On Air: AAFP President Engages With Students in Online Forum
I recently returned from the AAFP's National Conference of Family Medicine Residents and Medical Students -- which set attendance records, by the way, with more than 1,200 students and nearly 1,100 residents -- and I am tremendously fired up! The energy of that group, and the challenges they put before us, motivate me and all of our Board members to do an even better job representing these critical members of our Academy.
With that in mind, I want to share some innovative new things we have been working on to connect with students and residents.
| My Google Hangout with Family Medicine Interest Group leaders in July allowed students to ask questions on a variety of topics, including direct primary care, leadership development and patient satisfaction.
Almost a year ago, I was invited to be a featured speaker for the American Medical Student Association's National Primary Care Week webinar series, part of the AAFP's collaborative efforts with AMSA on this annual event. I participated in a webinar with a number of student leaders. This exciting experience allowed me to get the message of family medicine out to students nationally. That led me to think about ways we could start a similar process within the AAFP. I have been trying hard to increase our use of technology and to find new ways for the Academy to connect with medical students where they are and how they want to be reached. Many medical students and residents are extremely adept at using Facebook, Twitter, YouTube and Skype and actually prefer to access information digitally.
I often have ideas and send out frequent emails to Academy staff asking questions and seeking suggestions for growth. On this topic, our Medical Education Division responded quickly with a suggestion that we try Google Hangouts to connect with students. I had never heard of this tool before, but the Academy staff members responsible for increasing student interest in family medicine were exceedingly excited about the opportunity. We explored the resources, did test runs, and mobilized our dynamic Family Medicine Interest Group Network leaders to work through it. This process is similar to platforms like Skype; however, in addition to connecting people by video, it also allows users to share screens, use PowerPoint, correspond with other participants in the session and perform other tasks. The utilities seemed ideal for some of the things that we wanted to do.
We had our first Hangout on July 8, and you can watch it on the FMIG Network's Google Plus page or on YouTube. We recognized that this resource would allow us to reach out to medical students and residents all over the country. We also realized that we needed to focus the content so that these video installments, which are 15 minutes in length or less, are long enough to be informative but short enough for busy med students to work into their schedules.
The results of the first Hangout were outstanding. We received a great deal of positive feedback, and, most importantly, the FMIG Network leaders were excited about having a new tool to help them coordinate FMIG groups all over the country. Google Hangouts allow us to create an immediate connection between AAFP leadership and our students and residents. This is one of the things that we love most -- being able to talk with these enthusiastic members personally, answering their questions and sharing our passion for family medicine. This platform could help connect students who don't have much exposure to family physicians at their medical school with FP leaders who can provide them with insights on important issues in health care.
In addition to using Google Hangouts, I'd like to find other ways of tapping into this technology to help all of our members. For example, one of the biggest challenges we all face in these busy times is traveling to and from meetings. Although face-to-face meetings are critical for some functions and discussions, a great deal of what occurs at many meetings could easily be handled in a different fashion. Email is not always ideal, because visual cues and clues are still important and connect people in significant ways. Perhaps, however, Google Hangouts could allow us to have some meetings in a more dynamic fashion and respect people's need for work/life balance. Any time we can minimize travel and still get the work of the Academy done -- that is a good thing!
Moreover, especially with students and residents, utilizing this technology may allow a quicker connection between these member groups and our leadership for such things as noon conferences, forums and talking groups. In fact, some of you may have ideas about how to use this and similar technology. I would love to hear your thoughts, and I hope we can continue to move our Academy into a more efficient future. In so many ways, this is actually an aspect of the patient-centered medical home (PCMH) because what we can do for ourselves to become more effective and efficient is something we can then also do for our patients.
These days of telemedicine and telehealth are challenging us to expand our boundaries. I look forward to continuing that expansion with all of you. Our next Google Hangout will be about the PCMH and is scheduled for 12:30 p.m. EDT on Aug. 26. You can join us on Google Plus or YouTube.
Reid Blackwelder, M.D., is president of the AAFP.
Reality Check: Residents Aren't Prepared to Deal With Patients' Financial, Coverage Limits
In medical school, our patient encounters typically consisted of completing a history -- including talking with patients about any concerns or issues that led them to seek care -- doing a physical exam, and developing a diagnosis and treatment plan with the resident and attending.
In the real world, it turns out, it's not that simple. I recently began the first year of family medicine residency, and I quickly realized that some important steps were left out of the learning process. As students, we were not often exposed to what happened next for patients. We missed the part where the physician talked with the patient about his or her insurance, what it covered and what it did not.
| This week I'm attending the AAFP's National Conference in Kansas City, Mo., which offers students and residents opportunities to learn about clinical skills, leadership and more. One thing students don't learn in medical school is how to manage patients who lack the means to pay for needed treatment.
I recently saw a patient, a woman in her mid-30s, who came in for a checkup. In addition to her chronic conditions, including hypertension and diabetes, she complained of joint pain in her knees and hips. After taking her history and talking with her about her discomfort, I wanted to have her tested for rheumatoid arthritis.
Her first question was, "How much will that cost?" The patient had private insurance, but her plan left a lot to be desired. It covered office visits and some medications, but it did not cover labs.
The patient, a single mom who also was supporting her mother, informed me that she already was paying off a large lab bill from a previous visit. She needed to repeat labs related to the medications for her chronic conditions, but she couldn't pay for those, let alone for a blood test for rheumatoid arthritis.
I could have ordered the labs, but there wasn't any point in doing so because she told me it would have to wait. It's not that she would have been noncompliant, she simply couldn't afford to do what needed to be done. From her perspective, doing the labs would have meant asking the people she supports to sacrifice something else.
I asked her to come back in two months so that we could reassess her situation -- both physically and financially. For now, she plans to continue treating her joint pain with OTC medications.
This situation is hard for me to get used to. I can't do what I want to do -- what I've been trained to do -- to help some of my patients. Instead, I have to consider a patient's medical, social and financial situation and work within those limitations.
Medical students should have more exposure to this part of the process so they are more aware of the reality that awaits them. What do you do -- or what can you do -- when your patients' financial or coverage limitations are barriers to needed care?
Tate Hinkle, M.D., is the student member of the AAFP Board of Directors.
Rural Practice May Pose Challenges, But It's Where I Was Meant to Be
Two years ago, at the beginning of my second year of residency, I signed a contract to work in a rural county in West Virginia. Although I've known where I was going for quite a while, I don't think I really understood what living here would mean until now.
I grew up in what most people would consider a rural area of West Virginia, but my new home is in an even less developed region of the state. You know the kind of area I mean, where you are driving down the interstate and there is nothing to see but trees. There are no gas stations and few restaurants -- it's really mostly just trees. Not only does the town nearest me not have a stoplight, there's no stoplight to be found in the entire county -- nor in an adjacent county, for that matter.
But this is exactly where I want to be. I love growing a lot of my own food and cooking or canning it. I wanted a home where my husband could hunt and my son could fish, and we were fortunate to find just that. The sense of community in these rural areas is genuine and is part of what drew me to work and live here. I did multiple rotations away from my medical school and residency, and those that really stood out for me were the rural ones. It was obvious to me that rural West Virginia was where I was meant to practice. Often, people will live in a larger city and commute to work because that is what resonates with their family or their lifestyle. Not us. We wanted to hear nothing but bugs when we open our windows at night.
There are things that I hadn't considered about living here, however, that quickly revealed themselves. The first neighbor I met warned me that the power goes out often, and that if it stays off long enough, there is no water either (not that I'm all that excited about tainted West Virginia water), because an electric pump brings it up the mountain.
I've also been warned that the road floods, and that I might get stuck at home or be unable to get home if there is too much rain, too much snow, or -- the more common scenario in a West Virginia flood -- too much of both together.
And then there is the Internet, which is only available through a satellite provider. It is expensive, takes eons to download documents and, generally speaking, makes it a struggle to even check my email. Gone are the days of streaming World Cup games or watching programs on Netflix.
Also gone is the option of running down to the local Mexican restaurant to watch a game while someone else cooks dinner; that's because the only restaurants in town are a Dairy Queen that closes during the winter and a carry-out pizza place. Oh wait, there's also a Tudor's Biscuit World, a standard found in nearly every small West Virginia town that I can't even begin to explain.
Don't get me wrong, I am happier than I've been in years. We eat food we cook ourselves for every meal and spend far more time outside. We could spend hours identifying birds and picking blackberries. My son is learning to ride his bike on our road, which might see three cars on a busy day. The moon rises behind two distant mountain ridges that we can see from our deck.
I realize this lifestyle is not for everyone. Although many of my patients and I choose to live in a rural part of our state, many are here by default. West Virginia has the highest homeownership rate in the country at 76 percent. That's right -- we are first in something positive.
It is a multifactorial situation driven, in large part, by a tendency to stay close to home, inherit land and homes, but also because there are not adequate employment and education opportunities for many of the state's residents.
One thing I have already learned is that most of the public health and wellness strategies used in larger cities will not work here. There is no venue for truly large-scale advertising because much of the population -- regardless of financial status -- relies on the newspaper and does not have access to the Web due to limited Internet availability. You can't direct patients to healthcare.gov or familydoctor.org. These patients need doctors, often doctors who will go to their homes, and patient information developed with appropriate health literacy in mind. Even a simple obesity intervention such as calorie-counting is often doomed to failure because many people cook from scratch and there are no food labels.
But these are challenges I embrace. I value the trust my patients place in me, and reaching out to connect with them to find solutions to their health care challenges -- especially those complicated by social, financial or logistical hurdles -- strengthens that relationship far more than any simple treatment regimen. I live here; I understand.
In addition to appreciating rural living challenges, I have been experiencing life without health insurance. I didn't go straight through college and medical school so -- like some of my patients -- I've had periods of time without health insurance coverage in the past. I have always found my advocacy voice for the uninsured to be louder than some, partly because of my first-hand experience with the medical system from an uninsured perspective.
The first time I found myself uninsured, I was 22 years old, had just graduated from college (this was before you could stay on your parents' plan until age 26), and was living in remote West Virginia in the Monongahela National Forest working on a research project as a contract employee. I would run on the rail trails nearby, and one evening, I rolled and broke something in my ankle. I don't know exactly what I broke because I didn't have enough money to seek medical attention. I bought a plastic air cast that I duct-taped into a hiking boot and went back to work because there were zero sick days. So, not only did I experience an injury without access to health care, I still live with the implications of an untreated fracture that didn't heal properly.
At least then it was just me. Now I have a family for whom I had provided health insurance for years, but that coverage ended June 30 when I graduated from residency. Why not just start my new job July 1? Insurance companies take up to 90 days to credential health care professionals, and until that process is complete, I can't see patients. So, just as many other graduating residents who have a gap between graduation and starting work, I again do not have health insurance. Granted, there are safety nets in place; I could extend my prior plan under COBRA (the Consolidated Omnibus Budget Reconciliation Act), if needed, and in West Virginia, we have an extensive network of federally qualified health centers where I can pay according to a sliding scale based on my income. However, a gap in coverage is a gap in access to my primary care health professional and to preventive services for my family, as well as being a huge gap in my peace of mind.
I think I am a pretty responsible person, and I value continuity of care. Yet here I sit with no ready access to health care despite knowing the risks and insurance industry protocols. This situation further fuels my desire to promote the AAFP's vision of transforming health care to achieve optimal health for everyone. We have made some progress but we still have a lot of work left to do, and each community provides its own set of lessons to be learned.
Kimberly Becher, M.D., is the resident member of the AAFP Board of Directors.
Keeping It Real: Preceptorship Exposes Students to Importance of Rural Family Medicine
Roughly 20 percent of Americans live in rural areas, but only 11 percent of U.S. physicians live in those same communities. In fact, the Health Services and Resources Administration (HRSA) has designated more than 6,000 Health Professional Shortage Areas for primary care, and 67 percent of those are in nonurban areas. According to HRSA, it would take 17,000 additional primary care health professionals to achieve a ratio of one clinician per 2,000 patients in these locations.
So, how do we convince more medical students to first choose family medicine and then practice it in the places that need them the most?
I recently had the opportunity to talk to students during the Appalachian Preceptorship, which exposes students from around the nation to rural family medicine in Tennessee. Ten students from seven medical schools participated in the four-week program.
Let them experience it first-hand.
Nearly 30 years ago, Forrest Lang, M.D., retired vice chair of the Department of Family Medicine at East Tennessee State University (ETSU's) Quillen College of Medicine in Johnson City, created the Appalachian Preceptorship to introduce students to rural family medicine in a highly relevant and culturally sensitive way. Since then, hundreds of medical students from all over the country have come to Tennessee to experience first-hand the delivery of primary care in Appalachia.
It is critical that we find ways to connect with medical students early in their first and second years, and this year all of the students participating in the program were sophomores. We know that in the first 18 years of the program, more than 80 percent of the students who participated matched to residencies in primary care, including 60 percent who matched to family medicine programs.
Students are called to medicine to help people, and there is no better way to do so than practicing family medicine in rural, underserved America. In the Appalachian Preceptorship, students participate in one week of didactic sessions at ETSU before spending three weeks with a physician practicing in a rural Appalachian community.
These dedicated family physicians allow students to become part of their practices, and the students see patients, participate in the diagnosis and management of acute and chronic diseases, practice preventive medicine, and enjoy a wealth of other experiences.
The experience is invaluable for both the students and the preceptors. In fact, we dedicate significant resources at ETSU to connecting with our preceptors throughout the year, and we devote a special weekend session to allowing them to offer feedback on our educational methods and identify and address the resources they need.
Another key aspect of this program is the opportunity it gives us to show students that it is possible to not only survive but to thrive in small-town practices. Some of the preceptors are from individual physician practices, and most of the rest belong to small groups. The students are able to experience how health care is provided in these communities and to really understand the nature of physician-patient relationships. In addition, each of these preceptors and the communities in which they work are great examples of different types of patient-centered medical homes. This reinforces to the students that team-based care is not about having everyone located under the same roof; but rather the resources that are available within the community to care for its residents.
Another advantage of this process has been the chance it offers to expose students from all over the country to our school's residency programs. Almost every year, students who have participated in the preceptorship interview with at least one of our three family medicine residency programs. These are outstanding students, and we are frequently blessed that at least one of them matches with us. This is important because data from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care indicate that up to 75 percent of physicians will practice within 100 miles of their residency. In this way, the ETSU programs are consistently fulfilling their mission to provide rural family physicians for our patients.
On a personal note, I had the privilege of talking with students about a number of issues, including the importance of herbal medicine in Appalachian culture, bedside manner and patient-centered communication. I encourage each of you to consider how you can be a part of such a process in your community.
If you are academician, are there ways you could create student or even resident experiences that can mirror some of these goals of exposing students to underserved areas? If you are in private practice, is there a school or residency in your area that you could connect with to create a unique and transformative experience for learners?
Although we struggle nationally with physician pipeline issues, this is how we can walk our talk and directly influence students. This is a great opportunity to remember that the root word of doctor is docere -- to teach!
Reid Blackwelder, M.D., is president of the AAFP.
Like Father, Like Son: How I Raised a (Future) Family Physician
Like many small-town family physicians, I've volunteered over the years as a team doctor for our local school's athletic teams. On Friday nights, I often found myself on the sidelines, watching football and cheering on the local team (which often included many of my patients). More often than not, my son Brett would tag along, soaking up anything there was to learn.
On one particular fall evening, one of our players was badly injured, and I hurried onto the field to evaluate his condition. In retrospect, I probably should have paused just long enough to tell my son, who was about 7, to stay put.
Last weekend I represented the AAFP at the Nebraska AFP's board meeting. My son Brett, left, is a student member of our state chapter's board of directors.
As I kneeled next to the injured young athlete, I heard a small voice from behind me say, "Dad, there's blood."
That's Brett. Always eager to experience and learn something new. It wasn't the last time he got an up-close view of his dad trying to help someone who needed it. We've lived in a few small Nebraska towns that lack urgent care facilities and hospitals. So when people needed help in a hurry, they often call me directly. If Brett was with me I got one of those calls, he often came along to the office.
I remember one day when Brett was about 10, a young girl fell and needed stitches in her chin. Brett and I were out running errands when I got the call, so we went straight to my office to meet the girl and her parents. With the permission of the patient and her parents, Brett watched me clean the wound and stitch it closed.
Through these types of encounters, Brett learned not only about medicine but about the importance of building relationships with patients, families and the community.
As a high-school student, he participated in a medical interest group and expressed interest in becoming a family physician. He followed up on that by shadowing other family physicians in our area.
When he enrolled in a college halfway across the country, I thought he might come back with plans to become a subspecialist because although Brett has seen all the positive things that family medicine has to offer, he is aware of the payment issues and other challenges we face, as well.
He also knows the time demands of being a family physician. One year, Brett and I signed up for a father-son basketball camp. The night they were taking photos of the sons with their fathers, I got tied up at work and was late. The other kids got a nice memento to remember the fun experience they shared with their dads, and Brett got a photo of himself. Alone.
But Brett has stayed the course. Now in his fourth year at the University of Nebraska Medical Center, he is a student member of the Nebraska AFP Board of Directors. This past weekend, I represented the AAFP at the Nebraska AFP's annual meeting, and my son was there as a member of our state chapter's board. It was a proud moment, and Brett has given me plenty of those.
He's served as president of the Student Alliance for Global Health and in the student senate at UNMC. But the point of this post isn't just for me to say how proud I am of my son. It's to point out the importance of mentoring. Brett obviously got an early start, but if we expose students -- in high school or college -- to the broad scope of family medicine and show them the relationships we develop with our patients, they will understand and value what we do.
And some, no doubt, will follow.
Robert Wergin, M.D., is president-elect of the AAFP.
Turn the Page: Saying Goodbye Not Easy for Graduating Resident, Patients
My residency is almost over. By this point in our careers, all graduating family medicine residents have spent four years in college, four in medical school and at least three years (sometimes four) in residency. You might think there would only be elation, joy and relief on the cusp of completing this grueling, 11-year process.
It has been years of 80-hour (or more) workweeks, cafeteria food (if you even have time to go there), missing your kids' school events, missing your spouse's birthday, being that relative who misses weddings, funerals and Mother's Day -- all while struggling to pay the bills. By this time in some other industries, we might have made a fortune by working such long hours, but instead we are in serious debt. Most of us owe more in student loans than we do on our mortgages.
| The bond a patient can develop with his or her family physician is amazing. Here I am with a patient who is interested in following me to my new practice -- more than two hours away.
So why would anyone sign up for the not-so-enticing path I just described?
Three words: the patient relationship.
As a medical student, you get limited exposure to continuity of care because rotations are usually eight weeks long, at most, so the number of repeated contacts with a specific patient or family is limited. Family medicine residency, however, focuses on relationships and caring for a patient across all settings, whether that be at the physician's office, a nursing home, the patient's home, a hospital or a hospice facility.
I've delivered babies and handed them off in the delivery room to a grandmother who is also my patient. Moments like that give you more enthusiasm and energy than a venti coffee ever could.
What I'm realizing as I near the end of my training is that patients get more than quality medical care from our interactions. They develop a bond with us that has far-reaching implications. My patients feel like they know me as a person, not just as a diagnostician. We have conversations about their priorities and how their financial and logistical realities relate to treatment. We grow to understand each other.
I don't think most patients in a residency training program realize how much we appreciate them. They quite literally provide the foundation for our specialty training. Most of us can remember our first patient in the office, our first well-child visit and our first reading of a patient's obituary. We remember the cards and notes patients send us, but most importantly, we remember how they humbled us with their complex medical cases.
I recently added a little spiel to each patient encounter I have about how I will be leaving the program and transitioning them to another resident in July. This conversation fails to get any easier with repetition.
I have had multiple patients cry. Several have stood up and hugged me, and a lot have asked for directions to where I am going next.
Through this process, I have noticed a difference between two groups of patients. Those who I inherited from a former resident (or from generations of residents in my program) smile and say I better pick a good physician to take my place. In contrast, the patients I acquired from the emergency room or hospital and brought to this practice during my residency -- many of whom had never had a family doctor before -- tend to enter a brief panic. I explain that the same attending physicians who have been joining our visits occasionally are still going to be here to precept the residents, that the incoming class of residents is wonderful, and that the same nurses will answer their phone calls. Some of those patients say that they don't want a new doctor, and they will drive the 2 1/2 hours to my new office to see me.
I've heard over and over, 'I've never found a doctor like you,' 'You listen to me,' 'You know my whole family.' They say they like being able to come with their kids to one big, long appointment for everyone. They like to see a face they know if they get admitted to the hospital. And women have told me they want to have the same doctor take care of them during and after their pregnancy and see their new babies.
To all of these cares and concerns, there's really only one reply I can give, and it's a reassuring one: That's family medicine. I am a family doctor, and they will get the same care and have the same opportunities across generations with their next family doctor. I am nothing special within family medicine; it's family medicine that is special.
There are more than 3,000 family medicine residents who will be graduating soon. What tips do you have for other third-year residents who are preparing to say goodbye to their patients? If you've had a particularly gratifying goodbye, please share your story in the comments field below.
Kimberly Becher, M.D., is the resident member of the AAFP Board of Directors.
Medical Student Advocates Make Big Impression on Legislators at FMCC
When I sat down at my state's table at the Family Medicine Congressional Conference (FMCC) earlier this month, I was quite surprised to find two of my Quillen College of Medicine students already sitting there.
Melissa Robertson, left, and Jessica White, right, seniors at East Tennessee State University's James H. Quillen College of Medicine, met with legislators from their state -- including Rep. Marsha Blackburn, center -- during the Family Medicine Congressional Conference in Washington.
The AAFP provides two scholarships for students and two for residents to attend this annual advocacy event in Washington, which trains family physicians (and future FPs) to advocate for their patients and for family medicine. The AAFP Foundation also awards a student scholarship, so I thought perhaps these students -- Jessica White and Melissa Robertson -- had earned scholarships to attend. But as it turns out, they decided to make the trip from Tennessee at their own expense because they thought it was an important learning opportunity.
In fact, 55 students and residents from around the country attended FMCC this year. Their spirit and efforts give me great hope for our future.
FMCC provides a remarkable blend of advocacy education and skills development along with the chance to immediately put those learnings into action. On the first day of the conference, we heard from advocacy experts, representatives of federal health agencies, congressional staff and two legislators.
On the second day of the event, more than 200 students, residents and practicing physicians took what they had learned on day one to Capitol Hill to talk with legislators and staff about issues such as physician payment, education and workforce. One of the best parts of this conference is the opportunity to share personal stories with our legislators. There is no question these conversations have a big impact and are one of the reasons face-to-face meetings have such potential to make a difference in promoting our interests.
Legislators and congressional staff hear from the AAFP Board several times a year, but stories from members can be so important because they speak directly to legislators who are elected to represent their state and district and tell them how constituents are being affected by the various challenges family physicians face.
For example, Jessica and Melissa, two seniors who have matched into family medicine residency programs, were able to talk about important education issues during our visits. As we reviewed the key points from the previous day's advocacy training sessions, we realized their presence was especially serendipitous given their paths to family medicine.
Jessica matched in Asheville, N.C., just across the mountains from Quillen. She will join the family medicine residency at the Mountain Area Health Education Center(MAHEC), which is a teaching health center. These centers provide creative approaches to training family medicine residents based in the communities that most need them.
Under the Teaching Health Center Graduate Medical Education (THCGME) program established as part of the Patient Protection and Affordable Care Act, GME funds go directly to the centers. However, the THCGME program, which started in 2011, is only funded through 2015.
The program is now completing its third academic year, graduating its first cycle of residents and sending almost 300 primary care physicians into the workforce. It should come as no surprise, then, that extending funding for the teaching health centers program is one of the Academy's top legislative priorities during this congressional session.
Without such an extension, Jessica's residency program cannot guarantee her salary for all three years of her training. Accepting this offer represents a remarkable leap of faith on her part. It also provided a great example to the people we talked with about the importance of extending funding for these programs.
Melissa is a nontraditional medical student and former elementary school teacher, so she brings a critical, real-world perspective to both medicine and medical education. She came to the AAFP's National Conference of Family Medicine Residents and Medical Students two years ago and got the advocacy bug there. During that conference, she was elected to the Society of Teachers of Family Medicine's Board of Directors and now is serving her second term.
Melissa, who matched to our East Tennessee State University residency program in Bristol, has a real knack for asking common-sense questions that help cut through administrative layers. Her particular path has made advocacy issues such as student debt and the primary care salary gap extremely important in her world.
Together, the three of us considered the day's congressional visits and how to tell these stories in meaningful ways. First up was Tennessee Tuesday, which is a weekly breakfast during which Sens. Lamar Alexander, R-Tenn., and Bob Corker, R-Tenn., welcome everyone visiting from our home state to Washington. They are always excited to meet their constituents and were especially eager to meet these medical students.
Next, we met with Rep. Marsha Blackburn, R-Tenn. Jessica's family lives in Blackburn's district, so this connection immediately lent relevance to our advocacy stories in a way that had not happened in my previous conversations with the congresswoman. Our legislators certainly pay attention to their constituents, and we were able to get some unscheduled time and a photo opportunity with Blackburn.
Moreover, during a subsequent meeting with Blackburn's health aide, we were able to talk about topics in a totally different light because of the students' circumstances. This latter meeting also showed Jessica and Melissa the critical role legislative aides play in setting agendas for elected members of Congress.
We then met with Rep. Phil Roe, M.D., R-Tenn., who represents Quillen's district. Originally, we had been scheduled to meet his legislative aide, but when he heard there were two medical students from his district present, he immediately made time to meet with them. In fact, their stories were so compelling that he asked if we would walk to the Capitol with him because he had to vote, but he did not want to cut short his discussion with Jessica and Melissa.
Jessica’s story about her uncertain financial situation at the residency program in North Carolina grabbed Roe’s attention in a way my previous discussions with him could not, in part, because Christ Community Health Services in Memphis is one of more than a dozen residencies that are expected to start receiving THCGME funds beginning in the 2014-15 academic year.
As a nontraditional student who made a huge financial sacrifice to become a physician later in life, Melissa's story also sparked his interest immensely. He specifically asked her about her medical school debt and how that influenced her and other classmates in their specialty choice.
Roe also took notice when Melissa addressed another of our advocacy points -- the need to renew and increase commitments to GME, such as through Title VII funding, and to consider how we can increase the number of students choosing primary care specialties.
As he prepared to walk to the Capitol, Roe asked Melissa and Jessica whether they would come back to his office after he returned from the vote because he wanted to talk more with them.
After we finished talking with Roe, I left for a media interview and then headed out of town for the Minnesota AFP meeting. By this point, Melissa and Jessica were seasoned advocates, and I knew our messages were in good hands and would be heard in powerful ways. They went on the next visit on their own and later went back to Roe's office.
The three of us texted about the overall experience later, and we made plans to improve how we present the need for advocacy to students and our residents. In fact, Melissa is meeting with the Quillen Family Medicine Interest Group this week to talk about how to prepare for the Academy's resident/student conference scheduled for Aug. 7-9 in Kansas City, Mo. That is the "pay it forward" concept in action.
So, what can you do to pay it forward? In addition to the scholarship opportunities mentioned above, the Association of Family Medicine Residency Directors sponsors 10 scholarships for residents to attend FMCC. But we could do more. Family medicine residencies, departments of family medicine, state chapters and even individual practices can help send students and residents to FMCC. Exposing students and residents to advocacy, a critical part of how we can improve the care of our patients, can pay huge dividends for those FPs-in-training and for our specialty.
Reid Blackwelder, M.D., is president of the AAFP.
Chance to Shape FP Training, Education Prompts Career Move
I've lived my whole life in Indiana. My children -- like the three generations before them -- grew up here as well. Those children, now adults, still live near us here in Indianapolis.
My education and training -- from Ball State University to the Indiana University School of Medicine and the family medicine residency at Community Health Network -- all happened in the Hoosier State.
|I'll be leaving my home state of Indiana behind next month to start a new job as the AAFP's vice president of education at the Academy's offices in Leawood, Kan.|
My career started in rural private practice in the
small town of Flora, Ind. -- population 2,000 -- before I came back to
Indianapolis as faculty at the residency where I had trained. I stayed with
Community Health Network for more than 20 years as residency director, vice
president of medical affairs for two of its hospitals, chief medical officer
for the entire eight-hospital network and, most recently, as the network's
chief academic and medical affairs officer.
So what would it take to get me to leave my home state? Nothing less than a chance to make a positive, lasting difference in the education and training of medical students, family medicine residents and our active members on a national scale. That, of course, goes hand-in-hand with enhancing the quality of care delivered by our specialty.
I'll be leaving my position on the AAFP Board of Directors on May 3 (after the Board meets during the Annual Leadership Forum and National Conference of Special Constituencies). Nine days later, I'll start a new journey in Leawood, Kan., as the Academy's vice president for education.
I feel as though I have been training for this role for the past three decades. The majority of my career has been devoted to medical education and improving quality of care, so it's a natural fit. For example, for the past five years, my job responsibilities have included oversight of medical student education at our network's hospitals, our residency programs and the CME offerings we produce.
At the AAFP, I will be responsible for the Academy's efforts related to medical education and CME, including the education and training of medical students and residents; student interest in our specialty, including federal policies that affect it; and CME curriculum development, production, accreditation and regulations.
Many challenges await, but I'm excited to lead the AAFP's excellent staff who work in these areas, including those who support two commissions -- the Commission on Continuing Professional Development and the Commission on Education -- composed of family physicians who volunteer their time to address these vital issues.
We must ensure that medical students have top-notch exposure to family medicine and that they have good experiences when they do. That can be difficult, in part, because practicing physicians who enjoy teaching have competing demands for their time. But there is no doubt that good role models help build student interest in the specialty.
We are facing a shortage of primary care physicians that likely will worsen because of an aging population, a sizable number of physicians nearing retirement and a large number of patients gaining access to insurance as a result of health care reform. More -- and more targeted -- funding for family medicine residencies is needed to meet this demand, and GME funding and reform are high on the list of the Academy's legislative priorities.
Family physicians want to keep up-to-date with evidence-based CME, and the Academy will continue to improve and expand its offerings to ensure timely and convenient access to high-quality CME. We will build on the strong programing currently offered, and we always appreciate input from our members on how to better serve their CME needs.
On a more personal note, the challenges of this role also include succeeding the immensely accomplished and respected Perry Pugno, M.D., M.P.H., who is retiring after 40 years in family medicine, including 15 years of service to the Academy.
The challenges are great, but so are the opportunities. The key to improving health care in this country is to make it more primary care-oriented by placing greater emphasis on prevention and wellness. Family medicine is the specialty that does that better than any other. I am proud to have this opportunity to further strengthen our specialty through continuing efforts to enhance medical education at all levels.
Clif Knight, M.D., is a member of the AAFP Board of Directors.
I Matched! And It's Good News All Around
I knew I wanted to be a family physician before I ever made it to medical school. As a college student with an interest in medicine, I shadowed an anesthesiologist and an orthopedic surgeon before our family physician suggested that I shadow one of his partners. It was that experience that set me on this path.
I was impressed that this family physician had patients who had been in his care for 30 years. He knew entire families and had a deep connection with the community. I spent time at that practice during my Christmas breaks and summer vacations, and it wasn't long before I realized, "This is who I am, and this is what I'm supposed to do."
Friday I got the good news that I had matched at the University of Alabama-Birmingham's Huntsville Family Medicine Residency. My classmates Libby Van Gerwen (who matched in internal medicine-primary care at Tulane University School of Medicine) and Brittany Holley (internal medicine at the University of South Alabama College of Medicine) also had reason to celebrate.
One particular patient encounter stands out in my memory. The physician had to inform a woman that she had cancer, and it was inoperable. Despite the horrible news, he was reassuring and told her that she wouldn't leave that day without a plan. The level of trust she had was clear. She valued his opinion and wanted his advice. It was a defining moment for me.
forward a few years to last Friday when I -- like thousands of other medical
students around the country -- received my National Resident Matching Program letter.
I had hoped to stay at the University of Alabama-Birmingham's Huntsville Family
Medicine Residency. I've been here two years for
clinical training, and I wanted to stay here for residency. I know the faculty, the community and the hospital. It's a good school and a
I felt good about my chances of staying, but you don't know where you're going until you open that envelope. It's a big moment after four years of medical school and four years of college. This is your career, the rest of your life.
Fortunately, I got the news I had hoped for, and I'll be staying in Huntsville. Nearly 10 percent of my class matched to family medicine, and news was good for our specialty nationally, as well. The number of medical students choosing family medicine increased for the fifth year in a row, and the number of U.S. seniors matched to family medicine also increased.
Although the numbers were encouraging, we have a long way to go. Our country is facing a shortage of primary care physicians. And it's projected that within a few years, we will be graduating more medical students than the number of residency spots available. The system clearly needs work.
One thing that would help would be having more family physicians such as the one I shadowed back in my hometown. If you're a family physician with a passion for what you do, reach out to students in your area or from your alma mater and show them what you do. You just might give a future family physician their defining moment.
Tate Hinkle is the student member of the AAFP Board of Directors.
Building the Family Medicine Pipeline
When I was running for AAFP President-elect, I said during a question-and-answer session at the Congress of Delegates that I would try to say yes to every opportunity that came my way. This can be daunting because there are so many opportunities to represent the Academy each week.
However, being president truly is a once-in-a-lifetime experience, and I have tried hard to follow through on my promise. I do everything I can to jump at invitations from state chapters, to medical student functions and other opportunities to meet with AAFP members all over the map.
|Family Medicine Interest Group advisers discuss ways to increase student interest in our specialty during a recent meeting in Nashville, Tenn.|
I recently had one such opportunity on my way back from the Nevada AFP meeting. I was invited to stop in Nashville, Tenn., to be a part of a dynamic workshop for Family Medicine Interest Groups (FMIG) faculty advisers. This leadership summit was an opportunity to bring together medical school and residency faculty and staff from all over the country who serve in adviser or support roles to the student-run FMIGs at their own or an affiliated medical school. One of the most important reasons for doing so is to develop relationships and create a sense of family in this group.
There is a significant turnover in this group because the role of student group adviser often falls to the newest faculty member in a department. In fact, many of the folks present had been involved with their FMIG's for less than a year. This makes it important for us to bring people together so we have an exchange of information as well as support systems for this incredibly important work.
FMIG's are remarkable. There is a great deal of direct student leadership involved for each medical school's group, with a select group of medical students elected or appointed to serve in roles to connect and coordinate between FMIGs. The AAFP recently selected its 2014 FMIG Network Regional Coordinators, who hail from Arizona, Illinois, Missouri, Pennsylvania, and Washington, D.C. These dedicated students work tirelessly to share information with FMIG student leaders at each institution and to provide opportunities for those leaders to connect and share best practices, much like what was done at the FMIG Faculty Adviser Summit.
The advisers all play different roles in this process, depending on their institution, environment and engagement of leaders. They have the responsibility for finding ways of sharing the excitement and passion for family medicine with students during their first two years of medical school, through the FMIG and other department efforts.
Most FMIG's are mainly made up of, and led by, first- and second-year students. Third-year students are on their clinical rotations and have less free time, and fourth-year students have often already committed to specialties. The group of advisers focused some of its discussion on how to keep third- and fourth-year students engaged in FMIGs to help support a family medicine specialty choice among the third-years and to use the fourth-years as mentors for the junior students.
This is a huge and critical aspect of addressing our pipeline challenge. The more we can tell medical students about the joys of family medicine, the more we may maintain their interest as they begin choosing specialties. In these challenging times, the message that our country truly needs primary care physicians is one that medical students need to hear, alongside the message of what's in it for them, which is the opportunity to have the greatest impact on population health and a specialty that provides variety, excitement and deep patient relationships.
This meeting allowed us to discuss the frustrations and the opportunities of a rapidly changing health care system and environment. I promised to take what I heard from the advisers back to the AAFP Board of Directors to help inform our deliberations related to developing our workforce pipeline.
I hope all of our active members work with medical students when given the opportunity. When students are early in their training, they are eager to see true patient encounters. At the same time, we have to recognize how impressionable students are. We need to make sure that our love of our patients and our thankfulness for the opportunities to answer our calling is what comes through. The more we do this, the more students will see that no other specialty creates the opportunities to get to know patients, make a difference and to truly impact families the way family medicine can.
Active AAFP members who would like to be connected with an FMIG faculty adviser at a medical school in their area may contact student interest strategist Ashley Bentley. Thanks for being a part of the learning process.
Reid Blackwelder, M.D., is President of the AAFP.
Support for GME Reform Exists; Agreement on How is Lacking
The Council of Academic Family Medicine (CAFM) recently released a report outlining its four pillars -- pipeline, process of medical education, practice transformation and payment reform -- for advancing primary care physician workforce reform. The article also emphasizes the importance of advocacy moving forward.
In an interview with AAFP News Now, AAFP Vice President for Education Perry Pugno, M.D., M.P.H., the Academy's liaison to CAFM, said the biggest barriers to implementation of these concepts are "the tremendous need for change in how U.S. graduate medical education (GME) is financed" and resistance to reform by people who benefit financially from the flawed system already in place.
Although there is widespread recognition of our nation's need for more primary care physicians, there is not agreement in Washington on how to meet that goal. Two bills have potential to greatly enhance efforts to increase the family physician pipeline, but the lack of progress in moving either bill forward illustrates how difficult -- and frustrating -- the political environment in Washington can be.
In 2011, Reps. Cathy McMorris Rodgers, R-Wash., and Mike Thompson, D-Calif., introduced a bill that would establish a pilot project allowing a portion of GME payments to go directly to non-hospital, community-based primary care residency programs. McMorris Rodgers and Thompson reintroduced the bill, which has support from the AAFP and other physician organizations, in the current session of Congress, but no companion bill has been introduced in the Senate. AAFP staff members are working with Senate staff members to try to find a sponsor for the bill in the Senate.
Meanwhile, Sen. Bernie Sanders, I-Vt., has introduced legislation to reauthorize the teaching health center program, which is set to expire in 2015. Republicans historically have been supportive of community health centers (federal funding for the program doubled under President George W. Bush), but thus far, Senate Republicans have been reluctant to put their names on a bill that specifically supports teaching health centers, a concept initiated as part of the Patient Protection and Affordable Care Act. To date, Sanders' bill has nine other co-sponsors -- all Democrats.
Family physicians might not give GME a second thought once they leave residency, but the way GME is funded affects the types of physicians we produce. Funding an outpatient residency through an inpatient facility doesn't work. And the proof that the existing system doesn't work can be seen in decades of failing to adequately increase the primary care workforce.
Providing GME funds directly to residencies would be a more efficient and more logical process. For example, CMS pays resident salaries in my program based on how much time the residents spend at our local hospital. Thus, residents have to work enough hours in the hospital to get paid, regardless of whether the training they need is hospital-based. Does that make sense for a specialty where the majority of physicians are more likely to practice in an outpatient setting?
In the teaching health center model, residencies are funded directly, and an education committee -- not a hospital -- dictates how residents are trained.
Indirect medical education payments also are an issue because CMS leaves distribution of those funds to the discretion of hospitals. Hospitals have legitimate claim to some of that money -- which is roughly $40,000 per resident -- because they provide residents with meals, sleep rooms and more when they are working at the hospital. Although some hospitals are good about sharing those funds, others are not. In my case, our residency receives no money from indirect payments. With 20 family medicine residents (including our first-year residents pictured with me above), imagine what we could do with a fraction of the $800,000 going to the hospital.
The federal government invests $13 billion a year on GME, but those funds need to be used appropriately to produce the workforce the nation needs. The family physician pipeline once again will be one of the key topics during the annual Family Medicine Congressional Conference, scheduled for April 7-8. I hope to see you in Washington.
Daniel Spogen, M.D., is a member of the AAFP Board of Directors.
Chemical Spill Puts Resident, Hospital to Test
Jan. 9 was like any other Thursday. I worked a full, busy and ordinary day as a family medicine resident at my hospital in Huntington, W.Va. Then I drove 30 minutes home to Culloden, W.Va.
It's worth noting that A) Huntington and Culloden are served by two different water treatment plants, and B) I didn't listen to news radio in the car.
On the way home, I stopped to buy groceries for the coming weekend. Although busy grocery stores are nothing unexpected, what I saw on this night was different. It was a new level of frenzy. Still, I didn’t think much of it. Many people in my community had been without power for a few days because of a recent storm. I thought maybe they were restocking their freezers and refrigerators.
I finished my shopping and went to the check-out line. That's when another shopper said to me, "You don't have any water. Why don't you have any water?"
I'm not accustomed to having my shopping cart critiqued, but I was willing to play along.
"Why do I need water?" I asked.
That is how I found out that an estimated 7,500-gallon spill of 4-methylcyclohexane methanol -- a chemical used to treat coal -- had been detected in the Elk River, less than two miles upstream from our area's water treatment plant.
At that point, I was too late. There was no bottled water left on the shelves in that store or any other store in town. I went home to a weekend without water -- me and 300,000 other people.
A state of emergency was declared for a nine-county area that includes Charleston, the state capital and West Virginia's largest city. We were told not to use tap water for any reason, which meant no consumption, no bathing and no cleaning anything.
Schools and businesses closed. The West Virginia National Guard was activated to distribute drinking water and assist residents affected by a chemical spill. Volunteers, like the Poca High School students in the photo above, handed out cases of bottled water to people in need.
Fortunately for me, my hospital and residency program weren't affected. I was able to shower at the hospital and fill water bottles to take home. My fellow residents were wonderful, watching my 6-year-old during his unplanned vacation while I was on call, and they also allowed my husband and son to shower or bathe at their homes.
In the bigger picture, it was fortunate for others in the area that the hospital was unaffected because without water, other health care facilities in the nine-county area were unable to care for their patients.
To transfer patients from one facility to another, you have to have an accepting physician on the receiving end. Although other academic and private admitting services at my hospital declined to accept transfers from the affected facilities in Charleston, our family medicine service did. If we hadn't taken these patients, they would have been sent to facilities in Ohio or Kentucky, and we didn't want that to happen to them.
And although I feel good about the care we were able to give, we were quickly overwhelmed. In addition to patients transferred from other hospitals (after being admitted for reasons unrelated to the spill) we also treated numerous patients who were exposed to the tainted water and were suffering with nausea, rash, headache, diarrhea and vomiting.
We also experienced a surge in patients suffering from influenza. Without access to water, people couldn't wash their hands, and the flu spread rapidly within a few days.
Soon, our hospital was full. People were admitted with no bed to go to, so gurneys were set up in the hallways with makeshift bed numbers taped to the walls.
People pitched in and helped out because in a crisis situation you have to adapt and be flexible. Residents who weren't on call offered to help. We stepped up and took care of patients who needed help.
Finally, on Jan. 15, patients from Charleston started going back to the facilities they came from.
This past weekend, people in my community were allowed to flush their pipes -- running faucets and showers, dishwasher and washing machines -- to clear the tainted water from the system. The process made the house smell, and the stuff coming out of the pipes was awful. But it's progress and a step closer to getting back to normal.
Would you be ready if a crisis affected your community? The AAFP has resources available to help families, medical practices and communities prepare for disasters.
Kimberly Becher, M.D., is the resident member of the AAFP Board of Directors.
Editor's Note: Photo is courtesy of Staff Sgt. De-Juan Haley via Wikimedia Commons.
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.
Residents Can Attest to Demand for FPs
I recently served as a panelist during National Primary Care Week activities at my alma mater, Marshall University's Joan C. Edwards School of Medicine. During our session, one of the medical school students asked me how family medicine might change in light of more mid-levels providing primary care. Specifically, the student wanted to know if demand for family physicians might fizzle.
Family physicians are in demand more than any other
specialty and have been for seven years running, according to Merritt Hawkins. The health care search and consulting firm
said in a report last month that the growing demand for family physicians stems
from the need for employed FPs in hospitals and health care systems.
The number of medical students choosing family medicine increased for the fourth straight year in the 2013 National Resident Matching Program, and more U.S. seniors matched to family medicine than in any year since 2002.
Despite those positive signs, the supply of family physicians is nowhere near balanced with the demand. Researchers estimate that the country needs 52,000 more primary care physicians by 2025.
The fact that family physicians are in demand should come as no surprise to family medicine residents. I receive solicitations daily from recruiters, despite the fact that I'm not looking for a job. I signed a contract more than a year ago for a position that will start in August 2014. Most residents don't sign that early, but I found exactly the kind of practice I wanted to join. The federally qualified health center is a patient-centered medical home with a physician friendly electronic health record. Its reimbursement model includes per-member, per-month fees.
The practice is continually pursuing, and receiving, innovation grants and trying new things, so I'm happy with my choice. I'm not circulating my resume. I don't even have a LinkedIn account. And yet, the calls, e-mails and snail mail keep coming at home and at work every day.
One of my fellow third-year residents -- who is looking for a family medicine job -- said she receives more than a dozen e-mails a day from recruiters.
So what did I tell that student during our panel discussion?
I said that nurse practitioners often specialize, so they can't necessarily improve access to primary care in areas of need.
I said family physicians should work to appropriately incorporate mid-levels into our practices because they can play a vital role on our health care teams.
And, I pointed out that many patients prefer to see a physician, and some will switch practices if they don't think they have proper access to their doctor.
We are in demand by patients and employers, and that isn't likely to change.
Kimberly Becher, M.D., is the resident member of the AAFP Board of Directors.
National Event Can Open Students' Eyes to What Primary Care Is Really About
I came to medical school knowing that I would become a family physician. That goal was driven, in part, by the diversity and complexity of the work family physicians do, caring for patients from birth to end of life. I want to take that comprehensive approach back to rural Alabama, where I'm from, and family medicine is the specialty that allows me to do that.
The choice isn't as clear for many medical students, who often aren't exposed to primary care in their first two years because family medicine and other primary care faculty are underrepresented in most medical schools during the preclinical years.
So, how do we get students more -- and earlier -- exposure to primary care and family medicine?
Next week offers one opportunity to
do just that. National Primary Care Week will be
celebrated at medical school campuses around the country Oct. 7-11, giving
students an opportunity to learn about, and experience, primary care. It's also an opportunity to highlight primary care physicians in leadership positions. For example, family physician and State Health Commissioner Cynthia Romero, M.D. -- pictured here with family medicine interest group leader Penelope Carter -- was the keynote speaker at the University of Virginia School of Medicine's Primary Care Week last month. (UVA celebrated a bit early).
During my second year at the University of Alabama, Birmingham, I was responsible for planning National Primary Care Week activities on our campus. Each day, we brought in a speaker from a different primary care specialty -- family medicine, internal medicine, OB/Gyn and pediatrics -- who talked about why primary care is the foundation of patient-centered care and how each specialty plays an important role.
There is a myth perpetuated in some academic settings that family physicians treat coughs and colds and refer everything else, but family physicians do so much more than most students realize. It's a powerful experience to have a physician from the community come to campus and describe a typical day in practice, which could include seeing patients in clinic, making hospital rounds, doing procedures, delivering babies and practicing broad-scope primary care.
Although I knew about that extensive scope of practice early on, I had numerous students come to me throughout the week, saying, "I didn't know this about family medicine," or, "I didn't know that about internal medicine."
The upcoming nationwide event has the potential to open students' eyes to what primary care really is about and what it looks like outside of an academic medical center.
So what's on tap for this year's National Primary Care Week? We've heard from family medicine interest groups around the country, and some obvious themes stand out. Students want more information about health care reform, and several schools are featuring speakers or panels that will look at how the Patient Protection and Affordable Care Act will affect primary care. Academy resources available for National Primary Care Week include a PowerPoint presentation with facts and analysis of the Affordable Care Act.
The AAFP also has presentation materials designed to educate students about the patient-centered medical home, which is another common topic for National Primary Care Week activities.
Team-based care and interdisciplinary panels also appear to be popular choices. Other intriguing offerings include residency fairs, flu-shot clinics and clinical skills workshops.
I encourage my fellow medical students to seek out activities on your campus during National Primary Care Week (and bring a friend) and throughout the year. Your colleagues have worked hard to design programming that will give you key insights and understanding you will need to make an informed specialty choice within the next few years. Regardless of whether you choose family medicine like me, we're all going to be working together in an evolving health care system characterized by an increasing demand for family physicians to carry us to better patient health outcomes, better patient experience of care and lower health care costs.
So, what is your medical school doing?
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