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Saturday Jun 20, 2015

Father's Day Flashback: Lessons Learned From Dads

I have been blessed with many father figures in my life, and each one has shared valuable wisdom that has helped me become a better physician, a better leader and a better person. In honor of Father's Day, and fathers everywhere, I want to pay tribute to the special fathers in my life by sharing some of their wisdom.

My great grandfather, Charles Light, was a Mennonite minister. My first memories of him were of a gentle man who lived simply on a farm and enjoyed quilting. He was a member of the Hereford Dairy Project and sailed on that initiative's first trips that brought animals to those living in poverty so they would have sustainable means to provide food and income for their families. He showed me the wisdom of paying it forward.

My great grandpa Otto McBride was a carpenter. My first memories of him were of his wonderful smile, which extended over his entire face and into his eyes. He could create anything with his hands. I still have the cedar chest he built for my grandma to keep my mother’s baby clothes in. He showed me the wisdom of building your own future.

My other great grandpa, Thomas Lloyd, owned his own shoe store in Racine, Wis. My first memories of him were of playing with the hundreds of seashells that he would collect in Florida and bring back home in jars. He showed me the wisdom of appreciating the beauty in nature.

My grandpa Don Beckenbaugh was a salesman in the Midwest who retired and moved to southern California. Six months after his retirement, he was offered a job selling real estate. Six months after that he became a broker who managed a successful real estate business in Laguna Niguel for 20 years. He was also committed to keeping his large family connected, and every time we had a gathering, he would go around the table and make everyone stand up and give a short speech to share what was new in their life. (That was the old-fashioned version of Facebook). He showed me the wisdom of believing in yourself.

My other grandpa, Allen Light, was a salesman who lived his entire life in the Midwest, which allowed me to spend holidays and summer vacations at his home for more than 40 years. He had a great sense of humor and a sharp wit and was an avid gardener and winemaker. He had a strong faith in God and held the importance of family above all other things. He took care of me when I was a baby, and he helped take care of my babies when I became a mom. He always took an active interest in whatever I did in my personal and professional life. When he developed cancer at the end of his life, he taught me what is was like to be a patient. He showed me that the burden of disease cannot break your spirit, but also that it cannot exceed your capability to live with disease. He showed me the wisdom of allowing faith, hope and love to guide your life.

My dad, Bob Beckenbaugh, is a recently retired hand surgeon. He was the first one to introduce me to medicine and show me how physicians can make a difference in the life of others. Dad also taught me to appreciate the power of humor and the importance of having fun. He taught me to laugh and tell jokes and to  swim, water ski and snow ski. He even tried to teach me to play golf, but he says I "hit the big ball (planet Earth) more than the little ball (the golf ball)." Most of all, my dad taught me that taking care of other people is the most important service you can do with your life, and that as a physician, patients should always be treated with courtesy and respect. My dad showed me the wisdom of keeping joy in your life and striving for excellence in caring for others.

For the past 36 years, I have been blessed with another dad, my father-in-law Ted Lillie Sr. He is a retired small business owner who cares deeply for his family and strives to help those who are less fortunate then himself. He taught my husband to be a wonderful father, and he has shown me the wisdom of perseverance in the face of adversity.

So this month, I say thank you to all my fathers, and thank you to fathers everywhere who take the time to make a difference in the lives of others.

Lynne Lillie, M.D., is a member of the AAFP Board of Directors.

Tuesday Jun 09, 2015

Vacation? Hardly. AAFP Commission Work Is Tough, but Worth It

I recently returned home from the summer meeting of the AAFP commissions, typically referred to as Summer Cluster by its participants. Such meetings are sometimes called "vacations" by people who aren't involved, but the truth is that they are hard work.

And our hard work is backed up by the hard work of those back home who cover for us.

More than 100 family physicians, residents and medical students volunteer their time to the commissions, which provide input that shapes the direction of the AAFP and family medicine. Members serve four-year terms on commissions, which focus on specific areas, such as advocacy, education, member services, public health, professional development and practice improvement.

Photo courtesy of Kim Yu, M.D.
AAFP President Robert Wergin, M.D., center, speaks during a meeting of the Commission on Membership and Member Services. More than 100 Academy members volunteer their time and provide input to the AAFP's seven commissions.

Liaisons from the AAFP Board of Directors and constituent chapter executives also participate in these biannual meetings, and many of us return home with wry smiles as people ask about the time we spent out of town. Cluster meetings typically are held in the summer and winter in Kansas City (near the AAFP's headquarters), which is known for its climatic extremes. Although it's a fine city, Kansas City in the sweltering summer (or dead of winter) is not an ideal vacation destination.

Here's the long and short of it: When commissioners, Board members, officers and chapter executives are in Kansas City for Cluster meetings, we are working. There is a significant amount of prep work for these meetings, including poring through agendas that often are hundreds of pages long.

Most of us are practicing physicians, and in this era of electronic health records (EHRs), we are never truly away from patient care. Almost all of us have to step out of meetings at some point to take a patient phone call. We consult our EHRs during breaks so we can address urgent patient care needs, and we check in with our staffs. For example, throughout each day of the recent meeting, I made time for various patient care issues. I filled prescriptions, sent portal messages asking for follow-up from six patients on various issues (all sent on one morning, and answered that afternoon), dealt with a patient who had a new problem (which also resulted in a phone call), and reviewed the care of residents I had precepted the day before the meeting started.

In addition to patient care, many of the Board members -- especially officers -- must also find time for media calls (just as we do when we are back home). AAFP President Robert Wergin, M.D., in particular, is essentially on call 24/7 to handle media requests and to dash off to represent the Academy at other events, be it the annual AMA meeting, a White House event or some other important gathering. Not a meeting goes by in which he is not dealing with several phone interviews or email reviews of important media opportunities. These are critical for getting family medicine's message out to the public, and he has done an outstanding job.

I admit that I get so recharged after spending a few days with friends and colleagues at Cluster meetings that anyone could be forgiven for thinking I was coming back from a restful time away. In the end, there is nothing more exciting or rewarding than being able to continue to take care of our patients and our practices, while at the same time doing the important work of the Academy.

Next month, the AAFP will make its annual call on chapters to nominate family physicians to serve on the commissions. I'm grateful for all those who have served because they challenge us as an organization to do what we do even better. But we also owe a debt of gratitude to the people in our practices, communities and, of course, our homes who cover for us and support us, which allows us to do important work for our specialty and our Academy. Thanks to all.

Reid Blackwelder, M.D., is Board chair of the AAFP.

Thursday May 14, 2015

Face-to-Face With Dr. Oz: Benefits of Touting Family Medicine Outweigh Risks

When discussing treatment options with our patients, we consider the risks and the benefits of the various options available. Ideally, we seek choices with benefits that far outweigh the risks.

The same is true for leadership, but sometimes you have to boldly stick your neck out to make your message heard.

Here I am talking with Mehmet Oz, M.D., on "The Dr. Oz Show." In a show about facing your fears, my segment dealt with the fact that some patients fear going to the doctor. I emphasized that patients need a family physician who can serve as their trusted health adviser.

Earlier this year, I got a phone call from Mehmet Oz, M.D., the cardiothoracic surgeon, author and TV host better known as Dr. Oz. We had met years before when I was working for the local NBC affiliate as a health consultant and reporter. His staff had initiated conversations with the Academy about interviewing me on his show, and now he was reaching out to me directly.

I hadn't jumped at the opportunity, and with good reason. It's been a rough year for Dr. Oz, who was called before Congress last summer because of concerns with some of the products that have been promoted on his show.

"You need to understand that our members aren't happy with some of your advice," I told him. I also let him know that family physicians are spending too much of our valuable time explaining to patients why we don't recommend some of the products and ideas they've seen on his show.

But again he asked me to come on the show to tell his audience about family medicine, and that audience is vast. Each weekday, nearly 2 million people tune in to watch on television, and many millions more watch online.

So here was a risk with a potentially huge benefit. This was an opportunity to talk to millions of Americans about the importance of family medicine and the critical role that primary care plays in health care. I could give this audience, which hasn't always received evidence-based information, a better understanding of who we are and what we do as family physicians.

As I considered it, the conclusion that I drew was that the benefits would outweigh any risks if I could reach viewers who don't have a primary care physician and make them realize that they should. Incredibly, that goal was accomplished before the show was ever broadcast.

The topic of the episode, which aired today, was fear. Specifically, my segment dealt with fear of going to the doctor, which can keep people away from our practices even when they are in dire need of care.

So we talked about why everyone needs a family physician, a trusted adviser who knows the patient and his or her family history. We talked about the scope of family medicine and the fact that we care for people from the beginning of life until the end. We also talked about our ability to help patients set and reach their personal health goals.

One woman in the audience had not seen a physician in more than a decade because of her personal fears and concerns about costs. When we had finished taping my segment, I walked over to her and said, "Can I help you find a family physician?"

"I would love that," she said.

I followed up with her, and -- with help from the New York State AFP -- was able to connect her with a family physician in her area. If nothing else, I know my appearance on that show made a difference for one person already.

We mitigated our risks with Dr. Oz as much as possible. We discussed beforehand things I would not do on the show, found out who the other guests would be, and received a guarantee that there wouldn't be any medical products or services or nutritional or diet products promoted during this episode.

This effort already helped at least one person in the studio audience. My hope is that viewers who see the episode on TV or online will find their way into our exam rooms. Americans need to understand the value and importance of what we do. For people to hear our message, we may have to take a few bold risks.

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

Tuesday May 05, 2015

Your Opinion Matters; Here's How to Share It

With more than 120,000 members working in a wide range of practice models in all 50 states; U.S. territories; Washington, D.C.; and U.S. military bases around the globe, we won't always have a consensus on issues that affect family medicine. In fact, we often don't.

Although family physicians are different in so many ways -- based on gender, generation, political affiliation and race, to name a few -- we all share a common goal: to provide the best care possible to our communities. It's important that we communicate and work together as members and as an organization to achieve that goal.

Tiffany Matson/AAFP
Here I am talking with attendees at the AAFP Leadership Conference. Hundreds of members and chapter staff attended the event last week in Kansas City, Mo.

Sometimes, the Academy receives feedback from members who feel they aren't being heard. Small- and solo practice physicians, in particular, have vented frustrations about the growing regulatory burdens their practices face and their need for help in addressing these obstacles. I understand because I am a rural, small-practice physician, and there are others like me serving on our Board of Directors. And I can tell you we do hear members' feedback.

AAFP officers, myself among them, offered updates on a variety of issues facing family medicine and took questions from members during a May 1 Town Hall meeting during the AAFP Leadership Conference in Kansas City, Mo. We discussed payment reform, workforce issues and more. Members will have another opportunity to ask us tough, direct questions Sept. 27 during a Town Hall meeting at the Congress of Delegates in Denver.   

But these annual events are only two examples of ways that AAFP leaders and staff listen to members' opinions. There are many other ways to make your voice heard.

The Academy regularly solicits member feedback through randomized surveys. If you want to make your opinion known, this is an excellent -- and easy -- way to provide input that affects AAFP products and policies. In 2013, the Academy polled members more than two dozen times on various issues, so if you receive a survey, please complete it!

The AAFP also gathers feedback about twice a month through the Member Insight Exchange. This is a growing group of family physicians -- currently, about 600 of them -- who have provided input on a wide range of issues, including AAFP products, Medicaid, health care apps, direct primary care and more. The Academy would like to expand the numbers of members who participate (log in required) and earn incentives for providing feedback.

It's also worth noting that we send a member of the Board to nearly every state chapter meeting.  These meetings offer a chance for us to provide updates about what the Academy is doing nationally, but more importantly, they provide an opportunity for us to listen to family physicians from across the country.

Last year, the Academy illustrated its commitment to helping all members have their voices heard when it created a pathway for the establishment of member interest groups. To date, 10 groups -- including one for solo/small practices and another for rural health -- have been created. Many of these groups plan to meet at AAFP Family Medicine Experience (FMX) in September in Denver.

AAFP leaders also are participating in quarterly online discussions with family medicine interest group leaders to answer questions and discuss issues that matter to medical students.

In addition, AAFP leaders and staff have responded to members' questions and concerns posted on the Academy's listservs. Although we don't respond to every comment, the Academy monitors and discusses comments we receive via social media. And you can communicate with me directly through the AAFP President Facebook page and on Twitter @aafpprez.

I want to assure you your voice and input matter greatly. As a practicing family physician, I understand firsthand many of the frustrations of our members. As an Academy, we will continue to work hard on reducing those frustrations so that we can bring the joy of practice back to our lives.

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

Wednesday Apr 08, 2015

FPs Have Ability to Inspire, Be Inspired by, One Another

During a recent review course at our local medical school, my practice partner gave a lecture about the patient-centered medical home (PCMH). My partner -- who also happens to be my wife -- was not too keen on making the presentation at first. She doesn't think of herself as a public speaker, but after a bit of encouragement, she agreed to share the story of our journey through practice transformation with an audience of about 250 people. And she was magnificent.

Every practicing physician has interesting and valuable stories that other physicians could learn from, but too often, we don’t seize the opportunities in front of us. Likewise, I think many family physicians fail to realize the value we bring to the health care system. But if our nation is to transition from a specialty-driven health care system to one built on primary care, family physicians must be the change agents in that revolution. We cannot wait for permission or validation from others; if we do not believe in ourselves, who will?

In medical school, we often heard the mantra, “see one, do one, teach one,” which emphasizes student learning through practice. A similar approach of “imagine one, do one, inspire one” could be applied to the changes that are needed in our health care system.

One of the experiences I enjoy most of late is when other physicians come to visit our practice to see what we’re doing. Some come to see what we’ve done with our electronic health record system. Others want to know how a small, rural practice became a recognized PCMH. Still others want to hear about our accountable care organization (ACO).

Being around people who are making changes and succeeding can give us the confidence, courage and inspiration to embark on our own transitions. And that doesn’t have to be a transition to a PCMH or an ACO. A growing number of our members are pursuing other practice alternatives, such as direct primary care.

We can create the change we want to see, but first we have to understand the possibilities. We can’t just sit back and wait to see what happens next. Of course, every family physician doesn’t have to run for a chapter presidency or testify before a congressional committee to consider him- or herself "involved," but we can all share our success stories with our colleagues and work with our staffs to provide the best care possible.

The Academy has pledged to deliver "strong medicine for America." So long as we inspire our family physician colleagues, and allow ourselves to be inspired by others, we will deliver on that promise.

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

Thursday Feb 19, 2015

Thomas Wolfe Had It Wrong: You Can Go Home Again

The only doctor who ever treated me while I was growing up was the local general practitioner, so my concept of a physician was someone who took care of everyone -- from birth to end of life -- and was involved in the community. Being exposed to subspecialty care during medical school and residency didn't change my perception of what I was meant to do. I knew I wanted to be a "real doctor."

Photo Courtesy Megan Sonnier

Here I am talking to a patient who -- like many in my hometown practice -- I've known for decades. In fact, he wrote a letter of recommendation for me when I was a high school student applying for a scholarship at the University of Alabama.

Not to gainsay Thomas Wolfe's compelling novel You Can't Go Home Again, but when I left Bibb County, Ala., to attend medical school in Mobile in 1975, that was exactly what I planned to do. I wanted to practice family medicine in my community.

I live in Brent, Ala., and work in Centreville. These neighboring small towns run together and are home to roughly 6,000 people combined. When I look at my patient list in the morning, I often know patients' complaints before I see them because I've already heard about their illnesses, conditions or concerns at church, in the stores or from my nurse.

At the heart of primary care is the idea that patients should have an ongoing relationship with a family physician they know and trust. I have that kind of relationship with my patients because I've lived here most of my life, and I've practiced medicine here for more than 30 years.

There were only two other physicians in the county -- both family physicians -- when I started my practice in 1982. One was another local who had come home to practice. One thing we learned about starting new practices in our hometown is that folks typically fall into one of three groups:

  • People who didn't know you before you became a physician or moved to town while you were away at medical school or residency;
  • People who knew you before you were a physician and will never come to you for care because they still think of you as a kid; and 
  • People who knew you before you were a physician and won't see any other doctor because they know and trust you.

Patients should have the right to choose their physician, and I understand that some of my old high-school classmates might be uncomfortable being patients of mine -- particularly women. On the other hand, I've delivered the babies of some of my former classmates, so it works both ways. My patient panel also includes former teachers, coaches and my high-school principal.

My wife grew up in a small town, too, and when I finished residency, we visited a few other communities before we decided where to start my practice. In fact, I had an offer to join a friend's practice in another location. But in the end, we couldn't find anything we liked better than my hometown.

I've built strong relationships in this community. To me, that's part of being a family physician. And I love what I do.

John Meigs, M.D., is speaker of the Congress of Delegates, the governing body of the AAFP.

Thursday Jan 01, 2015

New Year Brings New Life, New Hope

As the year winds down, the holidays give us an opportunity to share time with our family and friends. It is a time when the young create new memories and the old share theirs.

One of my most memorable holidays as a family physician happened just a few years ago. Brenda and I were preparing for New Year's Eve -- packing things to take to a friend’s house to celebrate the new year with friends and family -- when I got a call from the hospital. One of my maternity patients had arrived and was contracting. I admitted her and told the nurse I would stop by and check on her shortly. On my way to the party, I stopped at the hospital and confirmed my patient was in labor.

© 2014 Sheri Porter/AAFP
Here I am checking on a new patient in the hospital. Maternity care can make things challenging during the holiday season.

I spent the early part of the evening with good friends and family and limited my celebration to sodas and coffee. I received hourly updates about my patient, and by 10:30 p.m., her labor had progressed enough that I excused myself from the gathering and made arrangements for my brother to take Brenda home.

I went to the hospital and sat with my patient and her husband, monitoring her labor’s progress. At 11:30, it was time to start pushing. She did well, and around 12:30 a.m. -- at the start of a new year -- we celebrated the birth of their new son.

Both parents were elated, although the father did ask if we could have "rushed this along a little" so the tax deduction that comes with a new child could have been applied to the year that had just ended. I told him I didn’t have much to do with the timing, and he agreed. The next day, however, the local newspaper took a photograph of the county's first baby of the year, and the family received many gift certificates and congratulations from businesses in the community.

I headed home around 1:30 a.m. Brenda got up, and we opened a bottle of champagne and celebrated the new year, a healthy new baby boy, and a new patient in my practice.

That is family medicine. Sometimes our families have to make sacrifices, but it is part of who we are. And our communities are stronger for it. This was a memorable New Year's for me and this family. I'd like to hear the story of your most memorable holiday spent with patients in the comments field below.

Happy New Year from the AAFP. Take a look at this video to see some of what we accomplished in 2014.  And here's to a prosperous 2015.

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

Monday Nov 24, 2014

The Center for the History of Family Medicine: At First, I Didn't Care Either. But Now I Get It

Probably like many of you, I don't think about history much. Between the responsibilities of my practice, my family and my service to the Academy and its members, I just don't have a lot of time to study the past.

So when I was appointed recently as the Academy's representative to the Board of Curators of the Center for the History of Family Medicine, I did not know what to expect. As the principal resource center for the collection of the specialty's history, the center struck me as a dull abstraction at best and at worst, a waste of time, space and money. With all of the many issues and challenges facing our specialty, it just didn't seem important to me.

Photo courtesy the Center for the History of Family Medicine
Arthur "Lud" Ludwick Jr., M.D., won the Silver Star while serving as a physician on the frontline during World War II. Ludwick is one of the many physicians whose stories are told through the Center for the History of Family Medicine.

But then I came to the center and saw it for myself. And now I get it.

The center is much more than just a place where old papers are stored. It is the collective memory of family medicine. 

Told through its many documents, photographs, videos and artifacts, the story of our specialty is one of hardship, struggle and, ultimately, triumph. It begins in 1947, when a group of general practitioners -- facing the almost certain extinction of general practice -- formed the organization that we know today as the AAFP. It's a story worth remembering as we venture into the future and turn our sights to addressing the challenges and opportunities ahead through the Family Medicine for America's Health project.

But fundamentally, the story of family medicine is a story about people. It's a patchwork of the intensely personal stories of the many GPs and family docs who, throughout the history of our country, have served on the frontline of American medicine, caring for patients in wartime and in peacetime, and from birth to death.

Take for example, the story of  Arthur "Lud" Ludwick Jr., M.D., who won the Silver Star for "gallantry in action" while serving as a GP on the Italian frontline during World War II and then went on to have a long and distinguished career practicing in Wenatchee, Wash.

Or the story of Olin Elliott, M.D., of Des Moines, Iowa. Described by one colleague as "a delightful, well-rounded doctor, loved and respected by patients, colleagues, family and acquaintances alike," Elliott was renowned for his compassion and dedication to his craft. In 1957, when his wife was diagnosed with amyotrophic lateral sclerosis, he became her primary caretaker while still continuing his medical practice, providing her with medical treatment until her death. In later years, Elliott volunteered at a clinic for the homeless in Des Moines, and even after being diagnosed with pancreatic cancer in 1981, he continued to care for his patients up until the day of his death the following year. 

Or, more recently, the story of Regina Benjamin, M.D., M.B.A., a family physician from the small fishing village of Bayou La Batre, Ala., who went on to become the 18th surgeon general of the United States.    

All of their stories -- and the stories of many others -- are told through the center's collections.

And there are practical applications for the center's holdings, too. An important educational resource for the specialty, each year, the center sponsors both a research fellowship and an internship program. The information contained in the center's collections helps us understand -- and hopefully avoid -- the mistakes of the past, thus saving us time and money that might otherwise have been spent trying to reinvent the wheel. It also plays an important role in advancing our specialty by supporting and enhancing public relations and marketing efforts through interesting and informative exhibits.

In short, the center allows us to make a direct and vital connection between family medicine's distinguished past and its exciting future.

So now I get it. And I hope that you will have the opportunity one day to visit the center  -- either in person at the Academy's Leawood, Kan., headquarters or through its website -- and discover this for yourself.

After all, in the words of author and historian Theodore Draper, "If history can teach us nothing, we have nothing that can teach us."

Robert Lee, M.D., is a member of the AAFP Board of Directors.

Monday Oct 20, 2014

My Year as President: The Honor Has Been Mine

It is hard to believe that a year has passed so quickly. In fact, I was blessed to have a 13-month term as AAFP president, and I did my best to make the most of it. In so many ways, this time on the AAFP Board of Directors has reminded me of my professional path, having worked as a small-town family physician before becoming residency faculty.  

I always tell new faculty at East Tennessee State University that you have to work at least five years to see the patterns in medical training and avoid the panic that often comes when challenges arise. Similarly, I am finishing my fifth year on the Board, and I have learned a lot in that time. It has been an exciting period, and I want to summarize some of my experiences.

 © 2014 Marketing Images/AAFP
Speaking with students, like I am here at the National Conference of Family Medicine Residents and Medical Students, is one important aspect of being the Academy's president.

When I was running for president-elect, I promised I was going to do my best to say yes -- and I have. This has been an amazing year. I topped 1 million miles on Delta and visited 17 AAFP chapters. One of the most profound experiences was the chance to meet not only the state leaders that we install in those chapters, but to meet our members who have chosen to put their energy into patient care and help our communities. Thank you for your dedication, your inspiration and for working through the many challenges. The time I have spent with you has helped me do a better job of understanding those challenges and representing family medicine in Washington, D.C.

I have spent a significant amount of time trying to reframe discussions about health care, including about scope of practice. Although this remains a significant issue from state to state, it's important to remember that we have a number of states that have allowed nurse practitioners to practice independently for years, and the results demonstrate this isn't the right solution to our nation's primary care shortage. Every state in our country is experiencing poor patient outcomes, decreased provider and patient satisfaction, and high costs.

The solution to these problems is to truly focus on increasing the number of primary care physicians in practice, creating more effective patient-centered medical homes, and providing care in a team-based fashion. The Comprehensive Primary Care Initiative for example, is demonstrating that the kinds of changes the AAFP has been advocating for more than 10 years are the changes that lead directly to improved outcomes and decreased costs.

And there are more data to come, so stay tuned.

One facet of the president's job is to represent the Academy at meetings with other health care organizations, which creates opportunities to network and make important connections. After all, it's critical that team-based care also include organizational teams. I was honored to be invited to meet with a number of organizations -- some for the first time -- and help create new relationships for the AAFP or strengthen existing ones. Among the opportunities I have taken advantage of have been invitations to the Academy of Breastfeeding Medicine, the AMA, the American Academy of Physician Assistants, the American Association of Nurse Practitioners, the American Board of Family Medicine, the American College of Osteopathic Family Physicians, the American Osteopathic Association (AOA), the American Pharmacists Association, the Association of Family Practice Physician Assistants, the National Hispanic Medical Association, the National Medical Association,  the Society of General Internal Medicine, the College of Family Physicians of Canada and the Society of Teachers of Family Medicine.  

Another important role of the president is to represent the Academy in Washington, and I was fortunate to be able to make numerous visits to the nation's capital. The sustainable growth rate remains one of our biggest challenges, but I truly have hope that we are moving in the right direction. Proposed bipartisan and bicameral legislation already in play could provide a unique opportunity during Congress' lame duck session. Our comprehensive advocacy approach with organizations such as the AMA, the American College of Surgeons, the American College of Physicians and the AOA have created a unified voice for medicine that is getting the attention of those on the Hill.

We have other serious issues ahead, such as avoiding Medicaid cuts and addressing the regulated sunsetting of the primary care bonus, but we are opening more doors and sitting down at more tables to discuss these matters.  

Years of effort recently culminated in some major steps forward in graduate medical (GME) reform. The Institute of Medicine released its long-awaited report, with which the Academy substantially agreed. We followed that up with our own recommendations and a GME summit on Capitol Hill that was quite positively received. We are challenging long-held processes in significant ways. Much discussion and negotiation awaits, but once again, we are at another table addressing one of our primary goals.  

Just before coming to this week's Congress of Delegates and AAFP Assembly, I attended a premedical health fair at the University of California in Davis, a gathering of thousands of students who are considering careers in the health professions. In addition, I have been blessed to speak with students everywhere I have gone this year. Students are our life blood and our pipeline. These connections are critical, and I look forward to maintaining them.

One key way to stay connected is social media. Three years ago, the Academy made a commitment to giving members real-time updates about how the president is representing family physicians. The AAFP President's Facebook page now has more than 1,400 "likes," and the AAFP President's Twitter account -- @aafpprez -- has 2,400 followers. The Board also is providing regular and more in-depth updates through this blog. The better we stay informed and connected, the better we can advocate for each other.

It has been an honor to represent you, and I will continue to work for you during my year as Board chair. Thank you for the opportunity to take your stories forward. I am excited this week to be handing off the president's role to Bob Wergin, M.D. A small-town doctor who practices full-scope family medicine, he is the right person at the right place at the right time to lead us forward.

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

Wednesday Oct 15, 2014

The Flight of My Life: Reflecting on Six Years of Service

In its more than 40 years, my little Hatz biplane has had quite a life. In the two decades we have shared the sky, we have introduced more than 400 kids to the thrill of flying and traveled all the way across the country. It has brought me immeasurable joy.

But like all things physical, wear and age were beginning to show. So six years ago, we started the long process of restoration from the ground up. We replaced fabric covering, installed new instruments and a wood propeller, and finished with an updated paint job.

Today, she looks like a beautiful new airplane that's ready for new adventures. When you fly as a pilot and when you restore a plane, you keep a record -- a logbook -- that lists every flight and every improvement you make.

Coincidentally, it was six years ago that I joined the AAFP's Board of Directors. In many ways, looking back over those six years is like opening my Academy logbook.

Just like for my plane, there was a lot of work to be done in family medicine. The specialty was in crisis. Payment was woefully inadequate. AAFP membership was down. Student interest was low. Forty-seven million Americans were uninsured. As a candidate running for the AAFP Board, I asked the Congress of Delegates, rhetorically, if we were actually witnessing the collapse of primary care.

Fast forward to today, and the outlook for family medicine has changed. Day to day, our work in the trenches continues to be challenging, but the forecast for the future from the 10,000-foot level of the Board chair is now encouraging.

Six years ago, we knew family medicine was valued by our patients -- we could see it every day in our offices. Barbara Starfield, M.D., M.P.H., had showcased the value of primary care in her research. Still, recognition of those truths -- and support for primary care – from payers, employers and government was lacking.

Today, the patient-centered medical home model has shown that improving primary care is the key to meeting the triple aim for health care: higher quality, lower costs and improved care for patients. The Comprehensive Primary Care Initiative launched by CMS' Center for Medicare and Medicaid Innovation is changing the way our government pays for primary care -- paying for value over volume -- and it is expanding. A growing number of employers, health plans and government agencies are beginning to demonstrate that they really value what we do. When it comes to payment reform, we haven't arrived at our destination, but we are on the way.

On Capitol Hill, we no longer have to explain to legislators and congressional staff what we family physicians do and why we matter. Federal agencies seek the Academy's input on important health care issues, and legislators are actively looking for ways to train more family physicians to address our country's primary care shortage.

But what about access to care? Today, there are 10 million newly insured Americans thanks to the Patient Protection and Affordable Care Act (ACA). Our uninsured rate now stands at 13 percent -- 5 percent lower than it was six years ago and the lowest it has been since 2000. Americans may be split on the ACA, but there is overwhelming support for some of the basic tenets of the law: getting more people covered by insurance and reforming unfair insurance rules, including no longer allowing denial of coverage based on pre-existing conditions, caps on coverage, or retroactive canceling of coverage after someone becomes sick.

However, there is still much work to be done. We need restraints on rising health care costs, malpractice reform and a path to creating the primary care workforce our country deserves. And we still have  millions of uninsured. We haven't arrived at our Academy's ultimate goal of health care for all, but we are on the way.

Interest in family medicine is up nationally. AAFP membership reached a record high this year at 115,900. And for the fifth consecutive year, the number of medical students choosing family medicine climbed higher than the previous year. Twenty-five percent of all U.S. medical students are now Academy members.

To meet the needs of our nation's health care system, those numbers must continue to grow; this year, the AAFP took steps to proactively ensure that they can. Last month, the Academy unveiled a proposal that would significantly change the way graduate medical education is financed. Our proposal would bring transparency and accountability to a system that invests $15 billion a year on physician training but is unable to produce a workforce that aligns with the needs of the nation.

I'm also proud of the work the Academy is doing in public health. Last year, we included the social determinants of health in our strategic plan. And this year, we began the process of reimagining Tar Wars -- a program I helped develop more than 25 years ago -- as part of a comprehensive tobacco and nicotine prevention and control program that will include new tools for family physicians, community programs and advocacy.

We've talked about where the Academy has been, but where are we going? During the AAFP Assembly in Washington next week, the AAFP -- along with seven other national family medicine organizations -- will launch a national campaign that is the culmination of the Family Medicine for America's Health initiative and the biggest thing to happen in family medicine since the Future of Family Medicine project in 2004. This campaign will speak not only to family physicians but also to patients, payers and others, defining what we do as family physicians and why primary care is the vital foundation of our health care system.

Now when I climb in my biplane, I can tell she is still the same plane I have known and loved all these years, yet with new energy and new life -- the way she climbs, handles and how her paint flashes in the sun. She has come a long way.

Today, we are all part of a rebirth of family medicine. Our voice is being heard, our contributions are being valued, and we, too, have come a long way. Our country is counting on us to continue to be "bold champions" for America's health, transforming health care for optimal health for everyone.

As for me, my Academy logbook is now full. It's time to open up a new logbook and start my next adventure. Thank you for granting me the privilege of serving you. It has been the flight of a lifetime.

Jeff Cain, M.D., is Board chair of the AAFP.

Friday Oct 03, 2014

The Countdown Begins: One Year to ICD-10

One year. That's how long we have to get ready for the official implementation of ICD-10. Oct. 1, 2015, is the day we have been nervously awaiting since July, when CMS confirmed that as the revised compliance date for the new coding system.

Later this month, the Academy will offer CME courses related to ICD-10 to help us prepare during the AAFP Assembly in Washington. Will your practice be ready?

Every time I read an article about ICD-10, I wonder how small practices like mine will survive this new hurdle. A study conducted by Nachimson Advisors and published by the AMA estimated that small practices could suffer costs between $56,000 and more than $226,000. A large practice's financial impact is estimated to range from $2 million to $8 million. These figures are three times what was estimated by the same research group just five years ago.

ICD-10 has more than 68,000 diagnostic codes compared with ICD-9, which has a little more than 14,000 diagnostic codes. This is a significant shift for family medicine. The differentiation of right, left and bilateral accounts for about 40 percent of the increase in codes for ICD-10. Initial versus subsequent diagnosis codes might create an obstacle for the busy physician but will ultimately be helpful for tracking purposes.

According to the American Health Information Management Association, the new coding system will result in higher-quality data that can improve measures of quality and performance, provide "increased sensitivity" to reimbursement methodologies, and help strengthen public health surveillance.

But how do we get there? Updates to my practice's electronic health record (EHR) system have allowed us to "bridge" to ICD-10 for the past eight months. Testing and payment disruptions are variables that are impossible for me to anticipate, and every consultant we talk to offers a different opinion as we try to assess how to proceed.

In my search for assistance on the web, I found "The Road to 10: The Small Physician Practice's Route to ICD-10," an online resource an online resource to help small physician practices transition to ICD-10. This tool was developed by CMS in collaboration with industry partners. It allows a small clinical practice to create a customized action plan for ICD-10 readiness and preparation. It provides a five-step action plan that covers planning, training staff, updating systems and processes, engaging partners, and testing.

Although that resource is geared to small practices, the AAFP and its journal Family Practice Management have resources that can help practices regardless of size.

In addition, CMS recently announced the dates that it will do readiness testing using ICD-10 codes.  What are you doing to prepare?

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

Friday Sep 26, 2014

The Doctor is Out: Retention Poses Major Challenge for CHCs

HHS announced Sept. 12 that it is making nearly $300 million available to nearly 1,200 community health centers (CHCs) across the country. The funding is intended to help CHCs hire more than 4,700 new health care professionals and offer longer hours and expanded services, including oral health, behavioral health, pharmacy and vision.

The funding is expected to help CHCs reach about 1.5 million new patients.

Although the funding for additional staff is needed -- and welcome -- the change doesn't address one of the biggest problems CHCs face -- retention. Not only do these clinics need more physicians, they need the physicians already working in these settings to feel motivated to stay in communities where they are desperately needed.

© 2014 Casey Health Institute
My first job after residency was at a community health center, but I now work at an integrative primary care practice. Research has shown that family physicians at community health centers have lower rates of job satisfaction.

Federally qualified health centers (FQHCs) are a source of primary care for millions of uninsured and underinsured patients. They're also the place where many family physicians -- like me -- get their first "real" job outside of residency.

I spent my first four years out of residency at a CHC, and I loved it despite the challenges. I served a culturally and socioeconomically diverse population that was in need of good health care. I truly felt like I was living up to being the doctor I wrote about in my medical school personal statement.

In addition to the reward of serving a community desperate for medical care, many physicians are drawn to CHCs by offers of loan repayment -- either as part of a National Health Service Corps commitment or through state and local programs. Although many physicians enter these doors excited and eager to help the people they went to medical school to serve, too often, physicians are just as eager to leave after their loans are repaid.

Research tell us that family physicians at CHCs are less satisfied with their work situation than other physicians. The reasons are multifactorial, including low compensation and excessive workload. Isolation from cultural activities and limited career opportunities for physicians' spouses in rural areas also contribute to dissatisfaction.

I saw several colleagues come through, do their time, repay their loans, and move on. This is a common theme, because family physicians often feel burned out after just a few years at a CHC. Many went to an FQHC not just to get their loans paid off, but rather to make a difference and fulfill a personal mission to serve the underserved. One friend and colleague told me she planned to come back to an FQHC at some point in her career. But after five years of having worked in that setting, she felt that if she hadn't left when she did, she would never have wanted to go back.

More than half the states and the District of Columbia are expanding their Medicaid programs under provisions of the Patient Protection and Affordable Care Act. Many of these new Medicaid enrollees will be seen at CHCs because many private practices don't accept Medicaid. This could lead to an increase in patient visits -- and potential headaches -- at the centers, which often struggle to fill vacant positions for physicians and other clinicians. To make matters worse, the low retention often creates a burden for those who do stay.

My interest in CHCs started in high school because I had a mentor who worked in that setting. Later, I volunteered at CHCs during medical school, and I had no doubt where I wanted to go after residency.

When I left my first job at a CHC, it wasn't because I was burned out. I had an amazing opportunity to work as a White House Fellow and spent a year advising the U.S. Department of Agriculture on a range of issues related to nutrition. When my time there was up, I didn't go back to an FQHC. Although I don't miss the headaches, I do miss serving that population.

Today, I'm the medical director of an integrative primary care practice where we incorporate some of the features of an FQHC to ensure access to care, including a sliding payment scale for uninsured patients and a sliding scale for insured patients who seek services that may not be covered, such as chiropractic, acupuncture and massage therapies. At the same time we're trying to ensure access in the way FQHCs do, we're trying to avoid some of the pitfalls these centers face. We try to give our clinicians the time, space and support they need in order to be there for patients and to make them feel valued and respected.

So how do we get more CHCs to operate the same way and improve their recruitment and retention rates?

  • The Bureau of Primary Health Care (BPHC), a segment of HHS that funds health centers, should track physician retention at FQHCs and publish these data along with other quality measures. Ultimately, the goal would be to create a recommended standard for clinician retention that centers can be compared against.
  • Once a physician commits to a community for the long term, that community has a powerful advocate. The BPHC should encourage FQHCs to create strategies for physician recruitment and retention. The National Association of Community Health Centers has already done a lot of work in this area.
  • The AAFP recently established member interest groups to provide a forum for AAFP members with shared professional interests. A CHC member interest group would provide physicians who work in these settings to communicate with each other and develop relevant AAFP policy. If you are interested in starting a member interest group for family physicians in CHCs, you can find more details -- including information regarding the criteria and application process -- online.

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

Thursday Sep 11, 2014

FSMB Offers Licensing Solution for Docs Looking to Practice in Multiple States

My home state -- Iowa -- shares its borders with six other states. With my state-issued driver's license, I can drive not only in all six of those states but in any other state in the nation. As part of this system, a longstanding interstate compact allows the vast majority of states to share information regarding license suspensions and traffic violations of nonresidents. The states where infractions occur may forward information to a driver's home state, which then applies its own laws to the out-of-state offense.

That system makes sense. Unfortunately, the same can't be said of the way states view medical licenses. I've been in practice for more than 20 years, but the second I drive across one of those state lines, my Iowa medical license is invalid.

On Sept. 5, the Federation of State Medical Boards (FSMB) took a major step toward solving this problem when it finalized model legislation to create an Interstate Medical Licensure Compact that would expedite the process of issuing licenses for physicians who wish to practice in multiple states.

The key word here is "expedite." Under the current system, physicians who wish to practice in more than one state have to navigate a fairly burdensome process that involves paperwork, fees and three to six months of waiting.

Expediting the process would benefit physicians who live near a state line, are licensed to practice on one side of that state line and seek privileges at a hospital or other facility on the other side of that line. The change also could help alleviate physician shortages in rural and underserved areas and pave the way for greater use of telemedicine. (It's worth noting that earlier this year, FSMB adopted new guidelines for telemedicine.)

Under the terms of the model legislation, a physician would apply for a multi-state license through his or her home state. That state would determine whether the physician meets the following eligibility requirements for the compact:

  • Possession of a full and unrestricted license in a compact state;
  • Successful completion of a graduate medical education program approved by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association;
  • Specialty certification or possession of a time-unlimited certification recognized by the American Board of Medical Specialties or the American Osteopathic Association Bureau of Osteopathic Specialists;
  • A clean disciplinary record;
  • No discipline from any agency related to controlled substances;
  • No pending investigations by any agency or law enforcement entity.

The proposed legislation would make it easier for states to share information and improve tracking and investigation of physicians who have been disciplined or are under investigation. Physicians who do not meet these criteria may still be able to receive a license in multiple states but not through the expedited process.

The model legislation has the potential to help put more physicians in the areas where we are needed most, but, ironically creating an expedited process could take time. Now that the model legislation has been finalized, state legislatures and medical boards can begin to consider its adoption. Each state must pass the compact to participate. That means family physicians who want this proposal to succeed should talk to your state chapters, who could help move this issue forward, or your state medical boards. Better yet, share your opinion directly with your state legislators.

Robert Lee, M.D., is a member of the AAFP Board of Directors.

Wednesday Aug 20, 2014

When It Comes to Mentoring, Both Giving and Receiving Are Important

Many mentors helped guide and direct me to medicine, in general, and to family medicine, specifically. There are too many to name here, but there was always someone to help me when I reached the next transition point. From high school to college and through medical school and residency, I could list a steady stream of physicians who were there to offer support, guidance and teaching along the way.  

I truly valued these relationships and took to heart the importance of mentoring. Along my path, I have made a point of reaching back to offer the same guidance to others that was given to me. I treasure being a mentor, continue to learn from the students I teach, and I can't wait to see what they will do in their own careers.

Here I am with AAFP President Reid Blackwelder, M.D. It's important to have a more experienced physician we can turn to for guidance even after we've transitioned from resident to new physician.

I was satisfied with my own transition from mentee to mentor -- or at least I thought I was -- until I had a recent conversation with my husband.

My husband, an administrator in education, had been contemplating a position change. During the application process, he mentioned several mentors that he was turning to for strategic advice. After he accepted the position, he was promptly paired with a new mentor to help guide his professional development.

When I contemplated my own position change, I looked around and, for the first time in my career, saw no one there to help me. My first few years out of residency had been spent at a community health center with several seasoned doctors, one of whom was a mentor and had been faculty at my residency program. Those more senior physicians provided a great bridge to the real world.

However, at my current job, I'm the doctor who has been in primary care practice the longest, despite the fact that I'm only in my seventh year out of residency. I'm also the only family physician.  

Although I know the mentors I have called on in the past would still answer my call, it is easy to get caught up in the daily grind and not have time to reach out. Unlike residency, where there is always an attending around the corner, there are fewer people above us to help guide us after we move into our own leadership roles.  

New physicians are pulled in many different directions, and those who have families and/or are relocating may find it especially difficult to take time to reach out to other doctors and potential mentors. Doctors in small and single physician practices, as well as those in rural areas, are also at risk of feeling like they have to go it alone.

My recent state chapter meeting, however, reminded me that we are not alone. While there, I had the opportunity to discuss my career goals and aspirations with AAFP President Reid Blackwelder, M.D., of Kingsport, Tenn., whom I also now call a mentor. In addition, the meeting provided a chance to reconnect with friends and colleagues and swap stories and experiences. State chapters have a wonderful opportunity to bring family physicians of all different career experiences together, and that can facilitate these types of exchanges between new physicians and our more seasoned colleagues.

The chapter meeting's educational program was appreciated, but what really will stick with me is having that opportunity to reconnect with peers and learn from those more experienced than I am. I can't wait to do it on a grander scale at the AAFP Assembly in October. I hope to see you there.

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

Thursday Jul 17, 2014

Is Anybody Out There? Tell Us What You Think

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

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

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

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

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

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

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

Start today. We’re listening.

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

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