BY TONI LAPP
When Jason
Schulz's two sons fell ill on the same day recently, he wasn't surprised that
Doug Iliff, M.D., was able to see them that very day. It's the sort of service
Schulz has come to expect from Iliff's solo practice in Topeka, Kan.
"We've used (same-day appointments) quite often," Schulz said. "I don't remember ever not being able to get in the same day."
That's because Iliff's practice uses a variation of open-access scheduling, which is advocated in the Future of Family Medicine report. The project's Task Force 6 report said open-access scheduling would decrease the number of visits per patient and increase the "intensity" of services provided. The report estimated compensation would increase $9,133 per physician.
 Getting his sons in to see their doctor with a same-day appointment was no problem for Jason Schulz, left; appointment slots are open every afternoon for just such needs. "I don't remember ever not being able to get in the same day," said Schulz, checking out. |
Iliff wouldn't have his practice any other way. He asks his staff to leave all appointments open after 2 p.m., usually six to eight appointments, for patients calling in that day. It's simple practicality, he said.
"There's nothing more efficient than handling something right now. It makes sense to see someone when they've got the problem," he said.
Iliff noted a competitor's patients must schedule their physicals four to six months in advance. Iliff's patients can schedule physicals in about a week.
"The way we do this is not the most convenient to us," said office manager Gay Schneider. "But I can look our patients in the eye and know that we're putting them first."
Along the continuum
In the world of supply and demand, scheduling methods can be viewed along a continuum from traditional to advanced-access. Advanced-access purists leave most of their appointments open until the current day. By comparison, the traditional model fills all openings before the physician arrives in the office each day; the doctor accommodates last-minute visits by double-booking, working late or playing catch-up. Physicians somewhere in the middle, like Iliff, carve out some times for same-day appointments.
Offices can establish urgent care centers as an alternative to truly open-access scheduling, but patients usually don't see their primary care physicians, which goes against continuity of care. Furthermore, the patients often defer routine needs to another office visit.
Office manager and self-described "master scheduler" Cheri Murray of Wichita Clinics, which includes FPs, pediatricians and dermatologists, recalled days when the facility used traditional scheduling.
 FP Doug Iliff, M.D., of Topeka, Kan., maintains flexibility in his schedule with an eye on putting patients first. Here he visits with a patient during her physical. |
"We weren't really making effective use of our time," she said, because physicians -- concerned they might have a glut of physicals -- had established an elaborate system that qualified types of visits. One doctor had about 250 visit types.
"It was a behind-the-scenes scheduling nightmare," said Murray, estimating that patients waited six weeks for physicals.
Now there are no restrictions, except for surgical procedures that must be done in the mornings for practical purposes.
"We want the patients who call in today to get in and be seen today," she said.
On a grand scale
FP Mark Murray, M.D., M.P.A., of Sacramento, Calif., several years ago helped engineer Kaiser Permanente's switch to advanced access in northern California, replacing a 55-day wait for an appointment with same-day scheduling. The change worked for more than 100 primary care physicians caring for more than 250,000 patients.
Delays, he said, result from mismatches between supply and demand, and the traditional method of scheduling exacerbates the problem by reducing supply.
"What I recognized over a long period of time was that the distinction between urgent and routine appointments actually became a barrier to solving the capacity and continuity problems," he said.
Open-access scheduling is "basic queuing theory" used by industry, be it fast-food chains or other concerns, he says.
He advises practices to begin by measuring supply and demand. Supply is the amount of time allotted for patient visits. Demand is the amount of work generated on a daily basis, whether the appointments are walk-ins, call-ins or follow-up visits.
Of course, most physicians want to see an increase to their bottom line when they implement change. FP Todd Fristo, M.D., of Lee's Summit, Mo., measured statistics before and after implementing open-access scheduling. Before, the rate of no-show patients was 6 percent to 8 percent; after, the rate dropped to 2 percent to 3 percent. But there are other tangibles, he said: "My patients are happier and my front staff loves it."
Tips to move toward advanced access
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This is the fourth article in a series on the new model of care described in the FFM project report at http://www.annfammed.org/cgi/content/full/2/suppl_1/s3.
BY SHERI PORTER
The AAFP Board of Directors -- believing strongly that members need tools and resources to help move their practices into the future -- recently approved about $8 million to create a new model practice resource center that will open in early 2005.
The initial focus of the center will be to implement and evaluate a national demonstration project that would transform up to 20 family medicine practices to the new model of care advocated in the Future of Family Medicine project report.
"This is a critical investment by the Academy in the future of our discipline -- and it's an important and necessary step for our members," said Academy EVP Douglas Henley, M.D. "This center will seek to validate the new model of family medicine as proposed by the Future of Family Medicine report (available at http://www.annfammed.org/cgi/content/full/2/suppl_1/s3 ) by testing the model in the real world of family physician offices."
Family medicine practices that participate in the two-year demonstration project -- expected to launch in September 2005 -- will implement all of the new model elements, then evaluate their experiences to determine the model's impact on their practices.
"Members want proof that the new model will enhance patient care and satisfaction, improve efficiency and quality of care, and increase practice revenues," said AAFP Board Chair Michael Fleming, M.D., of Shreveport, La.
In 2006, the resource center is expected to expand its operations to provide products and services that will enable additional small- and medium-size family medicine practices to implement the new model of care.
The final report of FFM's Task Force 6, which studied the financial viability of the new model of care, is at http://www.annfammed.org/.
Family physician researchers will strive to use Internet technology to connect U.S. primary care physicians, thanks to a three-year, $3 million grant from the NIH. The project to build the Electronic Primary Care Research Network, EPCRN, is being undertaken by the Federation of Practice-Based Research Networks in cooperation with AAFP's Center for Health Information Technology and the University of Minnesota, Minneapolis.
"We expect this to accelerate the pace of discovery and speed the application of knowledge to the development of new prevention strategies, diagnostics and treatments," said federation chair Kevin Peterson, M.D., M.P.H., professor of family medicine at the university and member of the AAFP Commission on Clinical Policies and Research.
The EPCRN will give researchers access to potential study subjects throughout the country and establish a connection that will speed the application of research findings into communities that may not have direct access to research institutions.
The first step of the project is construction of an electronic infrastructure for the NIH using the next generation of Internet technology and potentially connecting every primary care physician in the country.
The grant was awarded as part of the NIH's "roadmap" program, a series of initiatives to identify major opportunities and gaps in medical research.
The work of the grant will address the important goal of translating research to practice, said Peterson.
"Primary care providers deliver the majority of the patient care in this country," he said. "It is essential that they are connected to bridge the gap between research and practice."
BY CINDY BORGMEYER
Responding to directives from the 2004 Congress of Delegates, the Academy on Nov. 30 sent a letter to the (then) American Board of Family Practice (now the American Board of Family Medicine -- see Board's name change reflects solidarity within 'family of family medicine') conveying AAFP delegates' actions regarding the board's Maintenance of Certification Program for Family Physicians, or MC-FP. The AAFP letter includes recommendations for easing transition to the new process.
Unfortunately, ABFM President Thomas Norris, M.D., on Nov. 10 sent a letter to the board's 66,000-plus Diplomates without having seen those recommendations.
In the Nov. 10 letter, Norris repeats a message relayed Oct. 12 - 13 by ABFM representatives in testimony during the Congress in Orlando, Fla.: "It is important to remember that the AAFP and the (ABFM) are separate organizations, with different accountabilities, and while the AAFP may make recommendations to the (ABFM), the (ABFM's) Board of Directors must make decisions regarding (ABFM) policies."
The letter goes on to acknowledge two primary concerns raised during the Congress -- a perceived lack of communication from the ABFM to its Diplomates about the MC-FP process and technical problems with the Self-Assessment Modules, or SAMs -- and then briefly describes actions the board has taken to address those concerns.
The board was "asked by the AAFP to suspend the MC-FP program, until improved communication and technical enhancements could be accomplished," Norris' letter states.
"While MC-FP will continue to evolve, the fundamental structure of the program will not change. … The one request we are not willing to honor is that we suspend the 'roll-out' of MC-FP," it concludes.
At the time Norris' letter was sent, the Academy had made no official MC-FP-related request of the board. The AAFP's letter, sent by AAFP Board Chair Michael Fleming, M.D., of Shreveport, La., delineates two MC-FP-related resolutions adopted by delegates at the 2004 Congress and outlines recommendations for achieving those resolutions' objectives.
Fleming's letter is at http://www.aafp.org/PreBuilt/Fleming_letter12-05.pdf. Help using PDF files is available at the site.
Briefly, the recommendations are:
"My hope," Fleming said of the Academy's letter, "is that now that the (board's) leadership has seen our recommendations, they will rethink their positions on the issues we've addressed and act accordingly." To do so, he added, would be in keeping with the collegial spirit of the many meetings between the Academy's and the board's executive committees, the memo of understanding between the two organizations, and their mutual commitment to collaboration in moving MC-FP forward.
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
In keeping with
recommendations made in the Future of Family Medicine project report released
last spring, the American Board of Family Practice has changed its name to the
American Board of Family Medicine. The proposed change, which took effect Jan.
1, was unanimously approved by the (then) ABFP Board of Directors last October.
Although no changes have been made to the ABFM's address or phone contact information, it does have a new home on the Web: http://www.TheABFM.org. E-mail addresses for ABFM staff also have changed accordingly, although the old addresses will continue to work for one year after the name change. You can find the new contact information by going to the ABFM home page and clicking on "Staff Directory" under "About ABFM."
WEB EXTRA!
WEB EXTRA! Chair of AAFP delegation to AMA
announces council run BY CINDY BORGMEYER
Members of the AAFP delegation to the AMA expected few surprises at the 2004 interim meeting of the House of Delegates Dec. 4 - 7 in Atlanta and, by and large, they weren't disappointed. AMA delegates at the meeting renewed their commitment to push for meaningful medical liability reform, an equitable "fix" for the Medicare physician payment formula and confidentiality of peer review processes.
What was disappointing, however: AMA delegates handily adopted several measures related to physicians' interests in so-called specialty hospitals despite protests from members of the AAFP delegation.
"The only people who testified for the community hospitals and against the specialty hospitals were family physicians Larry Anderson, M.D., and Daniel Heinemann. M.D.," said Daniel Ostergaard, M.D., AAFP vice president of international and interprofessional activities, who attended the meeting. "There was no sympathy whatsoever for the community hospitals."
At issue was AMA Board of Trustees Report 15, a lengthy document sporting 11 recommendations. Overall, the report recommends encouraging competition between community hospitals and specialty, or limited-care, hospitals "as a means of promoting the delivery of high-quality, cost-effective health care."
Unfair competition
But the playing field for the two types of facilities is far from level, Ostergaard contended.
"The majority of people in this country get their care in the community hospitals, particularly those in the smaller cities," Ostergaard said. "The creation of specialty hospitals has the potential to take patients away from the community hospitals -- patients who have Medicare or other insurance and whose financial reimbursements support community hospitals.
"Community hospitals cost-shift from the emergency room -- which loses money -- and all the indigent care that these hospitals take care of. The specialty hospitals aren't going to be taking care of indigents. The only way community hospitals can pay for the care they provide as the safety net for all people is through orthopedic and cardiovascular and those kinds of procedures. If those procedures are skimmed off by the specialty hospitals -- there's no money left."
And while some data may indicate specialty hospitals garner better outcomes on the limited types of procedures they do perform, such claims should be taken with a grain of salt, Ostergaard noted. The limited-care facilities don't care for the sickest patients, he said, and "they certainly don't take care of the whole patient, including their hypertension and everything else."
For more about the impact of specialty hospitals on communities and their full-service hospitals, go to http://www.aha.org/ahapolicyforum/trendwatch/twsept2004.html to download a PDF version of the American Hospital Association's September 2004 TrendWatch, which discusses this topic. Help using PDF documents is at http://www.aafp.org/pdf.xml.
"Corporate practice of medicine"
According to Anderson of Wellington, Kan., an AAFP delegate to the AMA, testimony was largely limited to three recommendations in the report. It was those areas that he and Heinemann took issue with. Namely, the report calls for the AMA to:
While that last recommendation ostensibly aims to eliminate interference with the doctor-patient relationship and end control of physician referrals by the hospitals or health systems employing those physicians -- what the AMA calls "corporate practice of medicine" -- the association is really trying to protect physicians' ability to self-refer, said Anderson.
"The AMA says 'We want competition,' but then says 'We don't want corporate medicine,' Anderson explained. "What they're really saying is 'We want competition, but we don't want anybody competing with our way of doing it.'"
Unintended consequence
The unintended consequence of prohibiting corporate practice of medicine would be the elimination of all arrangements in which physicians are employed by such systems, a prospect Heinemann, a former member of the AAFP Board of Directors who practices in Canton, S.D., finds untenable.
"The law in South Dakota (dealing with corporate practice of medicine) was modified when the prohibition was brought forward by (physicians working in) small rural hospitals who found it difficult to handle the business part of medicine," Heinemann explained. In his state and others, he said, such arrangements have allowed more physicians to remain in practice.
"There are probably only about 100 of these specialty hospitals throughout the country," said Anderson. "If each of them is owned by, say, 30 docs -- that's 3,000 doctor owners.
"A lot more physicians than that are employed by hospitals, so we did get that concession," he added, referring to the fact that delegates voted to refer that particular recommendation to the AMA Board of Trustees for further scrutiny.
The remaining 10 recommendations were adopted at the meeting.
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
WEB EXTRA! 2004 AMA interim meeting Dale Moquist, M.D., of Houston, chair of the Academy's delegation to the AMA House of Delegates, launched his candidacy for a seat on the AMA Council on Medical Education at the association's interim meeting Dec. 4 - 7 in Atlanta. Moquist, an AAFP delegate to the AMA since 1998, was nominated for the post by the Academy and has been endorsed by the Texas Medical Association.
As for why Moquist chose to make a run for the CME council, in particular -- it was a logical fit, he said.
"If you look at what the Council on Medical Education does, it deals with undergraduate medical education, graduate medical education and continuing medical education -- lifelong learning," Moquist noted.
"I've been precepting medical students for over 20 years," he explained. "I've been a full-time academic since August of 1988, and I've been very active in organizing and working with continuing medical education and presently serve as chair of the committee for CME of the Texas Academy (of Family Physicians). It only made sense that would be the council that I would go for."
As more red ink fills federal coffers, Congress will focus attention on the federal budget and set deficit-reduction sights on health care programs for the poor and elderly. That means family physicians may see incremental, if any, progress on medical liability reform.
Those are among the conclusions drawn by the AAFP Division of Government Relations and other political analysts as they evaluated the confluence of current economic, political and social trends.
Government relations staff shared their insights with constituent chapter leadership during the State Legislative Conference Nov. 5 - 6 in Savannah, Ga. On Nov. 17 - 18, David Mitchell, partner at GMMB, a Washington-based political and public affairs firm, and J Toscano, GMMB senior vice president, presented an "environmental scan" of the 2005 political landscape to the AAFP Board of Directors in Leawood, Kan. The analysts see a growing concern with deficit reduction that could divert attention from medical liability reform and expanded access to health care.
"The context for almost all important legislative decisions will be budget cutting and cost containment," Kevin Burke, director of AAFP's Government Relations Division, told State Legislative Conference participants.
Medical liability reform faces an uncertain future, according to Burke, Mitchell and Toscano. Despite President Bush's support, the analysts don't foresee great strides on a national level because "the votes aren't there yet in the Senate," according to the GMMB environmental scan. Though the 2004 election added four Republican senators, the new Congress will lack the needed 60 votes to end a possible filibuster on the issue.
Moreover, voters are unlikely to pressure legislators for medical liability reform. Sixty-eight percent of them see access to health care, not medical liability, as the nation's top health priority, according to GOP pollster Glen Bolger and Democratic pollster Geoff Garin.
Analysts also pointed to 8 percent annual growth in state Medicaid costs and predicted some form of cap on the federal match to state Medicaid expenditures. For example, Rep. Joe Barton, R-Texas, who chairs the House Energy and Commerce Committee, has promised hearings on comprehensive Medicaid reform that could include federal block grants or outright caps on federal Medicaid outlays.
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CMS should work with Congress to extend the moratorium on government audits that could have threatened the financial viability of family medicine residency programs nationwide. That was the recommendation issued recently by Daniel Levinson, acting HHS inspector general.
Levinson made his recommendation Dec. 8 in a memo to CMS Administrator Mark McClellan. M.D., Ph.D.
McClellan has 60 days to submit CMS' final management decision, including an action plan. That plan could follow any of five IG recommendations, which range from refining and continuing present regulations to making direct Medicare payments to nonhospital preceptors.
An extended moratorium would continue to prevent Medicare intermediaries from retroactively disallowing Medicare medical education payment for residents' time in ambulatory settings with volunteer preceptors.
"The AAFP is grateful for the IG's conclusions," said AAFP President Mary Frank, M.D., of Mill Valley, Calif. Medicare intermediaries' audits and retroactive repayment requests "put many family medicine residencies at financial risk," she said.
WEB EXTRA UPDATE!
The AAFP and four other family medicine organizations have called on CMS to immediately extend a moratorium on retroactive denials of graduate medical payments to residency training programs that rely on volunteer preceptors. The request came in a Dec. 14 letter to CMS Administrator Mark McClellan, M.D., Ph.D.
The letter is family medicine's response to a Dec. 8 report by David Levinson, acting HHS inspector general. Levinson's report urged CMS and Congress to work together to extend the moratorium and clearly define the rules for use of volunteer preceptors in community-based residencies.
Family medicine's letter lauded Levinson's recommendation but added, "Because Congress will not be back in session until after the lifting of the statutory moratorium, we urge CMS to do whatever it can under its own regulatory authority to allow the use of volunteer physicians in those settings as of Jan. 1, 2005. … We call upon CMS to immediately revise its regulations to allow for the use of volunteer preceptors for family medicine on Jan. 1, 2005."
McClellan has 60 days to submit CMS' final management decision, including an action plan, to the inspector general's office. That plan could follow any of five IG recommendations, which range from continuing present regulations but defining the treatment of volunteer time to making direct Medicare payments to the supervisory physicians in nonhospital teaching settings.
Each option has advantages and disadvantages, according to Levinson. He urged Congress to resolve the question legislatively.
In the meantime, the government should extend the moratorium on CMS' policy of demanding repayment of Medicare funds to nonhospital settings that use volunteer preceptors.
"The AAFP is grateful for the inspector general's conclusions," said AAFP President Mary Frank, M.D., of Mill Valley, Calif. Medicare intermediaries' audits and retroactive repayment requests "put many family medicine residencies at financial risk," she said.
The next generation of family physicians got a reprieve from the threatened slashing of federal funds that support their training, thanks to the fiscal year 2005 omnibus appropriations bill passed in the last days of the 108th Congress.
The reprieve was part of a 3,000-plus-page bill that appropriates $89.5 million -- up from $82 million in fiscal year 2004 -- to fund Section 747 of Title VII of the Public Health Service Act. This program, the only federal support for primary care training, is the lifeblood of many departments of family medicine.
In addition, the FY 2005 appropriations measure earmarks $3 million for a Citizens' Health Care Working Group that was included, but not funded, in the Medicare Prescription Drug, Improvement and Modernization Act of 2003. The group's mission: to conduct regional public hearings on America's health care system and recommend congressional actions to reduce the number of uninsured people. Other provisions of the law:
BY CINDY BORGMEYER
Some Academy members got a
preview of it at the 2004 AAFP Scientific Assembly in Orlando, Fla.; some no
doubt read about it in the November/December Annals of Family Medicine.
"It" is METRIC -- Measuring, Evaluating and Translating Research Into Care
-- a new AAFP practice performance program that goes live Jan. 17.
Designed to link evidence-based medical practice to education that changes physician behaviors and outcomes measurement, METRIC offers CME credit for completing practice-based performance measurement projects.
But Bruce Bagley, M.D., AAFP medical director of quality improvement, expects the program to have even more far-reaching effects. What physicians learn from completing the METRIC program could, for example, aid their efforts to implement the new model of care described in the Future of Family Medicine report, he notes.
"We see it as a way to get family physicians interested in doing QI work in their practices," Bagley explains. "METRIC is really a 'low hurdle' in terms of the amount of work that physicians will have to do. Our hope is that we can teach family physicians how to do these kinds of interventions on an ongoing basis."
"This is a baby step," agrees Christine Pullman, manager of the METRIC program. But programs such as METRIC are key to developing a sustainable QI culture, she adds.
New "take" on CME
In awarding Prescribed credit for this activity, the Academy is moving in parallel with an AMA initiative that last fall began granting Physician's Recognition Award Category 1 credit for performance improvement activities.
Additionally, the AAFP has applied to the American Board of Family Medicine for formal acceptance of METRIC as fulfilling part of the board's Maintenance of Certification Program for Family Physicians, or MC-FP. METRIC was developed with an eye toward satisfying the requirements of MC-FP Part IV -- the performance in practice portion of the new certification process.
Go to http://www.aafp.org/x29503.xml for an overview of the METRIC program and links to information on its history and objectives, as well as to the METRIC modules themselves as they become available.
First up: A module on diabetes; look for it starting Jan. 17. A second module --on coronary artery disease -- will go live in July. Pullman plans to launch two modules, primarily on single disease conditions, annually.
Nuts and bolts
Each METRIC module will include :
Data submitted to the METRIC program represent a valuable resource and will be retained for use in future practice-based research "after having been completely disassociated from the physician's information," Pullman says.
One step further
Bagley says the program should help physicians see the value of using educational interventions as part of their ongoing QI efforts.
"For instance, if an FP puts a registry system in place as one of the interventions chosen as part of his or her METRIC action plan, it is our hope that the physician will realize the value of that system and apply the same principles to registries for multiple chronic conditions," Bagley says.
"The Academy's Practice Enhancement Program will also teach FPs the needed skills to implement the new model of care (described in the FFM report)," he adds. "Many of the interventions that we will recommend in the METRIC program will be the same as those recommended in PEP, so there is some synergy."
Read the Annals article on METRIC at http://www.annfammed.org/cgi/content/full/2/6/615.
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
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WEB EXTRA!
If it's January, it must be time to check out the new immunization schedules. The AAFP, in cooperation with CDC Advisory Committee on Immunization Practices and American Academy of Pediatrics, has released the 2005 Recommended Childhood & Adolescent Immunization Schedule, available online and in the Jan. 1 American Family Physician. The recommendations for children and adolescents through age 18 are at http://www.aafp.org/childimmunizations.xml. The Adult Immunization Schedule is at http://www.aafp.org/adultimmunizations.xml.
To the editor:
I read with interest your article on EHRs in the October FP Report ("EHR Improves Work Flow, Patient Care"). I would be especially interested in joining any list AAFP puts out offering my practice as an example of an EHR in action.
I have a solo family practice in a 100-year-old Civil-War-era house in Tennessee. I use SOAPware, offered by DOCS Inc., and networked the Dell computers myself. I am now wireless with tablet computers. My total outlay was $300 for the program and $6,000 initially for the computers. We have grown over time, and I probably have $15,000 invested in computers today.
In the four years I have been here, this system has paid for itself time and time again.
Of note to your readers, when Vioxx® was taken off the market, it took me two minutes to search my patient charts. I then printed a form letter for the 368 patients for whom I have ever prescribed Vioxx advising them to stop using the drug and throw out all Vioxx pills in their drug cabinets.
Sigrid Johnson, M.D.
Sweetwater, Tenn.
WEB EXTRA!
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Some of your tobacco-addicted patients may want to break the tobacco habit in 2005, and resources are available to help them. Guide your patients to http://familydoctor.org/x5158.xml for downloadable patient education materials. Physicians should check out http://www.aafp.org/tobacco.xml for additional smoking cessation materials available from the AAFP. New federal government quit-smoking resources include a Web site at http://www.smokefree.gov where patients can go for tips on how to quit smoking and access to tobacco cessation experts via online instant messaging. Toll-free telephone support for smokers wanting to quit is available at (800) 784-8669. |
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The new American Family Physician monograph, "Management of Herpes Zoster and Postherpetic Neuralgia" has been mailed to all active members. This free monograph, which will help you diagnose and manage shingles and postherpetic neuralgia in your patients, is an element of AAFP's Annual Clinical Focus 2004: Caring for America's Aging Population. Follow directions for taking and submitting the post-test and receive 2 Prescribed CME credits. Go to http://www.aafp.org/phnmonograph.xml to read the full text online, or if you prefer, download a PDF of the 24-page monograph. For help with PDF files, go to http://www.aafp.org/pdf.xml. |
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If you or someone you know is thinking about retirement, you'll find some valuable tips on the topic of physician retirement in a book written by FP Edward Shahady, M.D., of Tallahassee, Fla. The paperback, A Physician's Guide to the Art of Successful Retirement ($24.95), offers information on why physicians retire, common fears and concerns about retirement, and practical tips on retiring from your practice. Also included are suggestions for helping your staff and patients make the transition as you prepare to retire. Shop online at http://www.aafp.org/shop/430. |
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Proven value: The post-holiday blues may turn serious for your patients prone to depression. Help them fend off depression this winter by offering help in the form of an AAFP patient education brochure. Order "Depression in Adults: You Don't Have to Feel This Way" from the AAFP family health facts series. Enjoy easy online ordering at http://www.aafp.org/shop/1547. Pay $12.50 for a packet of 50 brochures. |
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A shipping fee may apply; Kansas residents pay a 7.525 percent tax. |
WEB EXTRA!
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FP Report is published by the
AAFP News Department.
Copyright © 2005 by
American Academy of Family Physicians.
