Having Your Say on the Future of Family Medicine

AAFP Calls for Member Input

September 10, 2013 02:34 pm Glen Stream, M.D., M.B.I.

As AAFP members, we all are aware of the many changes in health care that have occurred during the past decade. Thanks to the Future of Family Medicine (FFM) project, we have been prepared for many of these transformations, and, indeed, the AAFP has had a hand in promulgating the drive to put primary care and family physicians, in particular, at the foundation of the new health care system.

However, the work we did on the FFM project as part of the Family Medicine Working Party was done more than 10 years ago, and a lot has changed in health care in the United States since then.

That is why we need your help now. The Family Medicine Working Party once again is initiating a project to look at the future of family medicine, and we need you to contribute your thoughts on how family physicians can help make the health care system in the United States a strong, vibrant system based on primary care. What do our specialty and our practices need to be successful in this system? As you read through the following information on the project, we ask that you think about the past, present, and future of family medicine. Then we invite you to comment, either via the comments field at the end of this article or by sending us an e-mail so your voice can be heard.

Background

In late August, the Family Medicine Working Party launched a follow-up initiative to the FFM project, which was conducted more than a decade ago. The goal of this effort -- Family Medicine for America's Health: Future of Family Medicine 2.0 -- is to examine the challenges and opportunities facing family medicine today and define a path forward in the context of a rapidly changing health care landscape.

Twelve years ago, the seven national family medicine organizations initiated the FFM project. The goal of the FFM project was to develop a strategy to transform and renew the discipline of family medicine to meet the needs of patients in a changing health care environment. At the time, it was clear that fundamental flaws in the fragmented U.S. health care system could be addressed through the integrative, generalist approach that is -- and has always been -- the hallmark of family medicine.

Extensive national research, conducted by independent firms along with five internal task forces, focused on key issues facing family medicine. The project identified core values; a new model of practice; and a process for development, research, education, partnership and change with the greatest potential to transform the ability of family medicine to improve the health and health care of the nation. The new model of practice established through the FFM project had the following characteristics:

  • a patient-centered team approach;
  • the elimination of barriers to access;
  • advanced information systems, including electronic health records;
  • redesigned, more functional offices;
  • a focus on quality and outcomes; and
  • enhanced practice finance.

The study concluded that family medicine needed to oversee the training of family physicians who are committed to excellence, believe in the core values of the discipline, able to provide family medicine's basket of services within the new model, and capable of adapting to varying patient needs and changing care technologies.

Family Medicine for America's Health: Future of Family Medicine 2.0

Significant change has occurred in the decade-plus since the initiation of the FFM project. This period has been marked by active experimentation within the specialty, and much good work has been accomplished, most notably, the implementation of the new model of care now known as the patient-centered medical home (PCMH).

Despite enormous progress -- including the emergence of the PCMH as a central component of the landmark Patient Protection and Affordable Care Act -- many new issues and questions confront the specialty. This combined with the significant changes underway in our health care system have prompted us to revisit the FFM project. The goal of this new effort is to look through today's lens at the challenges and opportunities facing family medicine in order to

  • define the role of the 21st century family physician (key attributes, practice scope, role within the health care system); and
  • ensure family medicine can deliver the workforce to perform this role for the U.S. public (via medical school/residency training and re-engaging existing family physicians, etc.).

As part of this process, the family medicine organizations will consider the following questions:

  • What are the core attributes of family medicine today in the context of an apparent decline in the scope of services and clinical care provided by many family physicians?
  • How will family medicine respond to the challenges of an evolving health system? The significant changes in health care include
    • a move from the traditional "practice owner" model to one of physicians as employees of larger health systems;
    • greater system integration and accountable care organizations (ACOs);
    • health information technology, meaningful use and advances in the use of technology for care coordination;
    • the expansion of scope of practice by many nonphysician health care providers;
    • evolving models of payment reform; and
    • physician performance measurement and reporting.
  • Is there a need for curricular reform for medical school education and residency training -- potentially moving from three to four years of residency training?
  • How do we best communicate to relevant stakeholders the value and benefits of family medicine -- the important role family physicians play in the evolving U.S. health care system?

Project Sponsors and Leaders

Similar to the earlier FFM project, Family Medicine for America's Health: Future of Family Medicine 2.0 is an effort of the Family Medicine Working Party. The seven leadership organizations within the specialty of family medicine are the

  • American Academy of Family Physicians
  • American Academy of Family Physicians Foundation
  • American Board of Family Medicine
  • Association of Departments of Family Medicine
  • Association of Family Medicine Residency Directors
  • North American Primary Care Research Group
  • Society of Teachers of Family Medicine

Working Party members from each of the organizations have designated representatives to a steering committee and core team, who will take the lead in driving the work of the project. Steering committee members are

  • Samuel Jones, M.D. (ABFM) -- committee chair
  • Stacy Brungardt (STFM)
  • Ardis Davis (ADFM)
  • Frank deGruy, M.D. (NAPCRG)
  • Kevin Helm (AFMRD)
  • Douglas Henley, M.D. (AAFP)
  • Grant Hoekzema, M.D. (AFMRD)
  • Jason Marker, M.D. (AAFP Foundation)
  • James Puffer, M.D. (ABFM)
  • John Saultz, M.D. (STFM)
  • Kurt Stange, M.D., Ph.D. (NAPCRG)
  • Glen Stream, M.D., M.B.I. (AAFP)
  • Barbara Thompson, M.D. (ADFM)
  • Jane Weida, M.D. (AAFP Foundation)

Core team members are

  • Tom Campbell, M.D. (ADFM)
  • Jennifer DeVoe, M.D., D.Phil. (NAPCRG)
  • Jerry Kruse, M.D. (STFM)
  • Bob Phillips, M.D., M.S.P.H. (ABFM)
  • Glen Stream, M.D., M.B.I. (AAFP)
  • Mike Tuggy, M.D. (AFMRD)
  • Mary Jo Welker, M.D. (AAFP Foundation)

Two national firms have been selected to collaborate and assist with the project. We have retained CFAR to lead the strategic planning initiative. CFAR is a management consulting firm specializing in strategy and organizational development. CFAR was spun out of the Wharton School in 1987 and has academic roots in business and the social sciences. APCO Worldwide will lead communications and brand development efforts. APCO is a public relations firm with deep expertise in health care, health policy and social marketing.

Timeline and Outcomes

We anticipate the research and planning phase of the project to be completed by April 2014, at which point, we plan to move quickly to implementation of

  • an action-oriented, strategic plan with a five-year timeline, addressing the issues most critical to family medicine and providing a role for the seven family medicine organizations and
  • a family medicine communications platform developed through research and creative testing that aligns with stakeholders' expectations, perceptions and emotional attachments, along with a plan to communicate the value and benefits of family medicine.

The success of this project relies on input from the broad community of family physicians, like you, who are on the front lines of care and whose unique experiences will inform and direct the process. The project also will include extensive research and outreach to family medicine and our key stakeholders, including teachers, medical students, residents and researchers.

We will provide regular updates on progress of the effort, and we invite you to share thoughts or insights with the Working Party, core team or steering committee via e-mail at FutureFM@aafp.org.


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