Media Offers Platform to Educate Public About Health, Family Medicine
Cold and flu season is here, and newspaper and TV health reporters from markets around the country likely will be calling their local primary care physicians looking for an interview for what has become an annual story. If the call came to your office, would you respond in a timely fashion? You never know where a simple conversation might lead.
to the media offers us an invaluable platform to share important public health
messages, providing a multiplier effect on our ability to care for our
communities. It also provides us with an opportunity to show the vast range of
Many years ago, I was at grand rounds when it was announced that WGAL, our local NBC affiliate in Lancaster, Pa., was looking for a family physician who could participate in health segments for a new talk show. I was intrigued, and out of a few hundred physicians who applied, they picked me.
It wasn't a paying job, at first, but I saw it as a public service. It wasn't about growing my patient panel. Instead, I saw this as an opportunity to educate the public and decision makers about family medicine and give viewers a better understanding about what we do. I covered topics that involved pediatrics, obstetrics, geriatrics and more and often was asked to comment on breaking news that involved health care. The broad range of topics discussed highlighted the scope of practice that family medicine provides, showcasing our specialty to a 20-county audience.
After four years of occasional appearances, my segments became weekly features. Eventually, the station asked me to contribute daily segments for the evening news.
The high profile position with WGAL -- combined with my involvement in the Pennsylvania AFP and advocacy work related to domestic violence -- led to me becoming the Physician General of Pennsylvania, working as a public health adviser to the governor.
My role with the television station lasted nearly 20 years. Obviously, not every physician who gives an interview will have a career-altering experience. But when your patients read your name in the newspaper or see you on TV, they will feel good, knowing that you are engaged in your community. And by delivering public health messages to a broad audience, you're doing a service for that community and family medicine.
Should the media contact you directly for comment on AAFP policy or positions, or if they want to discuss national health care issues or AAFP clinical guidelines, please refer them to a member of the AAFP's public relations team. Jay Senter works with clinical, health of the public and research topics; Leslie Champlin works with health care legislation and policy, workforce and medical education topics. If the reporters want comment on local health issues, please work with them to provide that and let the PR team know if you need any assistance.
Wanda Filer, M.D., M.B.A., is a member of the AAFP Board of Directors.
Challenges, Opportunities Await in 2014
Happy New Year! This really should be a good new year.
Of course, there are always challenges. However, things are moving in some outstanding directions for family medicine. It is exciting that people around the country -- the media, policymakers and others -- are continuing to talk about primary care. What is even more exciting is that it seems the understanding of what primary care is and who provides it continues to become more focused. Moreover, seeing family physicians as the foundation of primary care in our health care system is a discussion that is really ramping up now, and it's long overdue.
It may seem hard to believe, but the sustainable growth rate (SGR) formula may finally be repealed this year! As the calendar year changes, support for the current bicameral and bipartisan effort to repeal the fatally flawed SGR remains strong.
This effort is critically important in and of itself. However, it also has been a huge roadblock for discussions about many other issues that are essential to continuing to transform our health care system. Other needed reforms related to things such as payment, graduate medical education and workforce have in many ways been delayed or derailed because so much time and energy has been needed to deal with the SGR.
I am encouraged, and excited, by the possibility of being able to carry our other important messages forward knowing that we can have some meaningful conversations about them on Capitol Hill.
We continue to see increasing interest from medical students
in family medicine. We are seeing an increase in applications from
Now, we need to have the important discussions about continuing to find ways of changing medical school education to emphasize family medicine and better address the social mission that should be a determining factor in a graduate's specialty choice.
We also need to address the problem posed by the combination
of increasing number of
And, I am pleased that payment reform is moving forward. It is certainly not happening quickly enough, and the issues of the salary gap, overvaluation of some procedures, and the inherent difficulties of the fee-for-service system still exist. However, CMS has signaled its recognition of the valuable services we provide in coordinating our patients’ care by creating new care management codes that allow us to get paid for things that we have always done and will always do.
Moreover, we have data from researchers at the University of Texas Health Science Center at
Our unique and comprehensive education and experience is becoming better recognized and appreciated. A recent patient survey has made it clear that patients value and appreciate us. They want to see their family physician for their health care needs, and they want that family physician to be the leader of their health care team. This validates what we have been saying for more than 10 years. The patient-centered medical home (PCMH) succeeds in meeting the quadruple aim: improving patient outcomes, improving patient satisfaction, improving physician satisfaction, and doing so at lower costs. A core contributor to the success of the PCMH is the role of physician-led teams.
In short, the messages that we have been giving for years finally are being heard and understood. There always will be challenges, but those also can be opportunities.
Thank you for all you do, including your dedication to our patients, our communities, our profession and our country. Your efforts have helped get family medicine to where it is and where it will be. It is an honor to serve with you. I look forward to an exciting new year as we continue to move health care transformation forward in our country.
As the way we deliver care to our patients evolves, I’m eager to further define who we are and where we are going as a specialty. Please follow me on Twitter to see where I think family medicine is going, and use the hashtag #WhereFMisGoing to join the conversation with our colleagues.
Reid Blackwelder, M.D., is President of the AAFP.
Sports Medicine One More Way FPs Support Communities
A regulation hockey puck is six ounces of frozen, vulcanized rubber. Struck by the right athlete, a puck can speed across the ice at more than 100 mph. So when 200-pound athletes are slamming each other into the boards, swinging sticks (and occasionally punches) while skating on solid ice in pursuit of said puck, it's not a bad idea to have a physician around.
where I come in.
I recently was attending an Iowa Wild game in my role as team physician for the local minor league team when one of the players was struck by a puck in the lower leg. It hit him hard enough that the crowd let out a collective groan.
I kept an eye on him to make sure he wasn't favoring the leg, but he kept on skating and stayed in the game. When the game was over, a trainer called me over to take a look at the injured leg. The puck had shattered his shin guard, ripped a nickel-sized hole in the tissue and exposed his tibia.
Hockey players, as it turns out, are pretty tough.
I irrigated the wound, removed pieces of the shattered shin guard from the wound and closed it with a vertical mattress.
What I didn't give him was a bill. Sports medicine of this kind -- treating injured players during or after a game -- typically is done on a volunteer basis. Teams show their gratitude with gear, tickets and other perks.
So why do it? Sports medicine is one more way that family physicians can support our communities, whether through a local high-school team, a pro franchise or something in between.
I was a track athlete in high school, and I stay active with cycling, running and skiing. As a medical resident, I knew my days of being an athlete were behind me, but I still wanted to be involved in sports. So I took extra training in sports medicine, and when I started my practice I volunteered as a team physician for the local high school.
A few years later, our town landed an arena football team, and it needed a primary care physician to work with orthopedists. It also needed someone to manage care of its players, coaches and their families. I not only see them at the games, but they come to my office for preventive medicine as well as when they are ill.
It's been fun to get to know the team and their families on a personal level and build those relationships. These are people who are extremely talented at what they do, and it's gratifying when they look to me for expertise at what I do.
Sports medicine can build your practice without an official connection to a team. Athletes -- pro and amateur -- talk amongst themselves about their injuries and how and where those injuries are being treated. And when an injured weekend warrior comes to me for rehab, often his or her whole family follows.
Over time, people in the community have come to associate me with sports medicine. When my sons were playing high-school sports, other parents often told me that having me on the sidelines was reassuring. That's a good feeling, much better than, say, a puck to the leg.
Robert Lee, M.D., is a member of the AAFP Board of Directors.
Future of Family Medicine 2.0: What's Your Opinion?
It's time for another update on Family Medicine for America's Health: Future of Family Medicine 2.0. In addition to providing you with details of the latest actions related to this important project, the update below offers family physicians an opportunity to provide input on four specific questions related to payment models, family physician training, research and the triple aim (improving patient care and outcomes and lowering costs).
You can address the questions below -- and offer other thoughts on the project -- at FutureFM@aafp.org
Family Medicine for America’s Health: Future of Family Medicine 2.0
Organizational Update No. 4
Dec. 17, 2013
This is the fourth update of the Family Medicine for America’s Health: Future of Family Medicine 2.0 initiative. The goal of this effort, which was launched in late August, is to develop a multiyear strategic plan and communications program to address the role of family medicine in the changing health care landscape.
a reminder, the Family Medicine Working Party identified a set of key principles that will
underpin this effort:
- Deliver on the triple aim: improving the health of the population; enhancing the patient experience of care (including quality, access, and reliability); and reducing, or at least controlling, the per-capita cost of care.
- Focus on the needs of residents and medical students, as well as practicing family physicians.
- Manage the tension between addressing the needs of family medicine as a specialty and needed changes to the health care system of which it is a part.
CFAR, the strategic consulting firm hired for this project, is now working on its "current state" analysis. This document is designed to create a shared understanding about where the profession is today. This shared understanding serves as a foundation on which to build an implementable strategic plan that identifies risks to take, investments required to do so, and a realistic understanding of how to bridge the gap between the current state and the desired future we want to create. Following are the key issues that are being examined as part of this process:
- Core attributes: What are the core attributes of family medicine today, and what do they need to be in the future, for our profession to achieve the triple aim in the service of our patients and the larger health care landscape?
- Evolving ecosystem: How should family medicine change in response to the challenges of an evolving health care system to best meet the needs of the nation?
- Education: What changes are needed in the continuum of education (from medical school through residency and into CME) to train the family physicians needed in the new health care system?
value: How do we best communicate to relevant stakeholders the value and
benefits of family medicine and the important role family physicians play in
meeting the health care needs of the U.S. population?
CFAR has sought broad input from family physicians -- and those who work alongside
them -- in the development of the current state analysis. This has included
- conducting in-depth interviews with thought leaders and stakeholders in the field of family medicine; and
- conducting a strategic options survey designed to test the assumptions the community holds about the present, as well as perspectives on strategic choices in the future. The survey was sent to more than 6,000 front-line family physicians, as well as a variety of other primary care health professionals, such as OB/Gyns, general internists, nurse practitioners and physician assistants and physicians early in their careers.
We encourage feedback and would welcome input from family physicians through our dedicated email address FutureFM@aafp.org on the following questions:
- Can you share any examples of family physicians -- yourself included -- who are working in payment environments other than fee-for-service? How has that experience affected their practice (or your own)?
- What are some concrete steps family medicine can take to increase the number of family physicians trained to meet the needs of the American public in the future?
- How can the leadership of family medicine help family physicians meet the demands of the triple aim (improved patient care, improved health of populations, lower cost)?
- What kinds of research would help improve your practice?
APCO Worldwide, the communications consulting firm, is conducting research to develop the communications platform to reflect the strategic plan. APCO has conducted in-depth interviews to elicit attitudes and opinions about family medicine from external audiences including policymakers, major insurers, employees and purchasers and other primary care health professionals. These interviews focused on perceptions of family physicians, the role of family physicians in the new health care era and the future of family medicine. Following is a brief summary of the findings:
- There is marked appreciation for the skills and patient rapport that family physicians bring to health care.
- Family physicians are viewed as having a solid diagnostic ability based on their scope of medical and clinical knowledge.
- Treating the entire family gives family physicians an advantage compared with other primary care physicians in being able to consider social and behavioral dynamics in their diagnosis and treatment.
- Expertise in prevention and education helps position family physicians for the new health care landscape.
- Family physicians are seen as the natural choice to lead the patient-centered medical home and accountable care organizations, coordinating care and stressing wellness.
- There is a strong belief that new comprehensive care models provide family physicians the greatest opportunity to succeed in the new system.
- Retail clinics are seen as the greatest threat to the family physician.
- Most cannot imagine a health care system without family physicians.
APCO currently is conducting the quantitative research element of the communications planning process. The results of its broad public opinion survey will be presented in January.
We strongly encourage you to share your input. Again, you can provide feedback at FutureFM@aafp.org. We welcome comments on the items outlined above or other suggestions/insights that would be useful to this process.
The fifth meeting of the Core Team will be Jan. 9. The next combined meeting of the Working Party, Steering Committee and Core Team will be Jan. 16-18.
Jeff Cain, M.D., is Board Chair of the AAFP.
The Path to PCMH: You May be Closer Than You Think
Editor's note: During the AAFP's Scientific Assembly in San Diego, a panel discussion on practice transformation generated far more questions than the panelists could answer in the time allotted. This is the first post in an occasional series that will attempt to address the issues members raised -- such as how to get started with practice transformation and what resources are available -- during the panel.
My medical group recently received notification that all 11 of our sites had obtained National Committee for Quality Assurance (NCQA) Level 3 patient-centered medical home (PCMH) recognition. This represented the culmination of a two-year transformational process.
The results? Access to office visits for patients have improved, referrals to subspecialists are actively tracked and followed, and transitions of care between inpatient and ambulatory sites are becoming more seamless as we share essential clinical information. Proactively managing our entire population for chronic diseases through the use of a registry is moving the delivery of care away from simply episodic, office-based visits. Indeed, we have begun the journey to transforming our delivery of primary care.
As I reflect on the lessons learned from achieving certification, several things immediately come to mind. I, like many primary care physicians, was certain that I already was operating a PCMH. Only during the process did it become apparent that my practice was not truly patient centered. For example, before our transformation, there was no meaningful coordination of care, and tracking of tests and results was not robustly followed.
Another learned lesson involved obtaining NCQA recognition. Although the application process was personally enlightening in regards to care delivery, it was labor intensive and costly. The hours spent on this project -- not just by me, but by administrators, practice managers, office assistants, medical assistants and nurses -- were staggering. A question lingered throughout the entire process: Could I have possibly afforded the financial and time commitments to bring a solo or small-group practice to NCQA certification?
This is a question that echoes with many family physicians. Many small-group and solo physicians are operating their practices on the thinnest of margins. Concerns have been raised, such as how to survive an increase in overhead while achieving certification. Other concerns center on NCQA certification itself, because it is viewed as simply checking off the appropriate boxes and as not truly reflective of the real value of the "triple aim" of health system reform.
These are valid concerns our colleagues are voicing. Only one-fourth of AAFP members are practicing in a certified PCMH. The fee-for-service environment still is prevalent in all markets; however, new payment models that recognize those practicing in a PCMH are being introduced across the country.
A recent bipartisan, bicameral proposal to repeal the sustainable growth rate formula would replace it with alternative payment models aligned more closely with quality of care. Although this proposal is not yet a bill, it makes clear that future improvements in payment for primary care will involve a structured care delivery model such as the PCMH. Transformation may be critical to the viability of our practices.
Moving forward, the AAFP will continue to provide resources for members to help with the transformation process. For example, the PCMH Planner -- a step-by-step guide designed to help small practices transform -- will be available early next year. With new payment models emerging, now would be a good time for primary care physicians to educate themselves about PCMH requirements. You might be closer than you think. Not all aspects of the PCMH require up-front money, and you probably already are doing many of them.
Practice transformation can be overwhelming, and physicians often wonder where to start. Begin by analyzing your practice. Then select one aspect of the transformation to implement in your practice and begin the process.
Evaluating your practice is a good first step, but evaluating your market also is important. Some payers are paying per-member, per-month fees (some better than others) and offering other incentives for patient-centered care. Do you know what's happening in your area? Have you asked payers what incentives they are offering for patient-centered care?
Some physicians struggle with how to meet the requirements of PCMH while still based in a fee-for-service world. Open-access scheduling is one aspect of the PCMH that can help boost revenue by keeping your schedule full and avoiding costly no-shows.
In addition, establishing components of team-based care in our practice made us more efficient and allowed us to increase visits. My personal visits have increased 10 percent compared to when we started the transformation process two years ago, and patient satisfaction quality scores remain high. I no longer do work that can be done safely and efficiently by other members of my team.
Finally, remember that you aren't alone. TransforMED's Delta Exchange is a free resource for AAFP members. Join and learn from other family physicians in their journey to PCMH.
Every journey begins with taking that important first step. Are you ready?
Michael Munger, M.D., is a member of the AAFP Board of Directors.
Student Audience at Vanderbilt Gives Hope for Primary Care
As I have often said, one of the great joys of being an AAFP Board member is the opportunity to attend chapter meetings and talk to members from across the country. Every now and then, however, I receive an even more special invitation.
I recently was asked by the family medicine interest group (FMIG) at Vanderbilt to come speak during the medical school's Primary Care Week. It is nearly impossible for me to turn down a request from students, especially those from one of the 11 target schools that lack a department of family medicine.
Although Vanderbilt does not have a family medicine program, there are a number of family physicians in the region who have worked hard to give its students role models and mentors in our amazing specialty. I was honored to add my name to that list. Some students from Meharry Medical College -- another Nashville, Tenn., school -- also were present, but the majority of students were from Vanderbilt.
This was an outstanding experience. We had almost 100 students (including student leaders Eszter Szentirmai, Josh Hollabaugh, Allison Umfress and Ashlee Hurff, who are pictured here) who were interested in primary care and the role that it will play in the future of health care. I took the opportunity to tell my own story, which began at a time when my own alma mater -- Emory University -- lacked a family medicine department. My path was similar to theirs.
I was able to talk about the excitement of finding family medicine while at Emory and nurturing that experience to become a small town family physician. One of the messages that I gave students was to make sure they keep doors open and consider all possible career choices.
We talked about some of the challenges that stop students from picking primary care. For example, at some schools, students interested in primary care sometimes are told they are too smart for family medicine. That is an interesting comment. If anything, someone choosing family medicine is recognizing his or her ability to see everything broadly and doesn’t feel the need to be limited to a particular organ system, body part or group of diseases.
There is no question that these students made a choice and followed a calling into medicine because they want to help people. No specialty can help people as broadly and as immediately as family medicine.
They also were interested in advocacy. We talked about some components of the Patient Protection and Affordable Care Act and how it has provisions that provide incentives for primary care.
We talked about the need to come up with different payment models to support this transformation. We discussed the real need for hospitals to change their structure to be part of new models of care such as accountable care organizations, instead of focusing on keeping their beds full to maximize profits.
We talked about the role of physician-led teams in taking care of all patients and meeting the depth of their needs in this changing time, especially as patients with multiple chronic diseases become more complicated to manage. More patients than ever are presenting with comorbidities. As family physicians, we are at the front lines of managing this care, and we have the ability to make the greatest impact in patients' lives by managing their health at the earliest stage possible.
This also was a great opportunity to talk with students, many of whom are graduating in 2016 and 2017, about the disparity between the number of U.S. medical students who will be graduating and the number of residency positions that will be available. There was no question that reality is starting to sink in, and these students were interested in how they could advocate for change.
I told them that as medical students, it is critically important for legislators to hear their voices, and I assured them that representatives with medical schools in their districts will want to hear from them. I challenged them to reach out to their legislators, whether by email or a personal visit to their offices.
I am confident that Tennessee's representatives in Congress will be hearing from some of these students.
Having students from both Meharry and Vanderbilt created an interesting point of comparison. Here I was talking about primary care in a target school that ranked at the bottom of medical schools in an Annals of Internal Medicine article that evaluated schools in terms of addressing the social mission of meeting a community's needs. On the other hand, Meharry ranked second in that report, which considered the percentage of graduates who practice primary care, work in health professional shortage areas and are underrepresented minorities.
Based on the AAFP's annual study of family medicine residency matriculation rates, Meharry ranked 23rd in 2013 with 13.8 percent of students matriculating to family medicine residencies, and Vanderbilt ranked 126th (last) with 0.3 percent of students matriculating to family medicine residencies. These figures are based on a three-year rolling average calculated annually by the Academy.
The fact that we had students from both ends of the spectrum expressing an interest in primary care gives me hope that we can continue to open doors and make inroads. Family medicine is all about relationships with patients, but it also should also be about relationships between students in different schools sharing a culture and philosophy, and between students and those of us who are in regular practice. The more we can create and nurture these relationships, the more likely our students will recognize the path to family medicine is truly the one that allows them to follow their heart and fulfill their dream of helping people and changing the world.
Family physicians interested in reaching out to their local FMIGs to see how they can support those groups may contact AAFP student interest strategist Ashley Bentley.
Reid Blackwelder, M.D., is President of the AAFP.
Students, Young Physicians Provide Insights for Future of Family Medicine 2.0
Have you offered your opinion on the Future of Family
Your opinion matters, and now is the time.
In our first update on Family Medicine for America's Health: Future of Family Medicine 2.0, you had
a chance to learn about our initiative that aims to define the role of the 21st
century family physician, including scope of practice and our role within the
health care system.
In our December update below, we address some of the important questions being considered by the work group and introduce you to the young physicians, residents and medical students who have been selected to help answer those questions.
You can share your thoughts directly with us at FutureFM@AAFP.org. And you can be sure we will continue to share updates on our progress.
Family Medicine for America's Health
(Future of Family Medicine 2.0)
The Family Medicine for America's Health (Future of Family Medicine 2.0) initiative is moving forward according to schedule. The purpose of this effort is to develop a multiyear strategic plan and communications program to address the role of family medicine in the changing health care landscape.
The Core Team held two meetings in November. The meetings focused on CFAR's "current state" analysis and APCO's opinion research. The current state analysis is designed to create a foundation on which to build an implementable strategic plan that identifies risks to take, investments required to do so, and a realistic understanding of what it will take to bridge the gap between the current state and the desired future we want to create. During the meetings, there has been significant discussion about scope of practice, compensation and the impact of technology on the specialty.
address some of the key questions and ensure broad input in the process, the
CFAR team is focused on organizing two “Insight Groups” designed to engage and elicit feedback on the future of
family medicine. The first group includes
medical students and residents. The
second group includes young leaders who are in their early years of practice. Each of the seven family medicine
organizations nominated two participants to each of the groups. Please see below for names of the 28 individuals
who were nominated.
Discussions with these
Insight Groups are being facilitated by Dr. Bob Graham, Dr. Larry Green, and
Dr. Jim Martin. Members will contribute their perspective throughout the FFM
2.0 process. This will include
- participating in discussions about the future of family medicine with their facilitators;
- reviewing and reacting to the work produced by the Core Team and the Steering Committee; and
- meeting in person with the Core Team, Steering Committee, and a variety of stakeholders within and outside of family medicine at a strategic planning retreat in February.
APCO, which is leading the communications strategy element of the project, has completed a series of in-depth interviews with policy experts, payers, employers and specialists outside of family medicine. APCO's interviews will inform the quantitative element of their research, which includes a survey of a wide group of family medicine stakeholders. The results of that survey are expected in January.
We strongly encourage input from family physicians. Since our first report on this initiative, we have received more than 100 comments to FutureFM@aafp.org.
Following are several of the key questions the Core Team is considering as CFAR develops the current state analysis. We welcome input on these questions or general comments via FutureFM@AAFP.org.
- Is the patient-centered medical home (PCMH) the model of the future?
- How will the PCMH model need to evolve to meet the demands of the Triple Aim?
- Is population health a key part of family medicine? How should family medicine integrate with public health?
- How will disruptive technology alter the practice of family medicine?
- What changes are needed in the current payment structure to support the future of family medicine?
- What data is available/needed to support changes in payment structure?
- How does a narrowing scope in maternity and children's care impact the practice of family medicine?
The Core Team and Steering Committee will meet on Dec. 8. We will continue to provide monthly updates throughout this process.
Insight Group Members
Young Leaders (with nominating organizations)
- Michael Coffey, M.D., Somerville, Mass. (AAFP)
- Christina Kelly, M.D., Harker Heights, Texas (AAFP)
- Brooke Sciuto, M.D., Sacramento, Calif. (AAFP Foundation)
- Gretchen Dickson, M.D., M.B.A., Wichita, Kan. (AAFP Foundation)
- Kurt Lindberg, M.D., Holland, Mich. (ABFM)
- Amy McIntyre, M.D., M.P.H., Butte, Mont. (ABFM)
- Melissa Nothnagle, M.D., M.Sc., Pawtucket, R.I. (ADFM)
- Jill Endres, M.D., Iowa City, Iowa (ADFM)
- Carl Covey, M.D., Las Vegas (AFMRD)
- Carla Ainsworth, M.D., M.P.H., Seattle (AFMRD)
- Lauren Hughes, M.D., M.P.H., Ann Arbor, Mich. (NAPCRG)
- Rebecca Etz, Ph.D., Richmond, Va. (NAPCRG)
- Alisahah Cole, M.D., Charlotte, N.C. (STFM)
- Brett White, M.D., San Diego (STFM)
Students and Residents (with nominating organizations)
- Tate Hinkle, Brownsboro, Ala. (AAFP)
- Kimberly Becher, M.D. (AAFP)
- Nathaniel Lepp, M.P.H. (AAFP Foundation)
- Jessica Johnson, M.D., Portland, Ore. (AAFP Foundation)
- Charles Salmen, Brisbane, Calif. (ABFM)
- Kathleen Barnes, M.D., M.P.H. (ABFM)
- Jason Valadao, Wauwatosa, Wis. (ADFM)
- Jillian Fickenscher, M.D., Omaha, Neb. (ADFM)
- Natasha Bhuyan, M.D., Phoenix (AFMRD)
- Kari Sears, M.D., South Bend, Ind. (AFMRD)
- Vanessa Stagliano, Sagamore Hills, Ohio (NAPCRG)
- Richard Bruno, M.D., Baltimore (NAPCRG)
- Rebecca Mullen, Overland Park, Kan. (STFM)
- Nicholas Cohen, M.D., Cleveland (STFM)
Jeff Cain, M.D., is Board Chair of the AAFP.
FPs Doing Good Work in House of Medicine
recently represented our members at the AMA Interim Meeting in National Harbor,
Md. The AMA obviously is a very different organization than ours, but it
provides family physicians with another opportunity to lead and advocate at the
state and national levels. I was truly impressed by the tremendous
contributions being made by family physicians across the country.
Many of our members may not realize how involved some of their family physician colleagues are in the AMA, but we do everything we can -- anywhere we can -- to take our messages forward. I want to share my praise for a number of hard working FPs who represent our specialty and their patients through their work in the AMA.
The AAFP's delegation to the AMA is an outstanding group of dedicated individuals. Many of them have spent a decade or more involved in the AMA, and several are in positions of leadership. Our delegation is chaired by Joseph Zebley, M.D., of Baltimore and his co-chair Daniel Heinemann, M.D., of Sioux Falls, S.D.
Other members of the AAFP delegation are
- Neil Brooks, M.D., of Vernon Rockville, Conn.;
- Aaron George, D.O., of Durham, N.C..;
- Ajoy Kumar, M.D., of Saint Petersburg, Fla.
- Glenn Loomis, M.D., of Crestview Hills, Ky.;
- Frederick Ridge, M.D., of Linton, Ind.;
- Hugh Taylor, M.D., of South Hamilton, Mass.;
- Colette Willins, M.D., of Westlake, Ohio; and
Worthington, M.D., of Des Moines, Iowa.
Two of those delegation members -- Willins and Loomis -- serve on AMA councils.
David Swee, M.D., of Piscataway, N.J., is the alternate delegate. AAFP staff members Doug Henley, M.D.; Stan Kozakowski, M.D.; Perry Pugno, M.D., M.P.H.; and Julie Wood, M.D., also play important roles.
We also have critical representation from new physicians Janet West, M.D., of Pensacola, Fla., and Lindsay Bosford, M.D., M.B.A., of Sugarland, Texas; residents Charles Thompson, M.D., of Huntsville, Ala., and Messalina Jordan, D.O., of Brownsboro, Ala.; and students Jerry Abraham of San Antonio and Samuel Mathis of Galveston, Texas.
You might remember that Brooks is a former AAFP President. He is demonstrating a lifelong commitment to our specialty and is moving things forward in every avenue that he can find.
AAFP officers -- Board Chair Jeff Cain, M.D., (pictured with me above) President-elect Robert Wergin, M.D., and myself -- also serve as delegates. Each of us testifies during reference committees, as well as on the floor of the House of Delegates.
We also maintain connections with our state delegations and have many opportunities to talk about the priorities of family medicine in the context of the state chapters and their issues.
It's also worth noting that five members of the AMA Board of Trustees are family physicians, including the chair, David Barbe, M.D., of Mountain Grove, Mo.
Other family physicians on the AMA board are
- Gerald Harmon, M.D., of Pawleys Island, S.C.;
- William Kobler, M.D., of Rockford, Ill.;
- Albert Osbahr, M.D., of Hickory, N.C.; and
Permut, M.D., of Philadelphia.
All five of these men are AAFP members who understand the importance of family medicine. Each of them has the opportunity to be the AMA President-elect in the near future.
At each AMA event, we hold a dynamic meeting that is called a lunch but is actually more of a caucus. AAFP members from AMA leadership positions and state medical societies are invited to attend. We had more than 100 family physicians present at the most recent lunch as we reviewed AAFP priorities and policies, networked, created connections, talked about ways of engaging, and shared ideas and concerns. This is an important opportunity to communicate with members who may not come to our state chapter or national meetings.
It is exciting to be a part of this dedicated group of family physicians. As I have been saying, the answer to our country's health care needs is team-based care. The AMA meeting allowed us to reconnect with critical segments of our membership team to work to ensure policies that come out of the AMA are in line with the needs of our members. Ultimately, family physicians are on the front lines of organized medicine, working to improve outcomes for patients, increase their satisfaction with their care and decrease the cost of that care. Together we are stronger.
Reid Blackwelder, M.D., is President of the AAFP.
Giving Thanks for Work-Life Balance -- and the Dog
With the hectic schedules that we keep and the daily challenges we face, Thanksgiving presents a wonderful opportunity to pause and reflect on the things that are important.
One of the most important aspects of this holiday is that even if families are spread across the country, it is a time to gather, share a meal and give thanks. If face-to-face visits aren't possible, people often call or connect in other ways. And those connections are so important for recharging ourselves.
I find myself remembering that one of the main areas
of focus during our Scientific Assembly was finding balance in our lives. This
is an excellent theme to remember during Thanksgiving, so here is a story I'd
like to share.
My wife, Alex, and I have always had large dogs as part of our family. Sadly, we lost our last big black lab, Little Bear, in April. This left us with a 17-year old cat and the world’s largest Yorkie. Given the demands of an AAFP officer’s travel schedule, we decided that we wouldn't get a new puppy until my time on the Academy's Board of Directors ends in 2015.
Of course, you know what they say about best-laid plans. During a trip to the New Mexico AFP's chapter meeting, Alex and I fell in love with a malamute mix puppy and brought him home to Tennessee. He was able to fit in the pet carrier on Delta for just this one plane trip. He has since grown to 60 pounds at just 5 months of age.
New puppies bring additional responsibilities and even stress -- disrupted sleep schedule, need for frequent walks, lots of sudden play time, training, puppy class, socialization and so on. Not surprisingly, all of these things rather abruptly put into focus for me the critical need for balance.
Despite all of the above, which is certainly disruptive and even exhausting at times, our puppy, named Chashush (which is Apache for Big Bear) has actually helped create some balance for me. Alex and I have made important and healthy changes in our lives at a time we thought we might be too stressed to do so. We are outside getting exercise again with walks in our beautiful neighborhood, seeing the wildlife -- such as deer, raccoons and turkeys -- that are out early in the morning and late in the evening in our area. I am learning to recognize I can’t work 24/7, even though -- as Alex would tell you -- I still try.
Given his size, we committed to socializing Chashush early and regularly. Addressing this need has led to spending more time with friends because we often have puppy play dates that involve dinner and catching up with those friends. The dog also has been a wonderful focus for the grandkids, who are getting to know another member of our extended family and helping teach him how to interact with children.
We were not looking for a dog, and had, in fact, agreed not to get a new one during this hectic time in our lives. But it is remarkable what can happen when you hear a knock at the door and open it. I hope each of you will find time to open those doors that present opportunities to you, connect with friends and family (however you define them) who are important to you, and make them a part of your lives. This is definitely the time of year to do that on many levels.
Alex and I wish you and your family a happy, powerful and recharging Thanksgiving.
For news about the Academy and family medicine (and occasional updates about the dog) follow me on the AAFP President Facebook page.
Reid Blackwelder, M.D., is President of the AAFP.
AAFP Takes SGR Message to Capitol Hill
After spending a week at the AMA Interim Meeting in National Harbor, Md., AAFP leaders met with members of Congress and congressional staff Nov. 19-20 in Washington to discuss the repeal and replacement of the sustainable growth rate (SGR) formula and other issues of importance to family medicine. AAFP President Reid Blackwelder, M.D., offers an update on the Academy's advocacy efforts in the video below.
Reid Blackwelder, M.D., is President of the AAFP.
Patient Encounter Offers Reminder About Finding Work-Life Balance
As family physicians, we spend a significant portion of our days telling patients what they should or should not eat, how often and how rigorously they should exercise, and how much they should sleep, as well as offering tips related to bad habits they should stop.
But how often do we take our own advice?
recently saw a patient, a woman in her early 50s, who we'll call Janice. Janice
was struggling with short-term memory problems, forgetting things like paying
her bills on time. That costly error led to late fees and additional stress for
a woman with an executive-level job, two kids and ailing, older parents.
I completed a thorough evaluation to rule out any physical or mental issues. In the end, Janice simply had too much on her plate, and the stress was getting to her. I suggested that she clear time on her schedule for herself and manage her time better. Sometimes, I said, our own well-being has to move to the top of the priority list, or all the other things on that list will suffer.
After she left, I thought, "That was pretty good advice. I should take it."
Physicians, especially physicians with children, often struggle with being pulled in multiple directions. In addition to the demands of a time-intensive job, we have commitments to family, friends and others. How do we find balance?
We deliver important messages to our patients every day, but these encounters also can serve as needed wake-up calls for ourselves. Someone who has completed college, medical school, residency and a master's degree in public health shouldn't have to be told to exercise, rest and eat well, but there I was in need of a simple reminder to take better care of myself.
Less than a year ago, I joined a brand new practice dealing with the typical challenges that new practices face: implementing an electronic health record system, recruiting a health care team and attracting patients. Throw in a family that includes 3-year-old and 6-year-old boys (pictured above), and life can be pretty crazy sometimes.
So now when I need to do something for myself, even little things like finding time to exercise, I put it on my calendar so that important time is reserved for me. If you think, "I'll go for a jog after I take care of X, Y and Z," you can count on A, B and C waiting for you the minute you're finished with Z.
The holidays are fast approaching, and although this time of year can be stressful, it also is a good time to stop and take a look at what we're doing and how we're doing it. In the coming weeks, I'll be asking my patients, "How did things go for you this year? What negative things are you going to leave behind in 2013, and what positives will you take with you into 2014?"
Those are questions we should ask ourselves as well.
M.D., M.P.H., is the new physician member of the AAFP Board of
Center Provides Important Lesson on Where We Came From
"History is who we are and why we are the way we are." -- Author and historian David McCullough
A placard bearing that quote from McCullough, a two-time Pulitzer Prize winner, caught my eye during my first trip to the Center for the History of Family Medicine. I recently attended my first meeting of the Center's Board of Curators as a liaison from the AAFP Board of Directors. Although I have been actively engaged in our Academy for nearly 30 years, I am sorry to admit that I was not aware of the wonderful resources available through the Center.
I am proud of our specialty and our heritage, and the Center is home to thousands of books, articles and artifacts that track our history. This wonderful combination of library, archives and museum is available as a resource for members wishing to learn more about our roots.
Some of our more experienced members might find the Center's
resources interesting because those books, articles and artifacts document
something they experienced. For our younger members, the Center offers insight into
where we came from.
Our specialty is a relatively new one. Family medicine officially became a medical specialty in 1969 (not long after this photo from the Center's archives was taken at the 1968 Congress of Delegates). At the time, the number of physicians entering what had been regarded as general practice was dwindling rapidly. Specialization, on the other hand, was viewed as important and valuable.
Our leaders understood the role of specialists, but they also believed in the importance of primary care, building relationships with patients and tying it all together rather than having a system of highly fragmented care. Family medicine leaders were courageous and worked for what they believed in, despite opposition from many in the medical establishment who opposed the idea of family medicine as a specialty.
Today, the mentality to speak out for our patients, practices and family medicine continues to be important in the face of new -- and old -- challenges in health care. It's something in the DNA of our specialty and something we can't afford to lose.
I encourage you to become more acquainted with our history, and you can do this easily by exploring the Center's online resources. In particular, I suggest you look through the Classics of Family Medicine, a list of seminal articles from the medical literature that have helped shape our specialty. Likewise, I suggest you explore our online exhibits, where, among other exhibits, you will find the "Distinguished Dozen: Twelve Books That Shaped the Face of Family Medicine."
For those interested in spending time in the Center to perform research leading to a publishable article or book, there is an annual fellowship available from the AAFP Foundation.
Remembering where we came from can help us find our way in the future. As McCullough said, "History is a guide to navigation in perilous times."
Clif Knight, M.D., is a member of the AAFP Board of Directors.
The Good, the Bad and the Ugly … A Tale of Three Bills
Congratulations to our Louisiana, Ohio and Pennsylvania chapters for winning Leadership in State Government Advocacy Awards at the AAFP's State Legislative Conference, Nov. 1-2 in Broomfield, Colo. Our national and state legislative leaders spent that weekend discussing issues related to scope of practice, the Patient Protection and Affordable Care Act, opioid abuse and rural workforce. This annual event presented a great forum for knowledge sharing and cross pollination of legislative strategies across the states.
If you have spent any time at your state legislature, you know that actions are worth more than words, and that legislators -- despite good intentions -- may craft bills that are good, bad or just plain ugly when it comes to public health and the practice of medicine.
My state legislature is no exception. In California, we just ended the first of a two-year legislative session, which meant that all bills were chartered, killed or pushed onto a second year session for more work. This year, we saw three scope-of-practice expansion bills: one for pharmacists, one for nurse practitioners and one for optometrists.
Here is the low down on each of these bills.
The first in this triad of bills became law, allowing pharmacists to furnish self-administered hormonal contraceptives, nicotine replacement products, and prescription medications not requiring a diagnosis that are recommended for international travelers. In addition, they will be allowed to order and interpret tests for the purpose of monitoring and managing the efficacy and toxicity of drug therapies in coordination with the patient's primary care physician, including by faxing or entering results in patients' medical records. And finally, they are allowed to initiate and administer routine vaccinations recommended by the CDC's Advisory Committee on Immunization Practices.
Why, you ask, is this expansion good for family physicians? The house of medicine initially opposed the bill. However, after several thoughtful discussions with pharmacists, the bill was amended to bring pharmacists into a patient-centered medical home model, which allows them to become a part of the health care delivery team in their area of expertise. This will result in more coordination between a patient's primary care physician and pharmacist, and it will decrease the barriers our patients may face in obtaining certain treatments.
It is always good when each member of the health care team is participating to the maximum that their training allows.
In stark contrast to the pharmacists, the nurse practitioner scope bill exemplified how bills should not be worked through the legislature. After years of working with physician organizations -- including by supporting several prior bills that were passed to allow increased scope of practice for nurse practitioners within a collaborative agreement structure -- nurse practitioners tried to pull a fast one on the legislature this year. Nurse practitioners argued that they can fill in primary care shortage gaps where family physicians cannot or are not willing to do so.
However, physician organizations successfully argued to the legislature that independent nurse practitioners would not improve quality and may adversely affect patient safety. This argument was further augmented by data provided by the California AFP showing that independent nurse practitioners would not improve primary care misdistribution in our state.
To their credit, state legislators heeded our message, and the bill failed to pass out of committee. By focusing on obtaining independence, nurse practitioners sought to further fragment the health care delivery system and to further undermine the cornerstone of health care reform by putting their financial self-interest above coordinated, patient-centered care. The nurse practitioner bill simply highlighted deficiencies in our fragmented health delivery system without providing a workable solution to the primary care workforce shortage.
The last of the three scope bills would have allowed optometrists to diagnose and treat all conditions presenting with ocular manifestations. It would not only allow them to initiate treatment of chronic diseases -- such as diabetes and hypertension -- but also complex conditions such as systemic infections and autoimmune diseases.
Needless to say, the house of medicine was strongly opposed to this bill. Yet, the author, an optometrist himself, would not take on any amendments to his bill. He was able to move this bill out of the committee that he chaired. But facing a high likelihood of defeat on the floor, he pulled the bill for further work next year.
I had an opportunity last week to participate in a community chronic disease forum hosted by the author of this trio of scope bills. After some careful repartee sitting around a small table, I came to realize that he, like many, if not all, legislators, drafts bills with the best of intentions. In this vein, it would be in our best interest as family physicians to keep close tabs on all our legislators and develop relationships with them. Successful advocacy takes good will and influence to bring about change.
So, what can you do? You can join the thousands of family physicians who have signed up to become key contacts for advocacy. Key contacts receive regular updates from the Academy's government relations staff on issues important to family medicine, and they occasionally are asked to reach out to their legislators by phone or e-mail to tell their stories and let lawmakers know how issues are affecting family physicians and our patients.
For those who aren't able to get directly involved with advocating for family medicine, you can still make a difference by supporting FamMedPAC, the Academy's federal political action committee. FamMedPAC enhances AAFP advocacy efforts by making direct, nonpartisan contributions to candidates for the U.S. House of Representatives and the U.S. Senate. FamMedPAC provides AAFP members with an easy way to get involved in the political process and to support candidates who support family medicine.
With mid-term elections approaching, you'll be helping to improve the delivery of health care in this country, and helping put family physicians on equal footing with the powerful insurance companies and trial lawyers. It's one way to ensure our voice is heard on Capitol Hill.
Jack Chou, M.D., is a member of the AAFP Board of Directors.
The Challenge of Working With Health Plans
Every year, AAFP leaders and staff members meet with several of the nation's largest health insurance companies to discuss payment and other issues important to family medicine. Last week at the Academy's headquarters in Leawood, Kan., we met with UnitedHealthcare (UHC), and it provided us with an opportunity to express our concern regarding UHC's recent move to make significant cuts to its Medicare Advantage provider network just a few weeks before Medicare open enrollment.
UHC representatives told us they made the decision because in some markets their networks were significantly larger than their competitors, who already have taken similar steps to reduce the size of their networks. They felt they needed to “optimize” those networks to align with their competitors. A narrower network, UHC's representatives said, will allow the company to invest more in certain practices through incentive payment programs and also will eliminate unwanted variations in care.
Regardless of whether UHC's business decision was good for the insurer, it was poorly timed, catching physicians and patients off guard during a critical time of year. We stated again that decisions that affect such a significant number of patients and physicians -- up to 18 percent of primary care physicians who contract with UHC in some markets -- should be communicated to the Academy in advance so we can alert our chapters and prepare our members.
According to UHC, the company did not remove patients from coverage altogether. Instead, it is working to move them to other practices in their network. As we told them, however, cutting large numbers of physicians could create capacity and access issues in some markets because many of our members do not have the ability to significantly increase their patient panels.
Despite the above matter, we were able to find common ground on some important issues. For example, United agreed that we need a more continuous dialogue at the staff level, and we identified a few issues that we will be actively engaged in with UHC moving forward.
UHC representatives also said they want to work with the Academy -- as well as other payers -- to standardize and align quality measures, which would vastly reduce the reporting burden physicians face. They also want to hear more about the new evaluation and management codes for primary care physicians that the Academy has recommended to CMS.
Care management fees are another issue we will be discussing with UHC, which has publicly stated that it plans to have at least 50 percent of its provider network working under value-based contracts, rather than strictly fee-for services arrangements, by 2015.
Fee schedules that pay less than Medicare in some regions also were a topic of discussion. We emphasized that other payers in these areas do pay above Medicare rates, and to be viable, family medicine must be valued appropriately.
Working with health plans can be challenging, but we can build on common issues that keep the patient's best interest as our primary focus. We will stay engaged and continue to promote the value of family medicine.
Robert Wergin, M.D., is President-elect of the AAFP.
Getting Health Care Right, Even as We Change It
If there's one thing that's constant about health care in the United States these days, it's change. Health care reform swept a wave of new ideas out of theory and into practice, from insurance exchanges to accountable care. Advances in medical research mean that physicians have more treatments to help our patients than ever before. As a country, we're coming to terms with how complex health care is and how much change is still on the horizon.
Amidst all the change and complexity, though, the importance of the physician-patient relationship has stayed exactly the same. As I reviewed this month's workforce issue of Health Affairs, I was reminded of the more than 20,000 hours of training and education I completed, learning to provide the right care to patients despite a wide array of variables. Complexity is what physicians train for throughout our careers. As physicians, we have the education, expertise and experience necessary to ensure the highest quality of care for patients.
Being a primary care physician has never been more challenging or interesting, and fortunately, there are more of us than ever. The number of new primary care physicians increases every year, and by 2016, more than 3,000 new physicians will complete their training annually.
I can't imagine doing my job without the full breadth of training and education I received when becoming a family physician. Our patients' health challenges are growing increasingly complex. More members of our local communities -- whose families we often have cared for during the course of many years -- are developing multiple complex conditions that require advanced training and a keen insight into what might be causing overlapping health problems. According to the CDC, 45 percent of adults have two or more of the most common chronic conditions, and with an increasingly sedentary lifestyle and persistently high childhood obesity, future generations are likely to face significant overlapping health challenges, as well.
Because of our training and our presence in virtually every community across the country, family physicians are uniquely able to mediate change and complexity in a way that helps make health care work better for patients. The relationships we have with patients, combined with our training and expertise, are key to our ability to ensure our patients get the right care at the right time. There's a reason that people with chronic conditions -- from Parkinson's disease to hypertension -- see primary care physicians at higher rates than they see subspecialists.
Ultimately, that's what patients want. When they come to see us, our patients want to see a trusted partner in health who is expert enough to diagnose their problem, develop a comprehensive treatment plan, advise them and lead their care. We offer our patients exactly that because we devote more years to the study of medicine than any non-physician health care provider.
There's a lot that's changing with health care, but the core of why we became family physicians is our relationship with our patients, their families and their communities. Even as health care changes and evolves around us, we remain steadfastly committed to our patients. In that commitment, some things never change.
Reid Blackwelder, M.D., is President of the AAFP.
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