risks, boldly sticking your neck out to make your message heard. Specifically, I made an appearance on The Dr. Oz Show in May because it was an opportunity to reach roughly 2 million TV viewers (and even more online) with a message about the importance of primary care and why everyone needs a family physician.

Fast forward a few months, and I was asked to make another appearance on the show, this time for a segment about proper use of pain medications. According to the CDC, nearly 2 million Americans abuse prescription painkillers and roughly 7,000 patients are treated every day in emergency departments for that misuse. Opioid prescribing, pain management and opioid abuse are issues the AAFP has been working on diligently for years -- including efforts related to advocacy, public health and education -- so I was eager to participate.

Here I am with Ada Cooper, D.D.S., spokesperson for the American Dental Association, and Mehmet Oz, M.D. We discussed appropriate use of opioids during a recent taping of The Dr. Oz Show.

The episode aired Oct. 19, but more on that in a minute.

It's been a rough year-and-a-half for host Mehmet Oz, M.D. He was called before Congress last year because of his promotion of weight loss medications, and a group of his peers called for his dismissal from his post at Columbia University.

His critics certainly got his attention. Oz conducted a listening tour with various medical groups this year and has vowed to make his show more evidence-based. He has sought input from many physicians and physician groups along the way, including the AAFP. I recently met with Oz, his staff, AAFP staff and members of the New York State AFP to talk about how family medicine can help make his show more evidence-based while also reflecting the importance of prevention and primary care.

The first step in this potential collaboration was the episode addressing the epidemic of opioid abuse. Use of opioid pain relievers in the United States quadrupled between 1999 and 2010. Among the 22,810 deaths related to pharmaceutical overdoses in 2011, nearly three-fourths involved opioids. In 2012, U.S. health care professionals wrote enough prescriptions -- 259 million -- for every American adult to have a bottle of pills.

So with access to an audience of millions of American patients, Oz and I discussed important questions patients should ask their doctors before starting a prescription pain medication. Here's a look at some of the questions and the information I provided.

What is the goal of taking this prescription?
This is an important question because patients need to make informed decisions. Too often, people take medication without understanding its risks and benefits and without asking if other options are available. Patients need to understand why they are taking a pain reliever, what kind of pain reliever they are taking and how much relief they should expect.

How long should I take these drugs?
Opioids are best used for the shortest time possible and at the lowest dose possible. I told the audience that they should know from the start how long they are supposed to take a medication. And if they think they have been on a medication too long, they should talk to their physician.

Are there any risks to me from these pills?
When I perform a risk assessment, I look for the following factors:

  • any history of addiction to or misuse of opioids;
  • any history of addiction to or misuse of alcohol or drugs other than opioids;
  • depression or other behavioral health disorders; and
  • is the patient taking any medications that might provoke an adverse reaction in combination with the opioid?

What do I do with extra pills?
We discussed the importance of safe disposal, including take-back programs, and the need to store pills in a secure location.

The questions can be downloaded as a resource for patients receiving a prescription for pain killers.

The AAFP will continue to work on this important issue. On Oct. 21, I will be in Charleston, W.Va., when President Obama speaks with law enforcement, educators, lawmakers and health professionals during a forum on opioid addiction. Watch for more details about that event in AAFP News.

Wanda Filer, M.D., M.B.A., is president of the AAFP.

Friday Oct 09, 2015

Leadership Gives Female Physicians More Control of Career Path

I've worn a lot of hats in my nearly three decades as a family physician. I've been an associate residency program director, founded a health care consulting firm, worked in a federally qualified health center, advised my state's governor as physician general and served as a health correspondent for the region's NBC affiliate -- all while functioning as a family physician and putting our broad training to work.

I never made my gender an issue in any of those jobs, but in my newest role -- president of the AAFP -- I may have underestimated how important it is to some. During our recent Congress of Delegates  -- and in my year as president-elect -- a significant number of our female members told me they were inspired to see a woman in my position. These are women who want to make a difference, feel they can be leaders and are seeking opportunities for growth. Fortunately, leadership isn't closed to them at the AAFP. There are five women on our Board of Directors. Three of the Academy's seven commissions were chaired by women this past year. Women also play important leadership roles in our state chapters and at the National Conference of Constituency Leaders.

I received the President's Medal during my installation at the recent Congress of Delegates in Denver.

I am only the third female president in the long history of the AAFP, but women in leadership is a trend that is growing in family medicine. Forty-two percent of our active members are women, and the numbers are even higher among our younger members, with women accounting for 55 percent of our residents and 56 percent of new physician members.

Forty years ago, there were a little more than 35,000 female physicians in the entire country. Today, the number has swelled to more than 321,000, and women represent nearly one-third of the U.S. physician workforce.

Medscape recently surveyed more than 3,200 female physicians, and what they had to say about leadership, career satisfaction and work-life balance was interesting. (It's worth noting that 15 percent of respondents were family physicians.)

More than half the women said they hold at least one leadership position. Forty-two percent were leaders in their practice, 12 percent were leaders in academic departments, and 12 percent were leaders in a professional organization.

Although we've made progress, there are still notable gaps. For example, none of the respondents were deans or vice deans. And I'm clearly in the minority, because only 4 percent were presidents of professional organizations.

Survey participants were asked why they sought leadership roles, and the No. 1 answer leaders gave was to be a positive influence (70 percent), followed by a desire to make change (68 percent). Those are great answers, but the response that resonated with me was from the 53 percent of female leaders who said it was because they want to shape their own path.

When I get frustrated in my practice with my clunky electronic health records system, meaningful use or any of the other challenges we face, I think about the work we're doing as an Academy, and I know it won't always be this way. Although we may be frustrated by our circumstances, we can use that as motivation to be active agents of change. We can use our stories of adversity -- both our own and those of our patients -- to make good things happen through advocacy.

When we are in control, things are better at home and work. Is it a perfect process? Absolutely not, but doing something about our problems improves situations for ourselves and our patients.

The women surveyed (90 percent of those who identified as leaders and 86 percent of nonleaders) agreed that it is important for women to be involved in leadership. But they diverged on whether or not it was an important personal goal, with 76 percent of leaders saying it was important to them compared with 42 percent of nonleaders.

The most common reason cited for not getting involved was time constraints. Interestingly, when the women were asked if they were happy with their careers and personal lives, leaders were more likely to be professionally satisfied and had similar responses to those of nonleaders about personal life satisfaction despite the added demands on their time.

Of course, timing is everything. I'm the first mom to serve as Academy president, but my daughters are both in their 20s. It's important to consider not only what you can do but when you can do it.

Women who were not in leadership were asked why they chose not to get involved. Some of the reasons they gave are things we should change, including lack of female mentors and lack of support. As women become a larger percentage of the physician workforce, these barriers become totally surmountable. We must help guide our aspiring young leaders (male and female), and we all need to build our own network of support both within and outside of medicine.

Wanda Filer, M.D., M.B.A., is president of the AAFP.

Wednesday Sep 30, 2015

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.

Tuesday Sep 22, 2015

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.

Wednesday Sep 16, 2015

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.

Friday Sep 04, 2015

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 Allison
Kelvin 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.

Wednesday Sep 02, 2015

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.

Wednesday Aug 26, 2015

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 University
An 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.

Monday Aug 17, 2015

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/AAFP
Residency 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.

Sign Up

Subscribe to receive e-mail notifications when the blog is updated.

Email address:


Our other AAFP News blog

Fresh Perspectives - New Docs in Practice


The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.