Students, Young Physicians Provide Insights for Future of Family Medicine 2.0
Have you offered your opinion on the Future of Family Medicine?
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
In our December update below, we address some of the important questions being considered by the work group and introduce 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.
To 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 Bob Graham, M.D.; Larry Green, M.D.; and Jim Martin, M.D. 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., Huntington, W.V. (AAFP)
- Nathaniel Lepp, M.P.H., New York (AAFP Foundation)
- Jessica Johnson, M.D., Portland, Ore. (AAFP Foundation)
- Charles Salmen, Brisbane, Calif. (ABFM)
- Kathleen Barnes, M.D., M.P.H., Seattle (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.
Shaping the Future of Family Medicine
A few months ago, the Family Medicine Working Party launched an initiative to examine the challenges and opportunities facing our specialty and define a path forward in a rapidly changing health care system.
Family Medicine for America's Health: Future of Family Medicine 2.0 is specifically designed to define the role of the 21st century family physician, including key attributes, practice scope and role within the health care system, and to ensure family medicine can deliver the workforce to perform this role via medical school/residency training and re-engaging existing family physicians, among other things.
When this project launched, we promised to share regular updates on its progress. Here is the latest information.
Family Medicine for America’s Health:
Future of Family Medicine 2.0
Organizational Update #2
As many of you know, the Family Medicine for America’s Health: Future of Family Medicine 2.0 initiative launched in late August. 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.
As 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; and
- 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.
The first of seven Core Team meetings was held on Oct. 15 in Chicago. The consultants retained for this project -- CFAR and APCO Worldwide -- have begun the research phases of their respective plans. CFAR conducted a series of interviews with family medicine stakeholders. Interviewees included family physicians practicing and teaching in a variety of settings, public health and mental health teachers and practitioners, osteopaths, physician assistants, nurse practitioners, and other specialists. The insights gleaned from the interviews will be used to inform CFAR's Strategic Options Survey, which launched during the week of Oct. 21 and will remain open for two weeks. CFAR also will begin gathering and working with data from a range of sources to build a solid understanding of the current state of family medicine, its strengths and its challenges.
APCO is conducting in-depth interviews with health policy experts, payers, health plan purchasers, other primary care professionals and specialists to gather insights and recommendations related to how these external stakeholders view family physicians. These discussions will inform the quantitative element of their research, which includes surveys of a wide group of family medicine stakeholders. This research will be used to guide the development of a comprehensive communications plan.
At the meeting, CFAR and APCO briefed the Core Team on feedback from their interviews. Issues surrounding scope of practice and length of training emerged as significant themes, particularly in the CFAR interviews. Additional questions arose from both CFAR and APCO's discussions that will require further discussion and evaluation, including
- Are family physicians “specialists” or “comprehensivists” who provide longitudinal care?
- What is the “unifying theme” among the diverse archetypes of family physicians?
- How do family physicians approach the needs and wants of patients differently than do other physicians?
- Do family physicians believe they have a mandate to lead the patient-centered medical home effort or are they deferring to others?
- What impact will technology and big data have on the practice of family medicine?
Since our first report to members on this initiative, we have received more than 140 comments to FutureFM@aafp.org. We are pleased that family physicians are taking the time to provide input and would encourage others to share their views through this dedicated e-mail address. We are closely reviewing comments and are incorporating suggestions into the planning process.
The second meeting of the Core Team will be Nov. 13. We will continue to provide updates throughout this process. We strongly encourage input and feedback and invite you to share your thoughts and recommendations by email to FutureFM@aafp.org.
Following are members of the Steering Committee and the Core Team.
Samuel Jones, M.D. (ABFM) -- Committee Chair
Stacy Brungardt (STFM)
Ardis Davis (ADFM)
Frank deGruy, M.D. (NAPCRG)
Kevin Helm (AFMRD)
Douglas Henley, M.D. (AAFP)
Grant Hoekzema, M.D. (AFMRD)
Jason Marker, M.D. (AAFP Foundation)
James Puffer, M.D. (ABFM)
John Saultz, M.D. (STFM)
Kurt Stange, M.D., Ph.D. (NAPCRG)
Glen Stream, M.D., M.B.I. (AAFP)
Barbara Thompson, M.D. (ADFM)
Jane Weida, M.D. (AAFP Foundation)
Tom Campbell (ADFM)
Jennifer DeVoe, M.D., D.Phil. (NAPCRG)
Jerry Kruse, M.D. (STFM)
Bob Phillips, M.D. (ABFM)
Glen Stream, M.D., M.B.I. (AAFP)
Mike Tuggy, M.D. (AFMRD)
Mary Jo Welker, M.D. (AAFP Foundation)
Jeff Cain, M.D., is Board Chair of the AAFP.
U.S. GME Results Not Aligned With Need
The U.S. birth rate hit an all-time low in 2012, dropping to 63 babies per 1,000 women aged 15 to 44. That's a little more than half the birth rate the nation experienced at the tail end of the baby boom.
This recent news
from the CDC coincides with a new report from the AAFP's
Robert Graham Center for Policy Studies in Family Medicine and Primary Care showing how our
country’s graduate medical education (GME) system has not kept up with the
needs of our changing population. Despite the declining birth rate and an
increasing need for a larger adult primary care workforce, our nation's medical
schools and residency programs are producing general pediatricians at a much
higher rate than family physicians and general internal medicine physicians.
Our aging boomer population -- coupled with expanding access to health insurance -- poses a potential crisis. People are living longer with more chronic diseases, but who will provide their care?
We know that new medical schools are opening, and many
existing schools are expanding their class sizes. But our goal can't be to just
graduate more physicians. Our country's goal for medical education should be to
produce the types of physicians our health care system actually needs.
The Graham Center's one-pager illustrates an excellent example of how primary care research can help drive health care policy. It reinforces an August report from the Council on Graduate Medical Education (COGME) recommending that GME funding be prioritized to align the health care workforce with population and health delivery needs. Specifically, COGME said increases in GME funding should be directed to the following high-priority specialties:
- family medicine
- general internal medicine
- general surgery
- pediatric subspecialties and
The United States spends nearly $13 billion a year on GME funding, an investment made with our country's tax dollars. For this level of investment, we deserve a workforce that meets our country's needs.
Jeff Cain, M.D., is Board Chair of the AAFP.
WIC One Example of How Shutdown Could Hurt Our Patients
On Monday, we told you how the government shutdown is affecting health care, as well as how it is affecting the Academy's advocacy efforts in Washington. Today, I offer one example of how the congressional stalemate could cause millions of our patients to suffer simply by affecting one vital, time-tested program.
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides supplemental foods, infant formula, breastfeeding support, health care resources and more to nearly 9 million mothers and young children who live near or below the poverty line. The WIC program has been essential in helping to improve health and nutrition for mothers and children and lowering health care costs.
But, the government shutdown has affected funding for this essential program. There was immediate speculation that state WIC programs would run out of money within a week or two, but state reserves and contingency funding from the U.S. Department of Agriculture are expected to keep programs running through the end of the month.
The question, however, is will Congress act before then? Faced with an Oct. 17 deadline to raise the federal debt limit, legislators and the White House have made no progress in preventing the country from defaulting on its debts, which could trigger a national -- and possibly global -- economic crisis and create chaos for the beneficiaries of government programs.
That's the big picture.
Practicing just outside the Beltway in Maryland, I'm thinking about my own patients. A national radio host made headlines last week when he said WIC wasn't "doing anybody any good." The four years I spent working in a community health center showed me otherwise. I've seen countless families who benefited from the program.
In the past week, I've been thinking a lot about one patient in particular, who we'll call Linda. She has six kids. Linda already was a mom when her birth control failed, leading to triplets. Linda and her husband both work full-time jobs, leaving them with significant daycare expenses for their four children who are not yet in school.
WIC not only helps people like Linda and their families make ends meet, it encourages healthy choices. You can't buy junk food through the WIC program, which means children are more likely to get fresh apples than french fries. If WIC funding isn't restored, unhealthy food will be a cheaper choice for the millions of moms who rely on the program.
Sequestration already will cut WIC funding by more than 7 percent, and a proposed House Budget Resolution would remove 1.7 million mothers and children from the program next year. (The House recently passed a bill that would fund WIC for two months, but the Senate and the National WIC Association deemed that stop-gap measure unacceptable.)
So how else is the shutdown affecting government nutrition programs?
The Supplemental Nutrition Assistance Program (SNAP), which provides food stamps to roughly 47 million Americans, is not affected by the shutdown. (As a side note, the House passed a bill in September that calls for $40 billion in cuts in the next 10 years.) However, the USDA school lunch program, which provides reduced-price and free meals to more than 30 million children, could run out of funds in a few weeks, according to USA Today. The USDA reimburses schools on a monthly basis, which means schools could be handed a tremendous challenge in November if the government remains gridlocked.
Millions of our patients rely on programs such as these to help them when times get tough. These nutrition programs determine how well people eat -- and sometimes whether or not they do eat. People shouldn't have to choose between paying their bills and putting food on the table.
Kisha Davis, M.D., M.P.H., is the new physician member of the AAFP Board of Directors.
Do Your Patients Know How Health Care Reform Will Affect Them?
Health care marketplaces created by the Patient Protection and Affordable Care Act are scheduled to open for enrollment Oct. 1. Unfortunately, fewer than one-fourth of Americans are aware that the marketplaces -- formerly known as exchanges -- exist, according to a Kaiser Health poll released in June.
In fact, fewer than half of U.S. consumers are aware that the ACA is being implemented, according to a poll released by Kaiser Health in April.
Kaiser Health's April poll said that 12 percent of consumers thought the health care reform law had been repealed by Congress, and 7 percent thought it had been overturned by the Supreme Court. Consumers who are unaware that the ACA is being implemented aren't going to be ready for enrollment deadlines and likely aren't aware of new services and benefits available to them.
Where are consumers hearing about the ACA? Forty percent of respondents said they were getting information (possibly misinformation) from friends and family. Roughly one-third named news outlets as their source of information.
Only 11 percent said they had received any information about health care reform from their physicians. In a more recent poll by HealthPocket, a website that compares health plans, half of respondents who had a primary care physician said they had not talked with their doctor about how the law will affect them.
But, providing good information to help our patients make informed decisions about their health care is something we do every day, and that's what we need to do now to help make sure our patients are aware of the options open to them.
In the short term, physicians can direct patients to a FamilyDoctor.org web page that addresses common consumer questions. Consumers also can get information about health insurance marketplaces -- and find out if they qualify for lower premiums and lower out-of-pocket costs -- at www.healthcare.gov.
A question-and-answer article in Family Practice Management also addresses numerous ways the ACA will affect family physician practices.
In addition, the Academy is working on developing resources to help physicians answer patient questions and to address how the law will affect our practices. Those resources are expected to be available September 3.
The bottom line is that family physicians need to be informed. We need to look at the parts of the Affordable Care Act that are good for our patients and make sure they are prepared to benefit from those provisions. We also need to be aware of how our practices may benefit from health care reform. We also need to continue to identify areas of the law that are not good for our patients or us and work to change them. We should find those aspects of the law that have potential and work to improve them. And we need to be able to answer our patients’ questions about how the law and its implementation will affect them.
Blackwelder, M.D., is President-elect of the AAFP.
Reflections on 25 Years of Tar Wars
This year, family physicians, residents, medical students and others will present Tar Wars to roughly 500,000 fourth-grade and fifth-grade students. Since I co-founded the tobacco free education program as a resident in 1988, more than 9 million children have heard the Tar Wars message worldwide.
As we celebrated our
25th year this week during the Tar Wars National Conference in Washington, I
was asked to reflect on how far we've come. (Watch the video below to hear more about how it all began).
Before we started the first Tar Wars program in Colorado, we knew we were making a difference one kid at a time when they walked in the door of our residency. But we wanted to make a difference in more lives, and we accomplished that by taking Tar Wars to local schools.
We had no idea it would ever grow this big.
A family physician once told me that if you don't care who gets the credit, it's amazing what can happen. I think the secret of Tar Wars' success was not only did we have a great message, but we also shared the program and allowed state chapters to own it, change it and make it their own. That freedom and creativity has allowed Tar Wars to grow and evolve for a quarter of a century.
The prevalence of smoking among U.S. adults has continued to slowly decline from 26 percent in 1990 to less than 20 percent today. Still, we have a long way to go. Tobacco remains the No. 1 cause of preventable death in our country, and about 4,000 American children smoke their first cigarette each day.
Children are bombarded with messages -- wrong messages -- in popular culture portraying smoking as cool or glamorous. Soon kids will be heading back to school. Will you be there to tell them the truth about tobacco? Here is how to get involved.
Jeff Cain, M.D., is
president of the AAFP.
FPs' Talents, Skills Are Needed Now More Than Ever All Around the World
Bienvenue, vítáme vás, yokoso, maeva, willkommen, ahla w sahla, hoan nghênh, bienvenidos.
Their clothing was different. Their cultures and customs were unique. Their practice settings varied. And their languages were numerous.
Yet regardless of what language was being spoken by
the roughly 4,000 family physicians gathered from around the globe for the
recent World Conference of the World Organization of Family Doctors (WONCA) in
Prague, Czech Republic, somehow the stories of these family
physicians seemed familiar.
Health care systems, economics and geography may dictate much of the scope or nature of the kinds of services that family physicians provide around the world, from providing high level surgical trauma care in remote parts of Australia, to making rounds barefoot in the mountains of Uzbekistan.
But one thing we all have in common is our practices center on our relationships with patients and the intimate conversations that make such a difference in their lives and their health.
WONCA provided a fantastic opportunity to step back and gain a new perspective on health care around the world by talking with family physicians and learning from their experiences in their own countries. The two-way exchange was refreshing and energizing.
There also were plenty of educational opportunities during the five-day scientific program which included workshops and lectures ranging from medical treatment to research, ethics and even physician self-care.
One of the biggest lessons from WONCA is how family medicine is increasingly being valued worldwide because of how chronic, noncommunicable diseases, such as heart disease and diabetes, have overtaken infectious diseases as the leading cause of morbidity, disability and mortality in the world.
World Health Organization Director General Margaret Chan, M.D., was our keynote speaker, and she pointed out in her speech that the fundamental shift in disease burden emphasizes a need for enhanced prevention and the care of chronic disease.
"A health system where primary care is the backbone and family doctors are the bedrock delivers the best health outcomes, at the lowest cost and with the greatest user satisfaction," she said.
Family doctors are the foundation for "comprehensive, compassionate and people-centered care," Chan added. Primary care and prevention are critical to addressing these chronic diseases and improving the health of not only our own patients but the people of the world.
"Today, you are the rising stars who offer our best hope of coping with a number of complex and ominous trends," Chan said. "Your talents and skills are needed, and wanted, now more than ever before."
The AAFP's presence at WONCA was important for the future of family medicine in our own country. We know that an interest in global health is one factor that draws students to our specialty. Medical students that participate in global health exchanges understand how a family medicine residency prepares them for international health. During WONCA, our delegation was able to build relationships with family medicine organizations in other countries to increase opportunities for exchanges with students, residents and maybe even with practicing family physicians.
We also took time at WONCA to celebrate and formally honor former AAFP vice president Dan Ostergaard M.D., and outgoing WONCA President Rich Roberts, M.D., for their roles in global health. Roberts (shown in the photo above his wife Laura and me) has traveled to 50 countries, and Ostergaard traveled to more than 60 countries in his three decades with the AAFP. Both men promoted the value and development of family medicine worldwide.
When Ostergaard retired as AAFP vice president for health of the public and interprofessional activities in January, he challenged our students, residents, new physicians and others to "look for opportunities to make a difference from our own backyards to overseas."
In short, WONCA offers an opportunity to get an international taste of family medicine, hear fresh perspectives on the common problems we all face daily and appreciate the increasing value of family medicine worldwide.
Interested in learning more about attending a WONCA meeting? Check out these future possibilities.
Jeff Cain, M.D., is President of the AAFP.
Chapters Can Help Each Other By Sharing Insights
One of the real joys of being on the AAFP Board of Directors -- and now being an officer for the Academy -- is the opportunity to meet members from all over the country, as we often are invited to attend the annual meetings of our chapters.
These meetings usually feature outstanding education presentations. There also are celebrations and transitions to new chapter officers, who visiting Academy Board members have the privilege of installing.
Additionally, we get the unique opportunity to hear how things are going in individual chapters, both the good and the bad. Although we often hear of the challenges family physicians are facing in their states, their success stories are equally striking.
Often, when you implement a new program or policy in your practice to meet a patient or practice need, you might not appreciate how impressive that change is and how it appears to others. As someone who has crisscrossed the country visiting chapters during the past four years, I've often seen the bigger picture, and I can tell you, some of these success stories truly are incredible.
The Academy highlights some of these achievements each month in AAFP News Now's chapter spotlight series. If you haven’t done so already, check out these stories. By sharing our successes on a state-by-state level, we can help benefit family physicians who may be facing similar circumstances in other states.
During the past three years, AAFP News Now has chronicled the efforts of more than 30 chapters, including the amazing rural outreach programs going in Idaho, a medical student mentoring program in New Hampshire, a primary care student loan repayment program in Iowa and an innovative CME program in Arizona.
It is important to see some of these bright spots because they suggest ways all of us could approach certain challenges. The issues being addressed are common for family physicians all over the country. Each chapter can relate to some aspect of these issues that affect our members.
At the Academy's' Annual Leadership Forum, I had the opportunity to host a breakfast for current chapter presidents and presidents-elect. We experimented during that event with sharing our bright spots. There were so many people with wonderful things to share that we ran out of time before we could hear them all.
I will be distributing a summary of these bright spots to chapter leaders. However, we have a real opportunity in this forum to do the same kind of sharing.
I encourage every family physician who reads this to take a moment and share something positive about what is going on in your practice or in your chapter. Please use the comment section to let us know what incredible things you are doing.
I look forward to seeing these discussions broaden and become a source of positive change and support for each other.
I realize we often need to talk about topics that can be divisive, and comments on listservs can sometimes go in a negative direction. For this blog, let's commit to not hiding our light under a bushel and happily advertise how incredible we are!
We all will gain by being able to recognize our own successes in the middle of what often can be difficult days. We also will see that such positivity and successes are more common than we perceive them to be.
We are entering a golden age for family medicine. People are beginning to look to us for the answers as they recognize that we really are the foundation of transforming our health care system. Now is the time for us to recognize these ourselves and to create a deep well of opportunities.
Thank you in advance for sharing and for being part of the solution.
Reid Blackwelder, M.D., is President-elect of the AAFP.
Help Other Communities by Sharing Your Public Health Success Stories
It has been 100 years since the first school of public health was founded in this country. And it has been nearly 50 years since the Folsom Report called for a new approach to providing health services based on a "community of solution."
Unfortunately, primary care and public health still operate in isolation more often than not. As an IOM report pointed out last year, "primary care focuses on providing medical services to individual patients with immediate health needs," while "public health focuses on offering a broad array of services across communities and populations."
Simply by reporting notifiable diseases we encounter in our offices, primary care physicians can prevent the spread of disease and contain potentially huge problems, such as probable food poisoning from a local restaurant. But surely there should be more coordination and communication. Couldn't working together with state and local public health departments lead to lower costs, better outcomes and healthier communities?
AAFP News Now reported earlier this year on the development of a new Web-based resource aimed at providing physicians and public health officials with tools and strategies to work together on population health. The Practical Playbook for Integrating Public Health and Primary Care will, among other things, analyze programs that successfully integrate public health and primary care and determine the common elements that help them succeed.
To that end, the Association of State and Territorial Health Officials (ASTHO) is compiling examples of such successes for analysis. More than three dozen organizations -- including state health departments, hospitals, nonprofit organizations and others -- already have told their stories about immunizations, cancer screening programs, asthma education, smoking cessation and more.
For example, the Washington State Department of Health is working with primary care clinics and local public health organizations in four counties, providing training, technical assistance and coaching to practices transitioning to the patient-centered medical home model. The project is expected to add new communities every six months and, eventually will be statewide.
Thus far, many of the stories submitted to ASTHO involve large, statewide and even national programs. What seems to be missing is something at the core of primary care in our local communities -- us.
Family physicians already are involved in these types of integrated programs. But we need to share the success stories from our communities so we can learn from them and possibly even replicate them elsewhere.
I'm not asking you to write a journal article. This is fast and easy. Most of the questions are multiple-choice. The bottom line is that taking 10 minutes to tell your story could help patients and your colleagues in another community benefit from your experience.
As family physicians, we participate in public health initiatives every day, and we need to be part of the broader integration of primary care and public health. With our compelling stories, we will be able to have a seat at the table and emphasize the resources we need for our patients.
Rebecca Jaffe, M.D., is a member of the AAFP Board of Directors.
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.
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.