Q&A With Reid Blackwelder, M.D.

New AAFP President Thrives on Relationships, Problem Solving

September 25, 2013 01:30 pm Sheri Porter

AAFP President Reid Blackwelder, M.D., of Kingsport, Tenn., is a glass-half-full kind of guy who isn't afraid of confronting challenges head on, and he thrives on finding solutions.

First and foremost a family physician, AAFP President Reid Blackwelder, M.D., makes sure that he spends time building relationships with his patients, including Perry Ann Butler and her son, Coburn, age 15.

In a recent interview with AAFP News Now, Blackwelder says he is prepared to lead the Academy into a new health care era that includes a strong emphasis on quality improvement, payment reform and value. He knows all too well that health care policy decisions often are divisive but stresses that compromise can turn tough situations into a win-win for everyone.

Blackwelder's plans for his presidential year include taking his can-do attitude into discussions about family medicine scope of practice, graduate medical education, student interest in the specialty and more.

Q. You will be the face of family medicine in Washington for the next 12 months. What will be the focus of your message to legislators?

A. Even though I'm excited that legislators are finally talking about primary care, their definition is different than ours. I want legislators to start using the term "family medicine" in place of the more general term "primary care." That transition will be a game-changer.

The reality is that primary care provided by family physicians is more comprehensive than that provided by some other primary care professionals, such as nurse practitioners. Our legislators need to make informed decisions, and the Academy can help by highlighting the value of family medicine, the level of training family physicians receive and the high quality care we deliver to our patients. Our words can serve as a powerful tool.

Q. You are assuming the top leadership position of the AAFP as the country prepares to implement the Patient Protection and Affordable Care Act. How can family physicians best prepare for that transition?

A. As family physicians, we have to stay on the cutting edge and continue to adapt and grow even as we keep doing what we do best: taking care of our patients. For the first time in a very long time, there is potential for us to be valued in this country as payment reform moves away from volume-based payments. Our scope of training is exactly what it needs to be to take care of people. But as more of us relinquish pieces of family medicine -- such as obstetrical care and hospital call -- it changes our role.

Even if we're not seeing patients in the hospital or delivering babies, we still need to coordinate that patient care. The key to this is relationships! If a hospital system says you have to admit your patients to a particular hospitalist group that you don't know, pick up the phone, call the group and schedule dinner. Reframe the conversation by asking, "How can we best care for our patients?"

Q. How can family physicians demonstrate to medical students the important role that family medicine plays in America's health care system?

AAFP President Reid Blackwelder, M.D., center, shown here with second-year medical students at the James H. Quillen College Medicine in Johnson City, Tenn., enjoys interacting with medical students and says teaching keeps him young.

A. We need to reflect our passion for our specialty. All physicians have bad days, but medical students are especially sensitive to our moods. When students see us interacting with our patients and enjoying what we do, it helps demonstrate why we went into family medicine and creates an image students will remember and a story they will retell.

Take that one step further. Invite a local medical student who is home for the holidays this year to shadow you in your practice for a day, and maybe that student will, for the first time, consider family medicine.

Q. What's the best part of working with medical students and family medicine residents in your various roles at Eastern Tennessee State University?

A. It keeps me young and energized. About the time I finish extended time with students, I've got residents who need me, and when residents aren't around, I've got my own patients to see. I absolutely love the variety that teaching adds to patient care.

Q. There's a lot of talk about the need to grow America's primary care workforce. What legislative or policy changes should be considered to alleviate the shortage?

A. A critical part of getting more students into the primary care pipeline is for legislators and policymakers to prove, through payment reform, that the health care system values what family medicine has to offer. Period. Do that, and the students will come.

We also need legislative reforms that ensure that our medical education system has a commitment to meeting the needs of the country. There is a social mission that needs to be integrated into medical education.

Q. America's health care system is rapidly evolving in the wake of health information technology, quality assurance initiatives and experimentation with new payment models. Have you seen any positive change in the past year?

A. As promised, I, along with the other AAFP officers, went directly to CMS with supporting data in hand to propose a major change in payment strategy. We asked CMS to recognize the comprehensiveness of family medicine office visits coded at 99213 and 99214 levels. We requested the creation of a new evaluation and management category, and I am encouraged that CMS was open to having that conversation.

Q. What's your biggest concern when it comes to ensuring appropriate payment for the primary care services that family physicians provide to patients across the country?

A. The biggest obstacle to payment reform is the entrenchment of the fee-for-service model. Some fee-for-service payment makes sense, but the trap lies in getting all parties -- especially legislators and subspecialists -- to agree to the size and shape of the fee-for-service piece in new payment models.

In addition, how we define quality improvement, outcomes and value is so important, and we have to get it right. The last thing family physicians want or need is more administrative burdens and check boxes that serve billing purposes but don't improve patient care.

Q. What can the Academy do to help small family medicine practices -- particularly those in rural America -- keep their doors open?

A. I hear those cries for help. The Academy has created a taskforce to address some critical issues faced by all of our members. I especially need physicians from small family medicine practices to tell me about their specific practice challenges.

In the meantime, remember that no one truly goes it alone. In every community, we have resources all around us. I suggest that family physicians get involved in their local health departments, attend medical staff meetings and collaborate with their colleagues who are in similar-size practice environments.

Q. You're going to have a busy year. How do you unwind in your down time?

A. My wife Alex and I relax at our home. It's nice to just sit on the back deck and be in the woods. I also enjoy my shop where I make wooden pens and craft jewelry with beads and gemstones I've been collecting for years. Wednesday evenings are sacred for Alex and me, and it's the best night of the week. I teach a meditative Yin yoga class with a group of eight to 10 friends, followed by dinner at our favorite Italian restaurant.


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