Shawn Martin, shown here addressing a Capitol Hill press conference in June, is an acknowledged expert on several key issues affecting family physician practices, including public and private payment, medical liability reform, graduate medical education and health system reform.
Shawn Martin, the AAFP's new vice president of advocacy and practice advancement, has spent the past 13 years working in the health care field, developing a vast knowledge of primary care and its role in the evolving health care system. In the process, he has become an acknowledged expert on several key issues that directly affect family physicians and their practices, including public and private payment, medical liability reform, graduate medical education and health system reform.
Martin will oversee the AAFP's Division of Government Relations and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care in Washington. He also will oversee the Division of Practice Advancement at AAFP headquarters in Leawood, Kan. He replaces Rosemarie Sweeney, the AAFP's former vice president of advocacy and practice advancement who retired in March after nearly 33 years with the Academy.
Before joining the AAFP, Martin served as the director of government relations for the American Osteopathic Association. In addition, he is the former chair of the Health Coalition on Liability and has served in leadership positions with other health care coalitions in Washington. The Hill newspaper named Martin one of its top 10 health care lobbyists in Washington.
AAFP News Now recently sat down with Martin to learn more about his perspectives on primary care and family medicine and to find out what he would like to accomplish as the AAFP's new vice president of advocacy and practice advancement.
- Shawn Martin, the AAFP's new vice president of advocacy and practice advancement, wants to help make family medicine the bedrock of the nation's health care system.
- In this interview, Martin identifies payment, overhead and regulatory obstacles as the most pressing issues faced by family physicians.
- Martin also says it is important to position family medicine to capitalize on opportunities that now exist in the evolving health care system.
Q. Why did you want to take this position with the AAFP?
A. There are a variety of reasons. There are some professional reasons having to do with the breadth and scope of the capabilities of the Academy. This was one of a handful of jobs that I always said, if it ever became vacant, I would apply for it. When I was with the American Osteopathic Association (AOA), I learned a great deal about the Academy, especially as the AOA collaborated with the AAFP on the patient-centered medical home. The more I worked with the Academy while I was with the AOA, the more impressed and intrigued I became by the AAFP.
Professionally, this is just a great step up to work with a great team, a great budget and a great set of issues. The AAFP has tremendous respect across the country, working in both the public and private sectors for family medicine and primary care.
I also felt I could bring some new ideas and some new energy to the Academy. I didn't want to come in and simply try to continue the great work Rosi Sweeney, (the AAFP's former vice president of advocacy and practice advancement) has done. I wanted to put my own energy into ensuring that the Academy continues to grow -- building on what Rosi has accomplished while also moving things forward. That was important.
Q. What are some of the new ideas you want to bring to the AAFP?
A. I am in a discovery phase with some ideas. But I think in a post health care reform world, there are some pressing issues, such as how do we blend advocacy efforts in the federal and state governments with those we are doing on the commercial side through practice advancement?
It is really a question of how do we navigate this strange new world that exists between public and private partnerships as the law takes hold. With a lot of these new health care initiatives, there are limited distinctions between commercial and public payers. How do we position family medicine to capitalize on these opportunities that exist?
As Medicaid begins to roll into the commercial market or as the commercial market begins to have more influence in state marketplaces through the state-based health insurance exchanges, what is the AAFP going to do? I don't have all of the answers yet, but it is a very exciting time to solidify family medicine as the foundation of the health care system.
Q. What do you want to accomplish in your new position with the AAFP?
A. I want to grow the AAFP's influence broadly in the public and private sectors. I want to grow the Academy's presence and influence among members of Congress, the administration, public and private insurers and payers, and the business community. I think if we do that, the value of family medicine and the great work of our members and staff will carry the day.
I think we have to position the Academy in the right places to let that work and message take hold.
Q. How would you rate the AAFP's presence and influence right now?
A. I think it is very, very good. I think the AAFP has done a lot of work to create entrees into a lot of these public and private sector worlds. But it can always be better.
Q. How do you think your past experiences will help you with your new position with the AAFP and in accomplishing some of the things you talked about?
A. I come out of both the lobbying and practice management worlds. I have brought that experience from my previous job. I think my past experience is applicable to the advocacy part of the job and the practice advancement, as well as the work the AAFP does in the private sector. The ability to shape a message and carry it forward to other organizations and individuals is a unique skill that I look forward to deploying in my position with the AAFP.
It is always good to be new in the sense that you can bring a different perspective to a situation.
Q. What do you see as the most pressing issues facing our members?
A. I can answer that question by putting our issues and challenges into three buckets. The economy of family medicine may not always be the most important issue, but it is always the most pressing issue. The economy of family medicine involves payment as well as overhead and regulatory obstacles family physicians face in practicing medicine. That is one major bucket.
A second major bucket looks at where family physicians are going to exist in the world. There is a lot of momentum right now to create a bottom-up health care system that is based on a foundation of primary care. There are a lot of people who do not want that to happen. A lot of people want this to be a top-down health care system or model. That would be very bad for the AAFP and its members. If that were to happen, the AAFP and its members essentially would become a commodity in a larger traded space.
If it is a bottom-up approach, our members would be able to take ownership of the health care system from a grass-roots component, and that would be very good for our members.
The third bucket is workforce. The economy and the positioning of family medicine dictate workforce in a lot of respects. How are we going to train future generations of family physicians? Where are we going to train them? Is the current model for training family physicians applicable? Could it be more applicable?
As you flush out the first two buckets, then the workforce bucket becomes a little more apparent. We also need to ask what the definition is of a primary care physician in a team-based care model. Are they the CEO? Are they dealing with the most complex patients? How are they interacting with their subspecialist colleagues?
In the team-based model, you have to redefine the role of the family physician. I think family physicians will provide more hands-on health care than they do today in certain instances, and they will resemble a CEO in other instances.
Q. You said one of the goals is to build a health care system from the ground up. How would you describe the health care system right now?
A. I think it is horribly fragmented. In large urban areas where academic and commercial-based hospitals tend to dominate, I think it is a top-down approach to health care. In those areas, there are large ivory-tower hospitals surrounded by subspecialty office buildings, and the hospitals own a few primary care practices out in the surrounding communities. It is kind of like the old beacon-on-the-hill type of delivery model.
In other places, there are strong networks of primary care physicians who have created a primary care foundation of health care. In those places, integration is moving upward. In still other places, there is nothing -- no structure, and patients are trying to navigate the best they can in a wilderness type of health care setting.
Q. Where do you see family medicine in five to 10 years?
A. I think the opportunity exists for family physicians to climb the mountain. I can see family medicine being the foundation of a new delivery system and health care system and concepts, such as the patient centered medical home, really taking hold.
The AAFP is fighting like hell to create a fundamental, core foundation of a health care system built on primary care. Data from the United States and around the world overwhelming support that position and the value of primary care.
Q. What would you like to say to AAFP members?
A. I am very grateful for this opportunity to serve the Academy and its members. It is a humble honor to have the opportunity to represent them every day and the great work they do every day.
I have two messages for them. The window is open on changes for both family medicine and the delivery system. There is a great opportunity to continue the work that has been in place and underway for the past several years.
I think the second message I would like to convey is be mindful and cautious of change. But don't be afraid of change. The health care system is going to change.
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