Larry Green, M.D., heads new AAFP policy center in D.C.
Larry A. Green, M.D., took the helm Oct. 1 at AAFP's new Center for Policy Studies in Family Practice and Primary Care.
Green has resigned as chair of the family medicine department at the University of Colorado in Denver, effective June 1, 1999. Green will direct the AAFP center part time until that date, will direct the center full time for two years and then will return to the CU faculty.
The Washington, D.C., center will conduct research and analysis to provide a family practice perspective to policy deliberations in Washington. In addition, the center will do research to support the development of and advocacy for AAFP policies.
This interview with the new director gives glimpses into the center's future and a backwards glance at what prepared Green for his new job.
Q. How will you set the center's agenda?
A. I plan to listen. I'll ask family physicians and others, "What's the single most important policy issue facing you today?" We'll synthesize the answers into an initial focus for the policy center by the beginning of the year.
Q. What might the center study?
A. Lots of questions deal with the scope of family practice. For example, will insurance companies restrict family doctors from taking care of people with asthma, congestive heart failure or mental health problems? Or will the companies insist we care for those patients?
Other questions deal with education. For example, in the 21st century, will we need to do vasectomies, tubal ligations, colonoscopies and Caesarean sections? If so, under what circumstances?
Q. How will the policy center be different from other research centers?
A. The task of most family practice research centers is to develop new knowledge; the centers are driven by investigator-initiated ideas. In most cases, the policy center will study existing literature and databases, analyze them and apply that knowledge to advance primary care in the nation's policy environment. The policy center will be driven by policy issues as they emerge.
Q. Give an example of a policy issue.
A. The Balanced Budget Act of 1997 has the unintended consequence of decreasing the number of family medicine residents that could receive federal funding. In developing language for bills to amend the BBA, it would have been helpful to access Medicare cost reports and see exactly how many family practice residents have been "counted" by Medicare and might be affected by the BBA. The policy center, an independent entity, should have access to that type of information.
Q. In what sense will the policy center be independent?
A. The center will publish its work -- if accepted in peer-reviewed journals -- without having to have AAFP approval. Independence is critical for the center's credibility. I wouldn't have taken the position without the independence.
Q. Isn't a lot of primary care analysis already available?
A. No. Most research has been conducted on small subsets of the population. We need to stop blaming other people for doing their research and accept responsibility for explaining what primary care is.
In most countries, primary care is expected to exist as the foundation of health care systems. As this century ends, however, the United States is wondering what primary care is, who does it, who should do it and how much to invest in it.
Newsweek offers parenting advice from FPs
The AAFP and Newsweek have joined forces for a special section, "Parenting and Child Care." The 18-page section in the Sept. 28Newsweek features articles written by family physicians with the assistance of Academy staff in the news and special projects departments.
Topics include choosing a child care provider, discipline, preconception care and nutrition.
The special section will be distributed to about 21 million Newsweek readers. An additional 100,000 copies, packaged in bundles of 50, are available for Academy members to order for free. Call the AAFP order department at (800) 944-0000 and ask for item #R020.
Q. What prepared you to head this policy center?
A. Among other things, more than 20 years of practice in rural and urban areas. I've maintained a practice throughout my academic life, and I now see patients about four half-days a week. My practice has been fabulous preparation to understand what family doctors are up against.
Q. How have you helped build practice-based research?
A. I was the founding director of the Ambulatory Sentinel Practice Network, which now has about 750 clinicians, including some 700 family physicians, pooling their office-based research.
ASPN studies have shown how much smarter we need to get about managing common conditions. ASPN work has also pointed out the indivisibility of mental health and primary care.
Q. What international experience have you had?
A. I've sampled primary care and family practice in New Zealand, South Africa, Canada and Europe. A worldwide renaissance is going on concerning family practice and primary care.
Even the new South Africa is embracing its whole population, struggling to bring everyone into the health care system.
But the United States has a growing number of people who don't have health care -- up into the 40 millions. Don't you think we could learn something from those other countries?
Q. Is the international perspective related to the policy center?
A. Yes. The evidence is continuing to mount that a foundation of primary care within a country reduces morbidity, improves mortality rates and improves health status. The Academy and its membership care deeply about this. That's why now is the time for the Academy to launch a policy center in Washington devoted to installing that foundation of primary care for all Americans.
