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Tuesday Sep 06, 2016

What I Know Now, and What Lies Ahead

My term as AAFP Board chair will end Sept. 21 when the Congress of Delegates adjourns in Orlando, Fla. As that date quickly approaches, I find myself reflecting on the six years that I have represented family physicians and our specialty as a member of the Academy's Board of Directors.

I've learned a great deal in those six years, traveling the country to meet with members, media, payers and policymakers. Here is a look at some important things I now know and a few things I don't know -- yet.

Here I am testifying about issues related to electronic health records during a hearing of the Senate Committee on Health, Education, Labor and Pensions.

What I know is that representing family medicine has been a wonderful experience. Knowing the good work family physicians do every day to care for patients made the job of talking to reporters and legislators easy. We represent not only physicians but also patients, and our patient stories can be incredibly powerful when we tie them to a specific health care issue.

Knowing that our membership -- 124,900 and growing -- had my back gave me a strong voice, whether it was in front of a microphone during media interviews or on Capitol Hill. The good, vital work of so many family physicians gave me a seat at the table, and our input is credible and valued.

I worked hard to gain your trust and confidence, and knowing I had it gave me strength even when the going got tough. I know it was a good day when we laid the flawed Medicare sustainable growth rate to rest after 17 patches and more than a decade of threatened double-digit payment cuts.

I don't know exactly how the Medicare Access and CHIP Reauthorization Act (MACRA) will evolve, but I do know the AAFP is providing feedback and working to ensure that the new law is implemented in the best way possible for primary care.

Health care is changing. It is moving from a fragmented, volume-based, fee-for-service world to a value-based payment and delivery system. I know this creates huge opportunity for family physicians because we deliver high-quality, cost-effective care. That is the answer to our nation's health care delivery question.

I don't know how value-based care will be defined by payers and policymakers. Will it be a complex set of rules and regulations that takes joy out of practice? Rest assured, the Academy is fighting to prevent that, making the voice of family physicians heard and working to keep regulations simple and manageable. Let the focus be on patient care.

What I know is having an adequate family physician workforce is key to the success of MACRA and a value-based system. Other providers with far less training will step forward -- and have -- to say they can fill the void in the physician workforce. They can't. They aren't family physicians.

I know the number of students matching into family medicine has increased seven years in a row. Will that tide rise high enough to fill a gaping shortage of primary care physicians? We know it won't without reform of the graduate medical education system  because there aren't enough family medicine residency positions to produce the workforce needed.

The Academy is working for that change while also building student interest in our specialty. On that front, there are encouraging signs that we are moving in the right direction. This year's National Conference of Family Medicine Residents and Medical Students set records, with final numbers showing 4,798 participants attended the meeting, including 1,326 students and 1,207 residents.

Meanwhile, our student membership has swelled to 32,000. That includes 31.8 percent of all U.S. allopathic medical students and 16.2 percent of osteopathic students.

What I know is that I have experienced great personal growth as a result of being elected to the AAFP Board of Directors six years ago. My granddaughter Shiloh was born on the second day of my first board meeting. She was a passionate, babbling newborn with a lot to say, but she was unfocused and hard to understand -- not unlike me during my first Board meeting! But over time, she has grown to become a focused, articulate and still passionate kindergartener who knows she has the unconditional acceptance of her grandfather. Again, that's not unlike me developing into a laser-focused Academy officer thanks to the support of our members.

Finally, I know I am excited to bring my full attention back to providing comprehensive, full-scope family medicine at my practice in rural Nebraska. I also know family medicine is a wonderful profession. No, a calling. I wouldn't want to do anything else.

Thanks to all for your support.

Robert Wergin, M.D., is Board chair of the AAFP.


Coming from the Midwest, I can only relate to your "homecoming" trip back to rural Nebraska. Fall couldn't have been a more perfect timing for a cozy drive on that rural road, with the occasional farm house in the distant rolling hills. This is where I found my inspiration to become a family practitioner 20 years ago. Things don't change that fast here, and its serenity imbues a pervasive wisdom that can't be found anywhere else. Things are not perfect here, like life itself, but it is here in Midwest that I found its most acceptance and forgiveness. It is unlike the metropolitan Los Angeles where I now reside. I went back there with my father, also a now retired physician, a few years back to a family friend's funeral in Rochester, Minnesota. We drove another few hours and visited our old house. The elderly lady there welcomed us in. She showed us what she did to upgrade the house. My father was also a well known doctor in the small community back then, and she respectfully acknowledged that she was told on many occasions that this was a "doctor's" house before it was hers. She said that her husband was a farmer all his life. They used to live 2 hours away from here. He has had health problems after retiring so she moved him to this house, which is less than a mile from the hospital that my dad had worked before. Despite many things that will have to change, including how we as a society can agree and will have to fork the bill for healthcare, many things don't change. My father's reputation as a doctor, a wife dutifully taking care of her husband "'till death due us part" the values that make life worth living, worth saving, worth caring - they won't change, no matter where you go. For me, I got mine from the Midwest. Welcome back...

Posted by Michael N. on September 06, 2016 at 08:08 PM CDT #

Thanks, Bob. For all your hard work and dedication to this profession and our members. You have been an exemplary leader and a terrific role model for many student and resident leaders along the way. It seemed that you never lost sight of the personal relationships, which I'm imagining is a lot like how you practice, and why your patients must really appreciate having you back full-time.

Posted by Chris Baumert on September 06, 2016 at 09:16 PM CDT #

Thank you for everything, Sheriff. And don't be a stranger.

Posted by Joanna Bisgrove on September 06, 2016 at 09:33 PM CDT #

Thanks again for your excellent service. Can't wait to see you in Orlando. Your reach is extensive--my first week in South Texas for my new teaching job, you were being quoted in the local senior citizen news in our office lobby. And thank the AAFP because almost every one of these newspapers has their health news contribution. Again, your comments today is a good blog piece.
Now with all that experience blending practicality with diplomacy, perhaps you can fix Husker Football!

Posted by John R. Carroll, MD on September 07, 2016 at 08:00 AM CDT #

Bob, THANK YOU for your leadership, friendship and unending humor! If I ever had a brother, I would want it to be you! Never a meeting goes by without hearing you say "That's like putting lipstick on a pig!" For much of health policy these days, that is very true! I will miss you, Brenda, Alicia and Shiloh but I know that you will remain a force for Family Medicine for the rest of your life and we are all better off because of your service and commitment. Thanks for being the second "Bob" in my life! Wanda

Posted by Wanda Filer on September 08, 2016 at 09:53 AM CDT #

Welcome back to the Midwest. It is hard to believe that six years have passed since we "Released the Bob". Though it has been hard, we have forgiven you for beating out our Missouri candidate. Good luck with your return from combat.

Keith Ratcliff

Posted by Keith Ratcliff on September 08, 2016 at 05:45 PM CDT #

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