Future of Family Medicine 2.0 Gathering Information, Insights
Last fall, the Family Medicine Working Party launched an initiative to define the role of the 21st century family physician and ensure that our specialty can deliver the workforce to perform this role. Here is the latest update on the progress of this important project.
Family Medicine for America’s Health: Future of Family Medicine 2.0
Organizational Update No. 6
We are entering the final months of the Family Medicine for America’s Health: Future of Family Medicine 2.0 initiative. As a reminder, the purpose of this effort is to develop a multi-year strategic plan and communications program to address the role of family medicine in the changing health care landscape. To read earlier monthly updates from FFM 2.0, please visit the project web page.
In February, the FFM 2.0 Steering Committee and Core Teams held a retreat that included approximately 60 members of the family medicine community and 40 external stakeholders, including payers, patient advocates, employers and providers outside of family medicine. The purpose was to seek a range of perspectives as we narrow in on the strategic commitments of family medicine for the next five to seven years. Although there is still much work to do, our Steering Committee came away energized by two realizations. First, although retreat participants did not always agree on tactics, they are very much in agreement about the need for change to improve health outcomes and lower health care costs in this country. Second, because of the alignment around this purpose, the time is right to explore how family medicine can collaborate with others in the health care ecosystem to bring about the changes in primary care we all seek.
In addition to the stakeholder
retreat, we hosted our first of three virtual town hall meetings to hear from
practicing family physicians and family medicine educators, and to inform them
about the work done to date. More than 225 individuals joined this town hall
meeting. The wide-ranging conversation touched on issues related to practice,
education and payment for primary care. An
archived version of this first town hall meeting is available
There will be two additional virtual town hall meetings: 8 p.m. EST on March 5 and 8 p.m. EST on March 26. You can register for the March 5 event by clicking here.
Following is an update on the progress and status of the FFM 2.0 project:
CFAR, the consulting firm leading the strategic planning process, is now in the process of analyzing the output of the strategy retreat and working with members of the Core Team on a set of recommended strategic commitments. CFAR also will continue to work with the members of the Insight Groups to test the rationale for these strategic commitments and their corresponding tactics. The Insight Groups include medical students, residents and young leaders in family medicine who are in the early years of practice. The Steering Committee then will review the recommended strategic commitments in April.
APCO Worldwide, which is leading the communications planning, has completed the quantitative research elements of the project. (Please see update No. 5 from January for more information on the results of the opinion survey). APCO has developed broad concepts that define the external understanding of family medicine. These concepts focus on defining family medicine within the context of primary care and demonstrating the overall value of a system based on comprehensive primary care. APCO will test its concepts in a series of focus groups. Once themes and messages are defined, APCO will develop a comprehensive communications plan aimed at reaching two key audiences: consumers and policymakers/influencers.
Seeking Your Input
Your feedback is critical to this process. We welcome and encourage your comments and questions and have a dedicated email address for input. Since our first report on this initiative, we have received hundreds of comments to this address -- all have been very valuable to the Steering Committee and Core Team.
Please continue sharing your thoughts at firstname.lastname@example.org.
Jeff Cain, M.D., is Board Chair of the AAFP.
Stories of Successful Underdogs Resonate With FPs
I read my first Malcolm Gladwell book more than 10 years ago when a fellow family physician gave me a copy of Tipping Point: How Little Things Can Make a Big Difference, at an AAFP commission meeting. Since then, I've read Gladwell's Outliers, Blink and What the Dog Saw.
I recently read the author's newest book, David and Goliath: Underdogs, Misfits and the Art of Battling Giants. In this book, Gladwell tests the reader's perception of what obstacles and disadvantages create apparent setbacks in life. His examples include the titular bible story, the dynamics of successful and unsuccessful classrooms and the thought processes of cancer researchers.
As I was reading, I kept thinking about family medicine, the apparent underdog in the playing field of medicine. David, who was skilled with a slingshot, faced Goliath, a man who clearly suffered from an endocrinopathy but who was big in stature and strong.
Family medicine has the right stuff. We are bright and strategic. But unlike the original story, there are many Goliaths on our battlefield, and this is distracting and time consuming, especially when we would rather focus on the things most important to us such as our patients, families and communities. How do we fight the many giant challenges -- dealing with payers, adapting to regulations, etc. -- that stand in our way?
In an interview with INC. magazine, Gladwell said, "Effort is the route available to the underdog. I may not be able to outspend you, but I can outwork you."
Gladwell's David and Goliath has a chapter about people who have been successful despite having dyslexia. Gladwell's theory is that if a task is made slightly harder, a person may learn better because he or she will be forced to concentrate more and is likely to read something multiple times instead of just once.
Family physicians certainly know about hard work. The amount of work required to become a family physician is significant -- 21,000 hours of standardized education and training, including exams overseen by a single certification body.
No one can truly replace us, although others are desperately trying to claim that they can. Gladwell makes a case for the proper number of students in a classroom to make learning optimal. Similarly, we are making a case for the number of hours of training required to provide primary care. Nurse practitioner (NP) training, in particular, ranges from 3,500 to 6,600 hours, and the clinical aspects of their education and training vary tremendously. Each of their three accrediting organizations has their own criteria for certification.
And yet, there are those who claim NPs and physicians are interchangeable. How can this be? Family physicians are the best medicine that the system has to offer.
But where is the best place to be standing in today's times? Should we position ourselves in the midst of the Goliaths who would prefer us to quietly do our work and not cause a fuss? Or do we steer clear of these challenges and let others decide our fate?
Gladwell observes that in many instances, underdogs can prevail with hard work and strong will. As modern day Davids, we, as family physicians, must strategically place ourselves where we can do the most good for the most people. Gladwell writes that while you are working on changing the game, you also have to make sure that you get the most out of the rules that already exist. That is exactly what the AAFP is trying to do. For example, the Academy continues to stay involved with the flawed AMA/Specialty Society Relative Value Scale Update Committee (RUC) rather than being absent from the table and having no voice at all. However, we also are advocating directly to CMS about payment issues.
And although it can be extremely frustrating, we continue to have regular meetings with the nation's largest private payers because it gives us an opportunity to work on common issues while promoting the value and importance of primary care.
We, the family physicians who are strong medicine for America, must emphasize our unique ability to listen, understand and help our patients, offering our valuable time and resources. We must be the brave David and use all our resources to stay in the game and win the fight.
You can learn about being an advocate for our specialty -- including a day of training and a day of lobbying on Capitol Hill -- at the Family Medicine Congressional Conference April 7-8 in Washington. I hope to see you there.
Rebecca Jaffe, M.D., M.P.H., is a member of the AAFP Board of Directors.
Dedication to Lifelong Learning Reflects Specialty's Heritage
I recently attended a meeting of the Family Medicine Working Party, which is a convocation of the seven organizations that represent our specialty.
These groups are led by outstanding family physician volunteer leaders, and these biannual meetings allow these leaders to ensure each organization is aware of what the others are doing. Often, a focus area for one group affects the other groups as well. Even if our initiatives don't directly overlap, it is important to hear updates about what is happening.
It also is a great opportunity to talk about some of the remarkable things that we see in family medicine. I was particularly inspired by a story from James Puffer, M.D., the president and CEO of the American Board of Family Medicine (ABFM). One topic that we routinely review with the ABFM is the process of maintenance of certification, and the exam all diplomates are required to take.
It is important to recognize that when family medicine began as a specialty, we were the first and only specialty that challenged our members to continue to recertify. Other medical specialty organizations had lifelong certifications in place that allowed a physician to take one exam, one time. Our specialty's founding fathers knew that lifelong learning was a critical aspect, and that certifying only one time would not guarantee that a physician was at the top of his or her game throughout his or her career. We now have data showing that recertification maintains a knowledge base over time, whereas taking a single exam one time allows a person's knowledge base to decline.
However, the inspirational part of this story has to do with a group of family physicians who continue to recertify well into their 80s and even 90s. In fact, the oldest family physician who recently sat for the recertification exam was 93. Puffer personally calls all of these physicians to let them know their scores and to ask an important question. He was especially pleased to call the 93-year-old physician to inform him that he had indeed passed. Puffer asked the man if he was still practicing. The family physician replied that he had not practiced for many years. So, Puffer asked why he was recertifying. This member said that he could not imagine letting his certification lapse. He has always been board-certified, he said, and he always would be.
I think this comment is a testament to something unique about family physicians. This is a dedication to true lifelong learning. This member is going to continue to challenge himself to learn more about his craft even though he is no longer practicing. It also speaks to the pride and work ethic of this member that I think exemplifies family physicians. We recognize that board certification means something. We recognize that in family medicine, we have made a commitment to continue to challenge ourselves to be the best that we can be in order to give the best possible care to our patients.
This kind of story challenges me to continue to do everything I can to help our organization be the best that it can be so it can serve members like this extraordinary family physician in the way they deserve. I hope that I, too, am continuing to recertify until it is time for me to go to my next great adventure.
Reid Blackwelder, M.D., is president of the AAFP.
Wording of CMS Proposed Rule Causing Undue Angst About Medicare
proposed rule published Jan. 10 by CMS is expected to save the federal government $1.3 billion during a five-year period by curbing fraud, waste and abuse in the Medicare Advantage (Part C) and Medicare Prescription Drug Plan (Part D) programs.
Unfortunately, the wording of the 157-page regulation also created significant angst among some family physicians. Specifically, CMS wrote that it is proposing "to require that physicians or non-physician practitioners who write prescriptions for covered Part D drugs must be enrolled in Medicare for their prescriptions to be covered under Part D."
Some AAFP members who don't participate in Medicare have expressed concern that the proposed rule would affect their ability to prescribe medications for their Medicare patients, but that isn't the case.
"We believe that allowing opt-out physicians and eligible professionals to continue to prescribe covered Part D drugs to a Medicare enrollee would ensure consistency with the Part B program in this regard," the rule says.
In short, the requirement to enroll with Medicare is being confused with a requirement to participate with Medicare. Under this proposed rule, physicians still have the same three options regarding Medicare:
- Physicians may sign a participating agreement and accept Medicare's allowed charge as payment in full for all of their Medicare patients.
- They may elect to be non-participating physicians, which permits them to make assignment decisions on a case-by-case basis and to bill patients for more than the Medicare allowance for unassigned claims.
- They may opt out and become private contracting physicians, agreeing to bill patients directly and forgo any payments from Medicare to their patients or themselves. For example, if you are using the direct pay model of care, you still could do so without changing how you practice or bill. However, you will have to enroll in Medicare for your prescriptions to be covered by these plans.
The rule proposes that physicians and others prescribing drugs for Medicare patients be required to enroll so that CMS can "ensure that Part D drugs are only prescribed by qualified individuals." CMS implemented similar policy regarding durable medical equipment this month. The enrollment requirement actually will have no effect on most AAFP members because both participating and non-participating physicians are already required to enroll to bill for any Part B services that they provide. And, as stated above, CMS plans to continue to allow an option for physicians who opt out.
It is important to remember that this is a proposed rule, and it will not affect family physicians this year. The AAFP has not finalized our response to this proposed rule. Now is the time for you as members to provide the Academy with your thoughts and concerns to help us clarify our response during the comment period. You can do this in the comments area below.
In addition to the enrollment requirement, there are other provisions of this proposed rule the Academy will address. For example, the proposed rule requires formulary inclusion of all drugs within the antineoplastic, anticonvulsant and antiretroviral drug classes, but it no longer requires all drugs from the antidepressant and immunosuppressant drug classes to be included in Part D formularies.
The Academy is in the process of reviewing the proposed rule and will provide comments to CMS before the March 7 deadline. What are your thoughts?
Reid Blackwelder, M.D., is President of the AAFP.
Town Hall Meetings Next Step for Future of Family Medicine Project
If you haven't shared your thoughts on Family Medicine for America's Health: Future of Family Medicine 2.0, it's not too late. In our latest update on this important initiative, you will find research results about family medicine reported this month at a Working Party meeting, a new set of questions being asked related to this project, details about a series of virtual town hall meetings scheduled to begin Jan. 29 and much more.
Family Medicine for America's Health: Future of Family Medicine 2.0
Organizational Update No. 5
Jan. 23, 2014
Work on the Family Medicine for America's Health: Future of Family Medicine 2.0 initiative continues. As a reminder, the purpose of this effort is to develop a multi-year strategic plan and communications program to address the role of family medicine in the changing health care landscape. To read earlier monthly updates from FFM 2.0, please visit the project Web page.
The Working Party, along with the FFM 2.0 Steering Committee and Core Teams, held a meeting in mid-January to inform and guide the project. A retreat will be held in mid-February that will include approximately 60 members of the family medicine community and 40 external stakeholders, including payers, patient advocates, employers and providers outside of family medicine. The goal is to help family medicine narrow in on its strategic commitments for the next five to seven years.
Following is an update on the current progress and status of the FFM 2.0 project.
CFAR, the consulting firm leading the strategic planning process, has finalized the "current state" analysis and developed three scenarios that illustrate possible future states for family medicine based on different strategy choices. CFAR co-developed these scenarios with the Core Team, the Steering Committee and the Insight Groups. The Insight Groups include medical students, residents and young leaders in family medicine who are in their early years of practice. Each of the seven family medicine organizations nominated two participants to each of the groups.
APCO Worldwide, which is leading the communications planning, has completed qualitative and quantitative opinion research that will inform their recommendations. Recently, APCO conducted a quantitative survey of 1,871 individuals across three primary audiences:
- Patients: 800 interviews with general population adults in the United States;
- Business and policy community: 271 interviews (96 with health care policymakers, 100 with employers/purchasers, 75 with health care payers); and
- Medical professionals: 800 interviews (400 interviews with physicians [150 family physicians, 100 other primary care, 150 subspecialists] 300 with medical students and residents, 100 with nurse practitioners and physician assistants).
Following is a summary of the findings presented at the January Working Party meeting:
- Family physicians are viewed very favorably by all stakeholders, especially patients. At least three of four stakeholders across audiences have a favorable view of family physicians and provide positive comments when asked why they rated family physicians the way they did.
- Family physicians' broad scope of knowledge, ability to treat entire families and caring nature are key themes that define family physicians positively.
- When asked about which member of the primary care community will have the biggest impact on the health care system, family physicians are selected most frequently across every stakeholder audience.
- Audiences believe that coordinating care, treating the whole person and using technology to improve patient care are the most exciting ways family physicians can engage in the new health care system.
- At least three of four stakeholders across the audiences feel that family physicians should focus more on preventive and chronic care versus acute care.
- The research shows that family physicians do a good job of connecting emotionally with stakeholders. The emotional connections audiences have to family physicians are important to identifying the right tone for communications positioning and the campaign.
Based on this and earlier research, APCO will develop recommendations on how to communicate the value and role of family medicine to external audiences. Concepts will be tested further in focus groups with various audiences.
Seeking Your Input
Your feedback is critical to this process. We welcome and encourage your comments and questions and have a dedicated email address for input. Since our first report on this initiative, we have received hundreds of comments to this address, and all have been very valuable to the Steering Committee and Core Team.
APCO would welcome your input on the following
questions as they build the communications plan:
- Are there specific issues you believe family medicine should be advocating around? For example, prevention, chronic disease, mental health, etc.
- Given the diversity of family medicine practices, do you believe there is a way to deliver a consistent "product" or set of services to patients regardless of geography or patient panel demographics? If so, what would that look like?
- Are there emerging technologies that family medicine should/can embrace to provide better care for patients or improvements to the health care system overall?
Please share your thoughts at email@example.com.
Family Medicine Virtual Town Hall Meetings
In addition, we are holding a series of virtual town hall meetings to hear from practicing family physicians around the country. After a brief overview of the project so far, we would like to hear from you about the issues that will be most critical to address in family medicine's strategic plan. We are very pleased that Glen Stream, M.D., M.B.I., past president of the AAFP, will be hosting the town hall conversations.
The first virtual town hall meeting is on Wednesday, Jan. 29 at 8:00 p.m. EST. There will be two additional town hall meetings on Feb. 26 at 8:00 p.m. EST and March 26 at 8:00 p.m. EST.
To register for the first town hall meeting, please click on this link:
Jeff Cain, M.D., is Board Chair of the AAFP.
Media Offers Platform to Educate Public About Health, Family Medicine
Cold and flu season is here, and newspaper and TV health reporters from markets around the country likely will be calling their local primary care physicians looking for an interview for what has become an annual story. If the call came to your office, would you respond in a timely fashion? You never know where a simple conversation might lead.
to the media offers us an invaluable platform to share important public health
messages, providing a multiplier effect on our ability to care for our
communities. It also provides us with an opportunity to show the vast range of
Many years ago, I was at grand rounds when it was announced that WGAL, our local NBC affiliate in Lancaster, Pa., was looking for a family physician who could participate in health segments for a new talk show. I was intrigued, and out of a few hundred physicians who applied, they picked me.
It wasn't a paying job, at first, but I saw it as a public service. It wasn't about growing my patient panel. Instead, I saw this as an opportunity to educate the public and decision makers about family medicine and give viewers a better understanding about what we do. I covered topics that involved pediatrics, obstetrics, geriatrics and more and often was asked to comment on breaking news that involved health care. The broad range of topics discussed highlighted the scope of practice that family medicine provides, showcasing our specialty to a 20-county audience.
After four years of occasional appearances, my segments became weekly features. Eventually, the station asked me to contribute daily segments for the evening news.
The high profile position with WGAL -- combined with my involvement in the Pennsylvania AFP and advocacy work related to domestic violence -- led to me becoming the Physician General of Pennsylvania, working as a public health adviser to the governor.
My role with the television station lasted nearly 20 years. Obviously, not every physician who gives an interview will have a career-altering experience. But when your patients read your name in the newspaper or see you on TV, they will feel good, knowing that you are engaged in your community. And by delivering public health messages to a broad audience, you're doing a service for that community and family medicine.
Should the media contact you directly for comment on AAFP policy or positions, or if they want to discuss national health care issues or AAFP clinical guidelines, please refer them to a member of the AAFP's public relations team. Jay Senter works with clinical, health of the public and research topics; Leslie Champlin works with health care legislation and policy, workforce and medical education topics. If the reporters want comment on local health issues, please work with them to provide that and let the PR team know if you need any assistance.
Wanda Filer, M.D., M.B.A., is a member of the AAFP Board of Directors.
Challenges, Opportunities Await in 2014
Happy New Year! This really should be a good new year.
Of course, there are always challenges. However, things are moving in some outstanding directions for family medicine. It is exciting that people around the country -- the media, policymakers and others -- are continuing to talk about primary care. What is even more exciting is that it seems the understanding of what primary care is and who provides it continues to become more focused. Moreover, seeing family physicians as the foundation of primary care in our health care system is a discussion that is really ramping up now, and it's long overdue.
It may seem hard to believe, but the sustainable growth rate (SGR) formula may finally be repealed this year! As the calendar year changes, support for the current bicameral and bipartisan effort to repeal the fatally flawed SGR remains strong.
This effort is critically important in and of itself. However, it also has been a huge roadblock for discussions about many other issues that are essential to continuing to transform our health care system. Other needed reforms related to things such as payment, graduate medical education and workforce have in many ways been delayed or derailed because so much time and energy has been needed to deal with the SGR.
I am encouraged, and excited, by the possibility of being able to carry our other important messages forward knowing that we can have some meaningful conversations about them on Capitol Hill.
We continue to see increasing interest from medical students
in family medicine. We are seeing an increase in applications from
Now, we need to have the important discussions about continuing to find ways of changing medical school education to emphasize family medicine and better address the social mission that should be a determining factor in a graduate's specialty choice.
We also need to address the problem posed by the combination
of increasing number of
And, I am pleased that payment reform is moving forward. It is certainly not happening quickly enough, and the issues of the salary gap, overvaluation of some procedures, and the inherent difficulties of the fee-for-service system still exist. However, CMS has signaled its recognition of the valuable services we provide in coordinating our patients’ care by creating new care management codes that allow us to get paid for things that we have always done and will always do.
Moreover, we have data from researchers at the University of Texas Health Science Center at
Our unique and comprehensive education and experience is becoming better recognized and appreciated. A recent patient survey has made it clear that patients value and appreciate us. They want to see their family physician for their health care needs, and they want that family physician to be the leader of their health care team. This validates what we have been saying for more than 10 years. The patient-centered medical home (PCMH) succeeds in meeting the quadruple aim: improving patient outcomes, improving patient satisfaction, improving physician satisfaction, and doing so at lower costs. A core contributor to the success of the PCMH is the role of physician-led teams.
In short, the messages that we have been giving for years finally are being heard and understood. There always will be challenges, but those also can be opportunities.
Thank you for all you do, including your dedication to our patients, our communities, our profession and our country. Your efforts have helped get family medicine to where it is and where it will be. It is an honor to serve with you. I look forward to an exciting new year as we continue to move health care transformation forward in our country.
As the way we deliver care to our patients evolves, I’m eager to further define who we are and where we are going as a specialty. Please follow me on Twitter to see where I think family medicine is going, and use the hashtag #WhereFMisGoing to join the conversation with our colleagues.
Reid Blackwelder, M.D., is President of the AAFP.
Sports Medicine One More Way FPs Support Communities
A regulation hockey puck is six ounces of frozen, vulcanized rubber. Struck by the right athlete, a puck can speed across the ice at more than 100 mph. So when 200-pound athletes are slamming each other into the boards, swinging sticks (and occasionally punches) while skating on solid ice in pursuit of said puck, it's not a bad idea to have a physician around.
where I come in.
I recently was attending an Iowa Wild game in my role as team physician for the local minor league team when one of the players was struck by a puck in the lower leg. It hit him hard enough that the crowd let out a collective groan.
I kept an eye on him to make sure he wasn't favoring the leg, but he kept on skating and stayed in the game. When the game was over, a trainer called me over to take a look at the injured leg. The puck had shattered his shin guard, ripped a nickel-sized hole in the tissue and exposed his tibia.
Hockey players, as it turns out, are pretty tough.
I irrigated the wound, removed pieces of the shattered shin guard from the wound and closed it with a vertical mattress.
What I didn't give him was a bill. Sports medicine of this kind -- treating injured players during or after a game -- typically is done on a volunteer basis. Teams show their gratitude with gear, tickets and other perks.
So why do it? Sports medicine is one more way that family physicians can support our communities, whether through a local high-school team, a pro franchise or something in between.
I was a track athlete in high school, and I stay active with cycling, running and skiing. As a medical resident, I knew my days of being an athlete were behind me, but I still wanted to be involved in sports. So I took extra training in sports medicine, and when I started my practice I volunteered as a team physician for the local high school.
A few years later, our town landed an arena football team, and it needed a primary care physician to work with orthopedists. It also needed someone to manage care of its players, coaches and their families. I not only see them at the games, but they come to my office for preventive medicine as well as when they are ill.
It's been fun to get to know the team and their families on a personal level and build those relationships. These are people who are extremely talented at what they do, and it's gratifying when they look to me for expertise at what I do.
Sports medicine can build your practice without an official connection to a team. Athletes -- pro and amateur -- talk amongst themselves about their injuries and how and where those injuries are being treated. And when an injured weekend warrior comes to me for rehab, often his or her whole family follows.
Over time, people in the community have come to associate me with sports medicine. When my sons were playing high-school sports, other parents often told me that having me on the sidelines was reassuring. That's a good feeling, much better than, say, a puck to the leg.
Robert Lee, M.D., is a member of the AAFP Board of Directors.
Future of Family Medicine 2.0: What's Your Opinion?
It's time for another update on Family Medicine for America's Health: Future of Family Medicine 2.0. In addition to providing you with details of the latest actions related to this important project, the update below offers family physicians an opportunity to provide input on four specific questions related to payment models, family physician training, research and the triple aim (improving patient care and outcomes and lowering costs).
You can address the questions below -- and offer other thoughts on the project -- at FutureFM@aafp.org
Family Medicine for America’s Health: Future of Family Medicine 2.0
Organizational Update No. 4
Dec. 17, 2013
This is the fourth update of the Family Medicine for America’s Health: Future of Family Medicine 2.0 initiative. The goal of this effort, which was launched in late August, is to develop a multiyear strategic plan and communications program to address the role of family medicine in the changing health care landscape.
a reminder, the Family Medicine Working Party identified a set of key principles that will
underpin this effort:
- Deliver on the triple aim: improving the health of the population; enhancing the patient experience of care (including quality, access, and reliability); and reducing, or at least controlling, the per-capita cost of care.
- Focus on the needs of residents and medical students, as well as practicing family physicians.
- Manage the tension between addressing the needs of family medicine as a specialty and needed changes to the health care system of which it is a part.
CFAR, the strategic consulting firm hired for this project, is now working on its "current state" analysis. This document is designed to create a shared understanding about where the profession is today. This shared understanding serves as a foundation on which to build an implementable strategic plan that identifies risks to take, investments required to do so, and a realistic understanding of how to bridge the gap between the current state and the desired future we want to create. Following are the key issues that are being examined as part of this process:
- Core attributes: What are the core attributes of family medicine today, and what do they need to be in the future, for our profession to achieve the triple aim in the service of our patients and the larger health care landscape?
- Evolving ecosystem: How should family medicine change in response to the challenges of an evolving health care system to best meet the needs of the nation?
- Education: What changes are needed in the continuum of education (from medical school through residency and into CME) to train the family physicians needed in the new health care system?
value: How do we best communicate to relevant stakeholders the value and
benefits of family medicine and the important role family physicians play in
meeting the health care needs of the U.S. population?
CFAR has sought broad input from family physicians -- and those who work alongside
them -- in the development of the current state analysis. This has included
- conducting in-depth interviews with thought leaders and stakeholders in the field of family medicine; and
- conducting a strategic options survey designed to test the assumptions the community holds about the present, as well as perspectives on strategic choices in the future. The survey was sent to more than 6,000 front-line family physicians, as well as a variety of other primary care health professionals, such as OB/Gyns, general internists, nurse practitioners and physician assistants and physicians early in their careers.
We encourage feedback and would welcome input from family physicians through our dedicated email address FutureFM@aafp.org on the following questions:
- Can you share any examples of family physicians -- yourself included -- who are working in payment environments other than fee-for-service? How has that experience affected their practice (or your own)?
- What are some concrete steps family medicine can take to increase the number of family physicians trained to meet the needs of the American public in the future?
- How can the leadership of family medicine help family physicians meet the demands of the triple aim (improved patient care, improved health of populations, lower cost)?
- What kinds of research would help improve your practice?
APCO Worldwide, the communications consulting firm, is conducting research to develop the communications platform to reflect the strategic plan. APCO has conducted in-depth interviews to elicit attitudes and opinions about family medicine from external audiences including policymakers, major insurers, employees and purchasers and other primary care health professionals. These interviews focused on perceptions of family physicians, the role of family physicians in the new health care era and the future of family medicine. Following is a brief summary of the findings:
- There is marked appreciation for the skills and patient rapport that family physicians bring to health care.
- Family physicians are viewed as having a solid diagnostic ability based on their scope of medical and clinical knowledge.
- Treating the entire family gives family physicians an advantage compared with other primary care physicians in being able to consider social and behavioral dynamics in their diagnosis and treatment.
- Expertise in prevention and education helps position family physicians for the new health care landscape.
- Family physicians are seen as the natural choice to lead the patient-centered medical home and accountable care organizations, coordinating care and stressing wellness.
- There is a strong belief that new comprehensive care models provide family physicians the greatest opportunity to succeed in the new system.
- Retail clinics are seen as the greatest threat to the family physician.
- Most cannot imagine a health care system without family physicians.
APCO currently is conducting the quantitative research element of the communications planning process. The results of its broad public opinion survey will be presented in January.
We strongly encourage you to share your input. Again, you can provide feedback at FutureFM@aafp.org. We welcome comments on the items outlined above or other suggestions/insights that would be useful to this process.
The fifth meeting of the Core Team will be Jan. 9. The next combined meeting of the Working Party, Steering Committee and Core Team will be Jan. 16-18.
Jeff Cain, M.D., is Board Chair of the AAFP.
Students, Young Physicians Provide Insights for Future of Family Medicine 2.0
Have you offered your opinion on the Future of Family
Your opinion matters, and now is the time.
In our first update on Family Medicine for America's Health: Future of Family Medicine 2.0, you had
a chance to learn about our initiative that aims to define the role of the 21st
century family physician, including scope of practice and our role within the
health care system.
In our December update below, we address some of the important questions being considered by the work group and introduce you to the young physicians, residents and medical students who have been selected to help answer those questions.
You can share your thoughts directly with us at FutureFM@AAFP.org. And you can be sure we will continue to share updates on our progress.
Family Medicine for America's Health
(Future of Family Medicine 2.0)
The Family Medicine for America's Health (Future of Family Medicine 2.0) initiative is moving forward according to schedule. The purpose of this effort is to develop a multiyear strategic plan and communications program to address the role of family medicine in the changing health care landscape.
The Core Team held two meetings in November. The meetings focused on CFAR's "current state" analysis and APCO's opinion research. The current state analysis is designed to create a foundation on which to build an implementable strategic plan that identifies risks to take, investments required to do so, and a realistic understanding of what it will take to bridge the gap between the current state and the desired future we want to create. During the meetings, there has been significant discussion about scope of practice, compensation and the impact of technology on the specialty.
address some of the key questions and ensure broad input in the process, the
CFAR team is focused on organizing two “Insight Groups” designed to engage and elicit feedback on the future of
family medicine. The first group includes
medical students and residents. The
second group includes young leaders who are in their early years of practice. Each of the seven family medicine
organizations nominated two participants to each of the groups. Please see below for names of the 28 individuals
who were nominated.
Discussions with these
Insight Groups are being facilitated by Dr. Bob Graham, Dr. Larry Green, and
Dr. Jim Martin. Members will contribute their perspective throughout the FFM
2.0 process. This will include
- participating in discussions about the future of family medicine with their facilitators;
- reviewing and reacting to the work produced by the Core Team and the Steering Committee; and
- meeting in person with the Core Team, Steering Committee, and a variety of stakeholders within and outside of family medicine at a strategic planning retreat in February.
APCO, which is leading the communications strategy element of the project, has completed a series of in-depth interviews with policy experts, payers, employers and specialists outside of family medicine. APCO's interviews will inform the quantitative element of their research, which includes a survey of a wide group of family medicine stakeholders. The results of that survey are expected in January.
We strongly encourage input from family physicians. Since our first report on this initiative, we have received more than 100 comments to FutureFM@aafp.org.
Following are several of the key questions the Core Team is considering as CFAR develops the current state analysis. We welcome input on these questions or general comments via FutureFM@AAFP.org.
- Is the patient-centered medical home (PCMH) the model of the future?
- How will the PCMH model need to evolve to meet the demands of the Triple Aim?
- Is population health a key part of family medicine? How should family medicine integrate with public health?
- How will disruptive technology alter the practice of family medicine?
- What changes are needed in the current payment structure to support the future of family medicine?
- What data is available/needed to support changes in payment structure?
- How does a narrowing scope in maternity and children's care impact the practice of family medicine?
The Core Team and Steering Committee will meet on Dec. 8. We will continue to provide monthly updates throughout this process.
Insight Group Members
Young Leaders (with nominating organizations)
- Michael Coffey, M.D., Somerville, Mass. (AAFP)
- Christina Kelly, M.D., Harker Heights, Texas (AAFP)
- Brooke Sciuto, M.D., Sacramento, Calif. (AAFP Foundation)
- Gretchen Dickson, M.D., M.B.A., Wichita, Kan. (AAFP Foundation)
- Kurt Lindberg, M.D., Holland, Mich. (ABFM)
- Amy McIntyre, M.D., M.P.H., Butte, Mont. (ABFM)
- Melissa Nothnagle, M.D., M.Sc., Pawtucket, R.I. (ADFM)
- Jill Endres, M.D., Iowa City, Iowa (ADFM)
- Carl Covey, M.D., Las Vegas (AFMRD)
- Carla Ainsworth, M.D., M.P.H., Seattle (AFMRD)
- Lauren Hughes, M.D., M.P.H., Ann Arbor, Mich. (NAPCRG)
- Rebecca Etz, Ph.D., Richmond, Va. (NAPCRG)
- Alisahah Cole, M.D., Charlotte, N.C. (STFM)
- Brett White, M.D., San Diego (STFM)
Students and Residents (with nominating organizations)
- Tate Hinkle, Brownsboro, Ala. (AAFP)
- Kimberly Becher, M.D. (AAFP)
- Nathaniel Lepp, M.P.H. (AAFP Foundation)
- Jessica Johnson, M.D., Portland, Ore. (AAFP Foundation)
- Charles Salmen, Brisbane, Calif. (ABFM)
- Kathleen Barnes, M.D., M.P.H. (ABFM)
- Jason Valadao, Wauwatosa, Wis. (ADFM)
- Jillian Fickenscher, M.D., Omaha, Neb. (ADFM)
- Natasha Bhuyan, M.D., Phoenix (AFMRD)
- Kari Sears, M.D., South Bend, Ind. (AFMRD)
- Vanessa Stagliano, Sagamore Hills, Ohio (NAPCRG)
- Richard Bruno, M.D., Baltimore (NAPCRG)
- Rebecca Mullen, Overland Park, Kan. (STFM)
- Nicholas Cohen, M.D., Cleveland (STFM)
Jeff Cain, M.D., is Board Chair of the AAFP.
FPs Doing Good Work in House of Medicine
recently represented our members at the AMA Interim Meeting in National Harbor,
Md. The AMA obviously is a very different organization than ours, but it
provides family physicians with another opportunity to lead and advocate at the
state and national levels. I was truly impressed by the tremendous
contributions being made by family physicians across the country.
Many of our members may not realize how involved some of their family physician colleagues are in the AMA, but we do everything we can -- anywhere we can -- to take our messages forward. I want to share my praise for a number of hard working FPs who represent our specialty and their patients through their work in the AMA.
The AAFP's delegation to the AMA is an outstanding group of dedicated individuals. Many of them have spent a decade or more involved in the AMA, and several are in positions of leadership. Our delegation is chaired by Joseph Zebley, M.D., of Baltimore and his co-chair Daniel Heinemann, M.D., of Sioux Falls, S.D.
Other members of the AAFP delegation are
- Neil Brooks, M.D., of Vernon Rockville, Conn.;
- Aaron George, D.O., of Durham, N.C..;
- Ajoy Kumar, M.D., of Saint Petersburg, Fla.
- Glenn Loomis, M.D., of Crestview Hills, Ky.;
- Frederick Ridge, M.D., of Linton, Ind.;
- Hugh Taylor, M.D., of South Hamilton, Mass.;
- Colette Willins, M.D., of Westlake, Ohio; and
Worthington, M.D., of Des Moines, Iowa.
Two of those delegation members -- Willins and Loomis -- serve on AMA councils.
David Swee, M.D., of Piscataway, N.J., is the alternate delegate. AAFP staff members Doug Henley, M.D.; Stan Kozakowski, M.D.; Perry Pugno, M.D., M.P.H.; and Julie Wood, M.D., also play important roles.
We also have critical representation from new physicians Janet West, M.D., of Pensacola, Fla., and Lindsay Bosford, M.D., M.B.A., of Sugarland, Texas; residents Charles Thompson, M.D., of Huntsville, Ala., and Messalina Jordan, D.O., of Brownsboro, Ala.; and students Jerry Abraham of San Antonio and Samuel Mathis of Galveston, Texas.
You might remember that Brooks is a former AAFP President. He is demonstrating a lifelong commitment to our specialty and is moving things forward in every avenue that he can find.
AAFP officers -- Board Chair Jeff Cain, M.D., (pictured with me above) President-elect Robert Wergin, M.D., and myself -- also serve as delegates. Each of us testifies during reference committees, as well as on the floor of the House of Delegates.
We also maintain connections with our state delegations and have many opportunities to talk about the priorities of family medicine in the context of the state chapters and their issues.
It's also worth noting that five members of the AMA Board of Trustees are family physicians, including the chair, David Barbe, M.D., of Mountain Grove, Mo.
Other family physicians on the AMA board are
- Gerald Harmon, M.D., of Pawleys Island, S.C.;
- William Kobler, M.D., of Rockford, Ill.;
- Albert Osbahr, M.D., of Hickory, N.C.; and
Permut, M.D., of Philadelphia.
All five of these men are AAFP members who understand the importance of family medicine. Each of them has the opportunity to be the AMA President-elect in the near future.
At each AMA event, we hold a dynamic meeting that is called a lunch but is actually more of a caucus. AAFP members from AMA leadership positions and state medical societies are invited to attend. We had more than 100 family physicians present at the most recent lunch as we reviewed AAFP priorities and policies, networked, created connections, talked about ways of engaging, and shared ideas and concerns. This is an important opportunity to communicate with members who may not come to our state chapter or national meetings.
It is exciting to be a part of this dedicated group of family physicians. As I have been saying, the answer to our country's health care needs is team-based care. The AMA meeting allowed us to reconnect with critical segments of our membership team to work to ensure policies that come out of the AMA are in line with the needs of our members. Ultimately, family physicians are on the front lines of organized medicine, working to improve outcomes for patients, increase their satisfaction with their care and decrease the cost of that care. Together we are stronger.
Reid Blackwelder, M.D., is President of the AAFP.
Giving Thanks for Work-Life Balance -- and the Dog
With the hectic schedules that we keep and the daily challenges we face, Thanksgiving presents a wonderful opportunity to pause and reflect on the things that are important.
One of the most important aspects of this holiday is that even if families are spread across the country, it is a time to gather, share a meal and give thanks. If face-to-face visits aren't possible, people often call or connect in other ways. And those connections are so important for recharging ourselves.
I find myself remembering that one of the main areas
of focus during our Scientific Assembly was finding balance in our lives. This
is an excellent theme to remember during Thanksgiving, so here is a story I'd
like to share.
My wife, Alex, and I have always had large dogs as part of our family. Sadly, we lost our last big black lab, Little Bear, in April. This left us with a 17-year old cat and the world’s largest Yorkie. Given the demands of an AAFP officer’s travel schedule, we decided that we wouldn't get a new puppy until my time on the Academy's Board of Directors ends in 2015.
Of course, you know what they say about best-laid plans. During a trip to the New Mexico AFP's chapter meeting, Alex and I fell in love with a malamute mix puppy and brought him home to Tennessee. He was able to fit in the pet carrier on Delta for just this one plane trip. He has since grown to 60 pounds at just 5 months of age.
New puppies bring additional responsibilities and even stress -- disrupted sleep schedule, need for frequent walks, lots of sudden play time, training, puppy class, socialization and so on. Not surprisingly, all of these things rather abruptly put into focus for me the critical need for balance.
Despite all of the above, which is certainly disruptive and even exhausting at times, our puppy, named Chashush (which is Apache for Big Bear) has actually helped create some balance for me. Alex and I have made important and healthy changes in our lives at a time we thought we might be too stressed to do so. We are outside getting exercise again with walks in our beautiful neighborhood, seeing the wildlife -- such as deer, raccoons and turkeys -- that are out early in the morning and late in the evening in our area. I am learning to recognize I can’t work 24/7, even though -- as Alex would tell you -- I still try.
Given his size, we committed to socializing Chashush early and regularly. Addressing this need has led to spending more time with friends because we often have puppy play dates that involve dinner and catching up with those friends. The dog also has been a wonderful focus for the grandkids, who are getting to know another member of our extended family and helping teach him how to interact with children.
We were not looking for a dog, and had, in fact, agreed not to get a new one during this hectic time in our lives. But it is remarkable what can happen when you hear a knock at the door and open it. I hope each of you will find time to open those doors that present opportunities to you, connect with friends and family (however you define them) who are important to you, and make them a part of your lives. This is definitely the time of year to do that on many levels.
Alex and I wish you and your family a happy, powerful and recharging Thanksgiving.
For news about the Academy and family medicine (and occasional updates about the dog) follow me on the AAFP President Facebook page.
Reid Blackwelder, M.D., is President of the AAFP.
Patient Encounter Offers Reminder About Finding Work-Life Balance
As family physicians, we spend a significant portion of our days telling patients what they should or should not eat, how often and how rigorously they should exercise, and how much they should sleep, as well as offering tips related to bad habits they should stop.
But how often do we take our own advice?
recently saw a patient, a woman in her early 50s, who we'll call Janice. Janice
was struggling with short-term memory problems, forgetting things like paying
her bills on time. That costly error led to late fees and additional stress for
a woman with an executive-level job, two kids and ailing, older parents.
I completed a thorough evaluation to rule out any physical or mental issues. In the end, Janice simply had too much on her plate, and the stress was getting to her. I suggested that she clear time on her schedule for herself and manage her time better. Sometimes, I said, our own well-being has to move to the top of the priority list, or all the other things on that list will suffer.
After she left, I thought, "That was pretty good advice. I should take it."
Physicians, especially physicians with children, often struggle with being pulled in multiple directions. In addition to the demands of a time-intensive job, we have commitments to family, friends and others. How do we find balance?
We deliver important messages to our patients every day, but these encounters also can serve as needed wake-up calls for ourselves. Someone who has completed college, medical school, residency and a master's degree in public health shouldn't have to be told to exercise, rest and eat well, but there I was in need of a simple reminder to take better care of myself.
Less than a year ago, I joined a brand new practice dealing with the typical challenges that new practices face: implementing an electronic health record system, recruiting a health care team and attracting patients. Throw in a family that includes 3-year-old and 6-year-old boys (pictured above), and life can be pretty crazy sometimes.
So now when I need to do something for myself, even little things like finding time to exercise, I put it on my calendar so that important time is reserved for me. If you think, "I'll go for a jog after I take care of X, Y and Z," you can count on A, B and C waiting for you the minute you're finished with Z.
The holidays are fast approaching, and although this time of year can be stressful, it also is a good time to stop and take a look at what we're doing and how we're doing it. In the coming weeks, I'll be asking my patients, "How did things go for you this year? What negative things are you going to leave behind in 2013, and what positives will you take with you into 2014?"
Those are questions we should ask ourselves as well.
M.D., M.P.H., is the new physician member of the AAFP Board of
Center Provides Important Lesson on Where We Came From
"History is who we are and why we are the way we are." -- Author and historian David McCullough
A placard bearing that quote from McCullough, a two-time Pulitzer Prize winner, caught my eye during my first trip to the Center for the History of Family Medicine. I recently attended my first meeting of the Center's Board of Curators as a liaison from the AAFP Board of Directors. Although I have been actively engaged in our Academy for nearly 30 years, I am sorry to admit that I was not aware of the wonderful resources available through the Center.
I am proud of our specialty and our heritage, and the Center is home to thousands of books, articles and artifacts that track our history. This wonderful combination of library, archives and museum is available as a resource for members wishing to learn more about our roots.
Some of our more experienced members might find the Center's
resources interesting because those books, articles and artifacts document
something they experienced. For our younger members, the Center offers insight into
where we came from.
Our specialty is a relatively new one. Family medicine officially became a medical specialty in 1969 (not long after this photo from the Center's archives was taken at the 1968 Congress of Delegates). At the time, the number of physicians entering what had been regarded as general practice was dwindling rapidly. Specialization, on the other hand, was viewed as important and valuable.
Our leaders understood the role of specialists, but they also believed in the importance of primary care, building relationships with patients and tying it all together rather than having a system of highly fragmented care. Family medicine leaders were courageous and worked for what they believed in, despite opposition from many in the medical establishment who opposed the idea of family medicine as a specialty.
Today, the mentality to speak out for our patients, practices and family medicine continues to be important in the face of new -- and old -- challenges in health care. It's something in the DNA of our specialty and something we can't afford to lose.
I encourage you to become more acquainted with our history, and you can do this easily by exploring the Center's online resources. In particular, I suggest you look through the Classics of Family Medicine, a list of seminal articles from the medical literature that have helped shape our specialty. Likewise, I suggest you explore our online exhibits, where, among other exhibits, you will find the "Distinguished Dozen: Twelve Books That Shaped the Face of Family Medicine."
For those interested in spending time in the Center to perform research leading to a publishable article or book, there is an annual fellowship available from the AAFP Foundation.
Remembering where we came from can help us find our way in the future. As McCullough said, "History is a guide to navigation in perilous times."
Clif Knight, M.D., is a member of the AAFP Board of Directors.
Getting Health Care Right, Even as We Change It
If there's one thing that's constant about health care in the United States these days, it's change. Health care reform swept a wave of new ideas out of theory and into practice, from insurance exchanges to accountable care. Advances in medical research mean that physicians have more treatments to help our patients than ever before. As a country, we're coming to terms with how complex health care is and how much change is still on the horizon.
Amidst all the change and complexity, though, the importance of the physician-patient relationship has stayed exactly the same. As I reviewed this month's workforce issue of Health Affairs, I was reminded of the more than 20,000 hours of training and education I completed, learning to provide the right care to patients despite a wide array of variables. Complexity is what physicians train for throughout our careers. As physicians, we have the education, expertise and experience necessary to ensure the highest quality of care for patients.
Being a primary care physician has never been more challenging or interesting, and fortunately, there are more of us than ever. The number of new primary care physicians increases every year, and by 2016, more than 3,000 new physicians will complete their training annually.
I can't imagine doing my job without the full breadth of training and education I received when becoming a family physician. Our patients' health challenges are growing increasingly complex. More members of our local communities -- whose families we often have cared for during the course of many years -- are developing multiple complex conditions that require advanced training and a keen insight into what might be causing overlapping health problems. According to the CDC, 45 percent of adults have two or more of the most common chronic conditions, and with an increasingly sedentary lifestyle and persistently high childhood obesity, future generations are likely to face significant overlapping health challenges, as well.
Because of our training and our presence in virtually every community across the country, family physicians are uniquely able to mediate change and complexity in a way that helps make health care work better for patients. The relationships we have with patients, combined with our training and expertise, are key to our ability to ensure our patients get the right care at the right time. There's a reason that people with chronic conditions -- from Parkinson's disease to hypertension -- see primary care physicians at higher rates than they see subspecialists.
Ultimately, that's what patients want. When they come to see us, our patients want to see a trusted partner in health who is expert enough to diagnose their problem, develop a comprehensive treatment plan, advise them and lead their care. We offer our patients exactly that because we devote more years to the study of medicine than any non-physician health care provider.
There's a lot that's changing with health care, but the core of why we became family physicians is our relationship with our patients, their families and their communities. Even as health care changes and evolves around us, we remain steadfastly committed to our patients. In that commitment, some things never change.
Reid Blackwelder, M.D., is President of the AAFP.
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