Volunteering Benefits Patients, Communities and the Docs Who Do It

Are you safe?

Have you eaten today?

Did you take your medication?

Those questions can be heard every day in any primary care clinic in the country, but they stopped me in my tracks when I heard them recently on a sidewalk in Washington, D.C.

In town to lobby Congress about physician payment and in the shadows of the U.S. Capitol, I heard those words spoken by a primary care physician tending to a homeless man on the city streets. For Catherine Crossland, M.D., medical director for homeless outreach services at Unity Health Care, working the streets of Washington with a backpack full of medical supplies is a regular part of her job. My brief glimpse of her inspiring work brought to mind how much good primary care physicians do every week through volunteering.

The AAFP's vision is to transform health care to achieve optimal health for everyone. Health care reform has expanded coverage to millions of people who previously were uninsured or underinsured. But even after the Patient Protection and Affordable Care Act is fully implemented, the number of Americans without insurance will still stand at 15 million to 30 million, depending on how many states fail to expand Medicaid coverage.

In other words, there are people who are falling through the holes in our health care safety net today and who will continue to do so for our foreseeable future.

We still have a job to do, in D.C. and in all our communities.

The uninsured and underinsured receive primary care in three places: community health centers, free clinics and through the generosity of physicians in private offices. In fact, the average family physician provides free or discounted care to eight patients per week.

The years I spent volunteering at the Stout Street homeless clinic in Denver were tremendously challenging and rewarding. Caring for the homeless raises questions we never had to consider in my then suburban practice. How do you dose insulin when the next meal is uncertain?

Of course, volunteering doesn't have to be anything as time-consuming as providing care at a free clinic. Family physicians make a difference every day in their communities, from making time to see the extra uninsured patient to teaching medical students in the office or presenting Tar Wars in the local schools.

During my Academy travels, it always amazes me to meet the innumerable family docs who make a difference even beyond their medical expertise by coaching youth sports or getting involved with their local school boards.

And the interesting thing is, when we help others, we are also helping ourselves. Volunteering enriches our lives in many ways. It connects us to others, refreshes our souls and even has medical benefits. Research has shown that people who volunteer have less depression and less stress than those who do not volunteer.

So, have you made a difference in the life of another today?

Thank you for what you do every day. Your patients, your community and you are healthier for it.

 Jeff Cain, M.D., is president of the AAFP.

Posted at 02:58PM May 31, 2013 by Jeffrey Cain, M.D.  |  Comments[1]

We All Play a Role in Mending Our Broken Health Care System

The role of an AAFP officer can be challenging. We have intense travel schedules; deal with myriad government agencies, health care organizations and committees, along with the accompanying alphabet soup of abbreviations and acronyms to memorize; represent diverse opinions within our own membership; and challenge our elected officials at every level to make changes in our dysfunctional health care system. 

That system is broken, and our country seems unable to move forward in addressing this critical failure despite great need. Whenever I get frustrated, however, I can count on reminders of why family physicians are so important, and how we must strive for success.

One of the many hats of a physician is to be a good neighbor and member of the community. The other day, my wife and I received a call early in the morning from our neighbor. She asked if we could come over and help her husband, who was outside yelling. We immediately went over and found that he had slipped and fallen. He complained of severe pain in his hip, and I was pretty sure it was broken. We moved him into a chair, waited for the emergency medical services (EMS) team and made sure he was on his way to be evaluated. Everything went smoothly, and it seemed the system had been effectively mobilized.

Later that afternoon, I followed up and found out that he had gone to the emergency room (ER), had an X-ray that, supposedly, did not show any fracture and was sent home. Unfortunately, no one made sure that he could actually transfer from the stretcher to a wheelchair and from the wheelchair to a car. They did not check to see whether he could walk.

So, when he finally got home, his wife had to find another neighbor to get him into the kitchen, where he sat for five-and-a-half hours unable to move and in excruciating pain. She finally called EMS again, and he was taken back to the ER, where this time a CT scan was done. 

The CT scan did show a fracture, and the report noted that the original X-ray revealed the fracture as well. He was admitted for surgery. I went by the next afternoon, and he was in a hospital bed after having been in the ER for several hours. At this point, the orthopedist had not yet decided when he might have surgery. He had not received medications and still was in agony. Neither he nor his wife had any idea what the plan was or when a plan might be implemented. His care was complicated by the fact that he and his wife are extremely hard of hearing, and he has early dementia. 

As I was headed out of town -- again on Academy business -- I called his family physician, who is a friend of mine, to make sure he was aware that his patient had been admitted. The physician had not been notified during the ER visit, and he appreciated the opportunity to go and provide continuity of care for this longstanding patient.

Certainly, things happen. Even in the best systems, some things don't go smoothly. However, such problems reinforce the fact that family physicians must be foundational to any health care system we have, and that we must work hard to create this reality. 

We have to be sure that we do thorough histories and physical exams and not just rely on tests. If a test result doesn't support our clinical judgment, then we have to believe the patient and not the test and keep pushing until we get an answer. 

We need to be sure that patients are seen as people and not as test results and assess that they actually can do the basics, such as stand and walk, if we truly are going to provide appropriate care. 

We need to address people's needs, especially acute pain management. 

We need to communicate to ensure that the right people are in the right place at the right time to provide care. We also have to communicate clearly so that our patients know what we are doing and why. 

Finally, we just have to care. I was extremely disappointed in our health care system in this case and felt that at most of these steps, we let this gentleman and his wife down at a critical time of need. Health professionals as a whole must do better.

Your voice is critical to helping us move our system forward. We must ensure the message of family medicine resounds loud and clear with our representatives, our physician colleagues and other members of the health care team, and our patients.

Thanks for all you do for our patients, our communities and our country.

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

Posted at 03:45PM May 24, 2013 by Reid Blackwelder, M.D.  |  Comments[2]

Nurses Play Vital Role

Trenton is a tiny town in the northwest corner of Georgia. If you could pick it up and move it on the state map, you could just about squeeze it into nearby Cloudland Canyon State Park. Travelers who aren't headed to the park might not notice Trenton unless they need a place to stop on Interstate 59 on a drive from Birmingham, Ala., to Chattanooga, Tenn.

Trenton has fewer than 2,000 residents, but it is the seat of Dade County -- by default. It is the only incorporated town in the county.

It was there, in rural Georgia, that I started my first job out of residency 25 years ago on a National Health Service Corps assignment. I had studied medicine in Atlanta and moved on to residency in Augusta. Now I was a big-city outsider in a small town.

I knew no one.

Verenice Hawkins, R.N., helped changed that.

Verenice was the nurse for the local health department and, as such, was a lynchpin in the community. People knew and trusted her. She helped spread the word about me, and she had good things to say. That was just one of the nice things she did to help me find my way during my four years there.

Long before anyone ever uttered the words "patient-centered medical home," Verenice and I -- along with my two nurses, med tech and front office staff, the local emergency medical services, two chiropractors, one pharmacy, and a physical therapist -- worked together to give our patients a medical home. We communicated, cooperated and coordinated the care we provided to our community.

I left Trenton in 1992 to take a job at East Tennessee State University, and I had not heard from Verenice for years until last week when she reached out to me … on Facebook! She's 80, but she is still working and making a difference. She says she can't fully retire because her community and patients need her, and she's still passionate about what she does.

So this week -- which happens to be National Nurses Week -- I have been thinking a lot about Verenice and the other nurses I have worked with through the years.

Today, the PCMH model is much broader than the small-town medical home Verenice and I provided two decades ago. Now it includes dieticians, physician assistants and so much more. But at its core, team-based care is about doctors and nurses working together for our patients.

Much has been made of the fact that our country is facing a shortage of 45,000 primary care physicians by 2020. But we also should note that an even larger shortage of registered nurses -- 260,000 -- is projected by 2025. We need more primary care physicians, but we also need more nurses. Both pipelines need to be addressed to meet patient needs.

Thank you to all the dedicated nurses who work so hard to care for patients and are critical, valued members of our health care teams.

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

Posted at 01:30PM May 10, 2013 by Reid Blackwelder, M.D.  |  Comments[0]

A New Approach to Recruitment and Retention

We invest years of time and energy into our more than 460 family medicine residencies -- selecting, training and preparing our bright new family doctors. But how well do we help our recent graduates find their ideal practice? And once they select a community in which to practice, who does the follow up to ensure that the "marriage" is a success?

What if there was a program for newly minted family doctors looking to find their ideal practice? What if the concept of the National Resident Matching Program (i.e., the Match) was applied to help rural and underserved communities showcase their unique opportunities and compete on equal footing with large health system recruiters?

Let's call it FamilyDocMatch.com.  

Perhaps there would be an application that included a personality survey and a desired practice profile, and for recruiting sites a detailed community profile emphasizing their uniquely attractive characteristics specific to workload, patient panel, call demands, scope of practice and community setting. 

During a recent visit to the Arizona AFP, I was intrigued by a discussion among new physicians, who voiced difficulty in finding their ideal practice setting. This was a concern especially for those who already were in their first job but looking for a permanent home. They were frustrated by the lack of answers to their questions about jobs, such as, "What is the call load really like?" or "Can I do a reasonable volume of obstetrics?" 

In their minds, there is no useful databank from which to compare and contrast jobs. 

Family doctors are the backbone of our medically underserved workforce, providing vital clinical leadership in our rural and safety net clinics. Family physicians have been the most sought-after physicians by recruiters for three years running. With worsening primary care shortages predicted due to expanded Medicaid eligibility and anticipated physician retirements, competition for family doc graduates is likely to heat up. Imagine, family doctors as a rare commodity! 

Communities that are not part of a larger hospital or health system network struggle to attract young graduates, as do small independent practices. Sometimes, opportunities are missed by virtue of poor visibility. Larger health care systems use central recruiting systems with recruiters who likely are unfamiliar with community specifics and cannot speak to the characteristics of a particular practice. Call responsibilities, patient mix, performance expectations, and practice leadership and philosophy are important aspects to consider in making a successful physician match, but such details are not common on a standard application and often are not available. 

Could a website like FamilyDocMatch.com help?

Consider the legal implications that surround negotiating an employment contract. Physician contracts are complex documents written in legalese with noncompete clauses and confusing eligibility for financial incentives programs. With more family physicians becoming employees, how can we educate ourselves on how to best negotiate appropriate pay for the level of work required? Unsuspecting recruits often are ill-prepared to address these issues, especially after they have left the safety net of residency. What if there was a job discussion site (i.e. a secure chat room) that allowed questions and answers to be posted about contracts? 

We already have sites such as Monster.com, Physician-Jobs.net, MDJobSite.com and PhysicianDepot.com to aid our searches, but job searchers have to sign up and trust that their personal information does not trigger inquiries from headhunters looking to fill a slot and get their commission.

Residencies often hold "Pick a Practice" opportunities for their graduates, and AAFP chapters, the AAFP and the AMA maintain job boards and career postings for those seeking new opportunities at all ages and stages of their careers. But where can you post a description of your ideal practice and share access to communities that might have the ideal placement for you?

FamilyDocMatch.com could be the answer. Just think, a personalized, confidential and reliable service for finding your ideal job that is not based on commercial exploitation and is not run by high-dollar headhunters. It would be a confidential match service dedicated to finding the best possible placement for the applicant. Maybe, just maybe, we can bridge the gap between rural and urban job placement and provide support and encouragement to retain our well-trained recruits in the job of their dreams.

Would a website like this would be helpful? Please share your comments below.

Barbara Doty, M.D., is a member of the AAFP Board of Directors.

Posted at 02:09PM May 01, 2013 by Barbara Doty, M.D.  |  Comments[2]

Overtime: Finishing the Story on Scope of Practice

Once again, the media is reaching out to get family medicine’s perspective on an important health care issue. 

I recently was interviewed about scope of practice issues by The Washington Post.

As a result of that opportunity, I was invited to be on "The Diane Rehm Show,"  a Washington-based radio program that is distributed by National Public Radio and SIRIUS satellite radio. It reaches more than 2 million listeners nationwide.

Happily, AAFP staff members were able to arrange for me to drive to a Knoxville, Tenn., radio station rather than flying to Washington, and I was able to link in and be a part of the discussion. 

The show's other guests were Mary Agnes Carey of Kaiser Health News; Ken Miller, Ph.D., R.N., C.F.N.P., associate dean at Catholic University School of Nursing; and Sandra Nattina, M.S.N., A.P.R.N., N.P., past president of the Nurse Practitioner Association of Maryland.

I was the sole physician, and we had a lively discussion about scope of practice, including whether or not nurse practitioners should be allowed to practice independently.

Unfortunately, there is never enough time to provide all the needed information. I applaud all our members who participated through e-mail, tweets and other social media. It is important, however, to address a couple of issues that needed more time than provided in this hour-long program. Many aspects of this discussion can be misunderstood or misrepresented, so I want to be sure that all of our members -- as well as other health professionals -- hear these points.

Primary care is being defined by some in creative ways, and even in this broadcast, the suggestion was made that nurse practitioners can do everything we do as family physicians. I made it very clear that although many different professionals can provide some primary care tasks and services, nurse practitioners are not family physicians. Both members of the team play critical roles, but we are not interchangeable.

Family physicians are intensely prepared for practice through a nationally standardized process of education, training and certification. Family physicians have a clear and consistent path from undergraduate through residency. By the time they graduate, each and every family physician has an undergraduate degree and a total of 21,000 hours of didactic and clinical training. They also have passed national exams at several stages in their training.

Depending upon the state and system, an NP may or may not have an advanced degree, may or may not have extensive clinical experience, and may or may not be receiving ongoing recertification. Examples of individual NPs with many years of clinical experience being able to provide independent practice cannot be used to overcome an inconsistent and non-standardized educational and training system for NPs as a whole. Moreover, a Health Affairs blog this week pointed out that 63 percent of all NPs are older than 45 years and 15 percent are older than 60 years.  In hard numbers that means of the 155,000 NPs in the United States, 98,000 are older than 45 and 23,000 are older than 60. This means the most experienced NPs likely will soon leave the primary care workforce, emphasizing the need to standardize education and training for their replacements.

Regulatory frameworks are not designed to limit access. Instead, they are in place to ensure patient safety. That is one mechanism by which patients receive the right care from the right provider at the right time. No health care professional can function within their scope of training without a regulatory framework. In scope-of-practice bills all over the country, states are pursuing different kinds of legislation regarding different processes from different providers, which further fragments our already broken health care system and creates more silos of providers.

Despite these changing, yearly legislative discussions, the AAFP consistently has championed the physician-led, patient-centered medical home. We need to be creative in developing these teams in each state given different situations. But the end result must be the right care from the right professional at the right time. Health care team members do not have to be in the same building or practice, but they do need to be involved with connecting the health care pieces throughout each community and system. Only family physicians are uniquely and consistently trained to provide leadership for this type of team-based care.

One of the other guests said during the broadcast that NPs can diagnose and make the right referrals. This concept of treating diseases based on specialty has contributed to the high cost and poor outcomes of our system. Family physicians have the education, training and experience to be able to manage many problems that often are sent by nurse practitioners to high-cost specialty care.

Not everyone with a broken ankle needs to see an orthopedist.

Not everyone with congestive heart failure needs to see a cardiologist.

And not everyone with COPD needs to see a pulmonologist.

I could go on.

We must be the next layer of care and referral when an advanced practice registered nurse reaches the limit of his or her scope, not a limited-practice specialist.

Finally, much is made of the "wealth of research" that supports similar outcomes between care provided by nurse practitioners and family physicians. Although often quoted, this data has been carefully evaluated, and it has several flaws in its methodology. Perhaps most important is that majority of the studies included in this review were from collaborative and not independent NP practices. Generalizing outcomes from nurse practitioner care alone is impossible with this kind of data. Moreover, much of the data comes from studies done after a diagnosis has been made. You cannot compare outcomes produced from following a treatment protocol for a diagnosed problem with those from the process of taking an undifferentiated problem, making the diagnosis and implementing a treatment plan.

There obviously are many other points that are important in these discussions. However, our impact improves when we speak with the same facts and emphasis. Decisions our citizens and politicians make should be with facts in hand, not based on the strong emotion of personal belief or anecdote. This is the essence of informed consent and good communication.

Thank you for your support, keep listening and keep tweeting.

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

Posted at 12:43PM Mar 29, 2013 by Reid Blackwelder, M.D.  |  Comments[4]

Physicians, NPs Should Work Together to Improve Primary Care

If one were to skim the latest headlines about scope of practice, you might think you were reading coverage from the sports pages. The media continues to inject words like "fight" and "battle" into the important discussion about independent practice for nurse practitioners.

This isn't a turf war. It is an issue of patient safety. Nurse practitioners can provide numerous primary care services that are within their scope of practice -- immunizations, screenings, management of acute and many chronic conditions, etc. -- but physicians provide the needed expertise when a patient's condition requires care beyond that level, when it is complex or ill defined. With the ever increasing complexity of care and the rising health care needs of society, collaboration is critical.

This should not be an us-versus-them debate. We should be working together.

I recently participated in a Politico panel discussion on the topic with American Association of Nurse Practitioners President Angela Golden, D.N.P., and others. Leading up to the webcast, some people seemed to be expecting an ugly scene.

Admittedly, many family physicians and nurse practitioners disagree on this topic. However, our stage was set for an intelligent conversation, not an episode of "Jerry Springer." Family physicians work side by side with nurse practitioners every day. Hostility isn't good for any of us or our patients.

I had never met the AANP's president before, and what I found during our time backstage was that we agreed on more topics than we disagreed. We had common clinical interests and had a very collegial conversation.

We're not going to agree with our colleagues -- nurses or physicians -- 100 percent of the time, and that's OK. The key is to make sure those disagreements don't interfere with patient care.

For me, that's what this issue is about -- patients.

Although nursing advocates have been quick to point out a worsening physician shortage, they have ignored the fact that our country also is facing a shortage of nurses. You can't replace one thing you lack with something else you don't have. Primary care should be the foundation of our health care system, and our country needs more primary care physicians, primary care nurse practitioners and physician assistants working together to address both access to care and quality of care issues.

Together with our nursing colleagues, we can improve primary care and our nation's health.

Wanda Filer, M.D., is a member of the AAFP Board of Directors.

Posted at 12:43PM Mar 29, 2013 by Wanda Filer, M.D.  |  Comments[0]

Mainstream Media Can Help Us Share Our Stories

The life of an AAFP officer is never dull. We have an amazing staff that ensures our leaders are able to make it to all kinds of media and advocacy opportunities.

For example, I recently represented the Academy at the Association of Health Care Journalists annual convention in Boston. This was a dynamic conference that brought together more than 700 journalists from all over the country to explore pertinent topics, as well as to network and develop their skills. 

I participated in a panel about improving patient outcomes and decreasing costs with Nancy Shendell-Falik, R.N., M.A., chief nursing officer and senior vice president of patient care services at Tufts Medical Center, and Donald Berwick, M.D., former head of CMS. (I also talked to several reporters one-on-one after the panel.)

The audience was composed of people who were experts in communication and in tune with social media. In fact, before our panel was completed, one person tweeted about wanting a photo with Dr. Berwick, while someone else tweeted that they wanted a photo with the "guy with the awesome beard!"

This kind of forum is important in many ways. It allows a formal presentation of our emphasis on developing physician-led, team-based care, as well as clarification that a patient-centered medical home (PCMH) is best defined by its community.

Here's the example I shared. Long before the PCMH was even an acronym, I had a small practice in Trenton, Ga. It had two nurses, a lab person, a front office person and me. However, that community also had two chiropractors, a physical therapy office, a home health agency, one pharmacy, the health department and emergency medical services. Together, we were our patients' medical home. We all took care of our patients and ensured that we coordinated care in our town. If a patient needed hospitalization, then we worked together to create that transition.

This concrete example of what creates a medical home is an important message to get out because it is easy for people to misunderstand or misrepresent some of these important buzz words and terms. 

It also is important to realize what a critical role journalists play in sharing our message. At this meeting, I recognized that reporters and journalists are often community members who are looking at ways to help the citizens of their cities or towns get better health care. These are not folks quick to emphasize partisan talking points. They truly are interested in hearing perspectives and finding the middle ground.

There were many experienced journalists present at the meeting, but there also were a remarkable number of reporters who were new to covering health care. The connections that I made will allow me to continue to talk with people who are going to take our message back to the grassroots level, which is where change truly happens.

I challenged all of the people I talked with to truly look for the positives. These may not be the most exciting stories, but they are stories that need to be told for us to have positive change.  Find the bright spots. Identify and write about those family physicians  and practices that are truly working to make things better on the front lines. The more we share our stories, the better we all work together in the larger sense to create a seamless patient-centered medical home.

I challenge each of you to tell your story. Find a reporter in your area who is looking for a connection and wants to make a difference. Together, we can bring about transformation.

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

Posted at 11:21AM Mar 25, 2013 by Reid Blackwelder, M.D.  |  Comments[0]

Growing AAFP's Media Outreach: Responding to CNN

If you want to deliver your message to a large audience, sometimes you have to be nimble.

A recent Friday afternoon found me on a rare day off, skiing in Breckenridge, Colo. So did the AAFP public relations staff, who tracked me down via my cell phone. I was on a chairlift when they asked if I could fly to New York to participate in a prime time panel discussion about health care on CNN.

The cable network needed an answer within a half hour.

My answer, of course, was "Yes!"

By Monday, we had plane tickets. Tuesday, I arrived in New York, and Wednesday, I was on the set, under the lights, in makeup. The Academy's public relations staff had me prepped. We had done our homework, and I was ready.

Our panel with Sanjay Gupta, M.D., was set to discuss ways to improve our nation's fragmented, inefficient health care system and followed broadcast of "Escape Fire: The Fight to Rescue American Healthcare." The award-winning documentary details how our nation spends $2.7 trillion a year on health care, but with a deeply flawed system that rewards quantity over quality, and focuses on the treatment of disease rather than preventing it.

      Filming for our panel lasted nearly half an hour, but CNN's edits brought the segment down to six minutes. In those few minutes, however, my goal was to make two important points: 

• patients are healthier when they have two things: insurance coverage and access to a usual source of primary care; and
• effective primary care results in higher quality and lower costs.

For those precious few minutes, I had dropped everything and canceled my clinics on Tuesday and Wednesday. Was it worth it? Absolutely. More than 500,000 people were watching CNN on Sunday night when the program aired twice. It will be broadcast twice again on March 16. 

The coverage by CNN is a national event, continuing an important conversation about what is wrong with our health care system. It also points the way to solutions that value family physicians and primary care.

The opportunity to talk to America through a national media outlet doesn't present itself every day, but the AAFP is getting, taking advantage of and even creating such opportunities more and more. Our public relations staff doesn't just respond to media requests; it is proactively reaching out to reporters with story ideas.

That staff has helped raise the profile of the importance of family medicine through the relationships it has built with the media. The number of on-message outcomes in print and online articles, radio and television broadcasts has increased 114 percent since 2008.

In any given week, the AAFP president routinely speaks to reporters for six to 12 interviews on topics ranging from health care policy to clinical issues. When the Supreme Court ruled on the Patient Protection and Affordable Care Act last June, Board Chair -- then President -- Glen Stream, M.D., M.B.I., did 10 interviews in one day. And that's not even the record. Former AAFP President, Ted Epperly, M.D., once logged 11 media calls in one day!

Again, you have to be nimble to get your message across.

Media mentions of the AAFP in the nation's top 20 markets have increased 330 percent in the past five years, including a 17 percent bump last year. Our media outcomes in the dozen consumer outlets we track -- such as Reuters and NPR -- have increased more than 50 percent since 2008, while our reach in trade publications also has increased steadily.

The hard work of the Academy staff, and our elected leaders, has given family medicine a respected voice in national discussions about health care.

Jeff Cain, M.D., is President of the AAFP.

Posted at 01:57PM Mar 13, 2013 by Jeffrey Cain, M.D.  |  Comments[2]

Feeling Detached: Lessons from Being a Patient (Again)

It's good to be back in Washington advocating for family medicine. And it's good to see the Capitol again, though my view today is a bit cloudy.

You see, my last visit here ended in an unexpected manner. Not because of a bad meeting or difficult legislators but because of my own health. As I was leaving the White House on Jan. 3, I noticed a new, large floater in my field of vision. By the time I was driving home that night in Colorado, I was seeing flashes of light.

Uh, oh. This was no thunderstorm. As you know, these are potentially symptoms of a detached retina.

After calling my family physician and an ophthalmologist, I was seen emergently and initially diagnosed with a posterior vitreous detachment in my right eye that later progressed to a retinal tear.

Frankly, I was scared. Our eyes are so important to what we do as physicians, not to mention in our everyday lives.

It's said that life teaches us lessons. If we don't learn them the first time, those lessons will be offered again. For me, it had been more than 15 years since I found myself playing the extended role of patient after an airplane crash. That accident eventually led to the loss of both legs below the knees, so I'm no stranger to being on the receiving end of health care.

But once again, I was reminded of how fragile we are and how quickly life can change. In a matter of days, I went from visiting the White House, seeing patients and teaching residents to being a patient in the operating room of my own hospital. Post op meant lying flat on my back, at home alone in a dark house. I went from being on the front lines of our advocacy efforts to being told that I could not read, use a computer, exercise or work.

Like my retina, I was feeling detached.

Fortunately, I have great colleagues at the AAFP who were able to handle my Academy duties, and I have other great colleagues who were able to handle my clinic and teaching duties in Colorado.

I ate even better than normal, as friends, family and colleagues circled the wagons to bring food, entertainment, and good cheer to the house. To keep my mind engaged, they even brought books on tape!

It's funny how sometimes we get so caught up in our lives that we take things for granted. I'm used to being a caregiver. I'm the guy who shows up to offer help. Once again, it was hard for me as a physician to be vulnerable, give up my role as caregiver, and be in a position to ask for help.

The good news is that I'm expecting to recover my vision in time. And I'm back to work, advocating for family medicine in Washington. This week I'm here talking to lawmakers about graduate medical education and the sustainable growth rate formula.

Sure, life offers all of us curveballs. But for family physicians, these setbacks also can remind us of how our lives and our work are so important and so intertwined.

I hope that you can take a moment this week to look around to really "see" your life, family and friends, patients, and those who appreciate you.

Today, I am grateful for the care of my family physician, our subspecialist partners, and to be back in the game for you in Washington, where together we can see and work toward a better future for our patients and our practices. Even if for this short time, I need a little help with accommodation (pun intended).

Jeff Cain, M.D., is the president of the AAFP.

Posted at 11:08AM Feb 06, 2013 by Jeffrey Cain, M.D.  |  Comments[3]

Chapter Meetings Shine Light on Constituent Issues

It's good to be home.

In less than three weeks, I have been to Fort Myers, Fla., for a leadership symposium; to San Diego for the Family Medicine Working Party (the biannual meeting of seven family medicine organizations); to Lake Tahoe, Nev., for the Nevada AFP's annual meeting; and back to Florida for the AAFP Foundation's annual meeting with its corporate partners.

Although all of these trips were important, the Nevada event stands out for me. It was our first constituent chapter meeting of the new year and just my second as president-elect. Each year, AAFP Board members make it to as many chapter meetings as we can. These events present wonderful opportunities to talk face to face with members, many of whom don't have the chance to travel to Academy events outside their own states.

(Here, my wife, Alex, and I talk with Nevada AFP chapter executive Brooke Wong and members Donald Farrimond, M.D., and Tom Hunt, M.D.)

To do our jobs as elected leaders, we need to hear the concerns and issues of family physicians across the country. In 2012, Board members made it to 43 chapter meetings. (Former Board members, such as Past President Ted Epperly, M.D., filled in at six others.)

During chapter meetings, Academy leaders give an update on what the AAFP is doing on a national level regarding a wide range of issues. But we're also there to listen.

What do you need?

What does your chapter need?

Although family physicians share common issues -- the need for fair payment being the obvious example -- some problems are unique to states and regions, and perspectives vary from one state to another. These meetings offer an opportunity for our national and constituent organizations to connect and for you as an individual family physician to shine a light on problems that need the Academy's attention.

The AAFP represents more than 105,000 physicians nationwide. Members' needs are many and diverse. We don't always agree. But there can, and should, always be dialogue on important topics. These interactions inform the Board's discussions about topics of critical interest to family medicine as we work to represent all family physicians.

These meetings also offer a chance for chapters to point out successes that might be replicated by our colleagues elsewhere. Bright spots and solutions to common problems must be shared.

I'm scheduled to attend chapter meetings in Idaho, New Hampshire, New Jersey, New Mexico, New York, Tennessee and Washington this year. Don't be shy. Let's talk.

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

Posted at 02:47PM Feb 04, 2013 by Reid Blackwelder, M.D.  |  Comments[2]

Season's Greetings

AAFP President Jeff Cain, M.D., delivers a holiday greeting, reflections on 2012 and a few thoughts about the new year in this video blog.

 

 

Jeff Cain, M.D., is the President of the AAFP.

Posted at 05:15PM Dec 24, 2012 by Jeffrey Cain, M.D.  |  Comments[3]

Your Support Helps AAFP Foundation Make a Difference

You might know that the AAFP Foundation -- the Academy's philanthropic arm -- provides domestic and international disaster relief, helps establish free clinics through Family Medicine Cares USA and helps address the health care needs of the underserved people of Haiti through Family Medicine Cares International.

But did you know that our Foundation also contributes more than $500,000 a year to Academy initiatives and programs, such as Americans in Motion-Healthy Interventions (AIM-HI), Family Medicine Interest Groups (FMIGs), the Robert Graham Center, familydoctor.org and Tar Wars?

In fact, the Foundation provided more than $100,000 for the National Conference of Family Medicine Residents and Medical Students this year. It awarded scholarships to help 169 students and residents attend the event this summer in Kansas City, Mo. Those numbers are set to increase to 200 students and residents and a $120,000 contribution in 2013.

In addition, the Foundation has committed to contribute nearly $600,000 to Academy programs next year.

Through the Family Medicine Philanthropic Consortium, the Foundation has awarded nearly $700,000 to AAFP constituent chapters since its inception in 2006, funding 162 student and resident initiatives and outreach programs in 35 states. This year alone, the Foundation funded 29 programs in 18 states for a total of $104,000.

These contributions are possible because of your generous support. Individual donations accounted for more than 10 percent of the Foundation's revenue and support in 2011. Dues check-off donations are the largest single source of member contributions to the Foundation each year and accounted for nearly $300,000 in 2011.

The final quarter of the year typically marks the busiest time of the year for donations as we pay our dues. Unfortunately, such donations fell 60 percent, year over year, in November. The amount of money donated in October and November combined was more than $50,000 less than during the same time last year.

The AAFP Foundation is one of the primary philanthropic organizations my wife and I support. I had the opportunity to serve as a member of the Foundation board for two years and observed directly the organization's compassion, dedication and hard work. Please consider the Foundation in your charitable giving. It deserves -- and needs -- our support.

It's not too late to make a tax-deductible contribution and support these worthy programs in the coming year.

Glen Stream, M.D., M.B.I., is the Board Chair of the AAFP.

Posted at 04:22PM Dec 17, 2012 by Glen Stream, M.D., M.B.I.  |  Comments[0]

AAFP Member Census: Five Minutes to Help the Academy Help Us

Data and analysis keep pouring in from the 2010 U.S. Census, and we have learned a lot. For example, we learned that the share of the Latino population grew nearly 4 percent.  The South and Southwest continue to grow their share of the population, as do suburban and exurban regions. 

Federal funds, Congressional seats and so much more have been affected by these results.

The AAFP is no different. It often uses member surveys to determine which programs and advocacy would most help us and help our patients. 

Every year, the AAFP conducts more than 300 research projects that ask subsets or sample sets of members their opinions on a wide range of issues. For example, the member satisfaction survey, which is sent to a random sample of members each year, guides many of the efforts of our Academy. (A summary of this survey is available on the AAFP website.)

There is one initiative, however, in which we are asking every member to participate. It's simple, online, has only 12 multiple-choice questions and takes less than five minutes to complete. It's the AAFP member census.

This short form asks us to provide information about things like our practice setting, whether we are practice owners or employees, what types of clinical services and procedures we provide, and whether or not we use electronic health records.

That's about it.

And the five minutes it takes to answer a dozen questions could make a difference in what you get out of your AAFP membership because the information is used by Academy staff to make sure that the products and services being offered are relevant and match our needs.

For example, information provided about clinical services and procedures helps our CME staff prioritize CME offerings and identify gaps in those offerings.

The goal is to have at least 60 percent of active members complete the census, and 52 percent have done so. However, the response from new physicians (only 32 percent!) is lagging and has left that segment of membership under-represented.

That's a problem because new physicians often have different needs and interests than our more experienced colleagues. For example, new physicians are more likely to be employed than non-new physicians and may have different needs for resources and services.

Whether you are a new physician or a 20-year veteran, I urge you to take five minutes and help our Academy help us.

Ravi Grivois-Shah, M.D., M.P.H., is the new physician member of the AAFP Board of Directors.

Posted at 01:14PM Dec 11, 2012 by Ravi Grivois-Shah, MD, MPH  |  Comments[0]