New AAFP President Looks Forward to Tackling, Resolving Difficult Issues

AAFP President Jeffrey Cain, M.D., of Denver, a self-described optimist, has some very specific priorities when it comes to the work he wants to see the Academy accomplish during his presidential year. Cain wants the AAFP to continue moving forward in its quest to ensure that every American has a medical home.

He also intends to keep a sharp focus on securing fair payment for family physicians -- payment that he says must equal the value FPs bring to the health care system. And Cain is adamant in his desire to ensure that America's physician workforce is sufficient to meet the country's growing needs.

In a recent interview with AAFP News Now, Cain talked about these issues and more, including what brings him the most joy in his daily work as a family physician.

Q. You are taking the reins of the AAFP at a time of tremendous stress in the U.S. health care system. What are the toughest challenges family physician face in 2013?

A. The weather forecast for family medicine is for short-term stormy weather and long-term clearing skies. Once again, we're facing uncertainty about the SGR (sustainable growth rate formula) that likely will spill over into the new year. There's uncertainty around what's going to happen in health care because of the upcoming election. And of course, we all face the usual burdens and challenges of operating busy family medicine practices.

However, I predict a long-term improving forecast for family medicine because of the proven economic benefit of the patient-centered medical home (PCMH) model of care. Leaders and policymakers in charge of overseeing our health care system understand -- in a new way -- the value that family physicians bring to the health care table, and that value is being written about and discussed all across the country.

Q. What can the Academy do to assist members in overcoming some of the hurdles they face in 2013?

A. Nationally, we will be strong advocates for family physicians. The AAFP will continue to fight for a health care system that makes certain all Americans have access to a family physician and that payment for those physicians reflects the value they bring to health care.

At the individual practice level, the AAFP will be working very hard to keep family physicians informed about whatever changes in health care policy are brought about as the result of federal and state election results. And of course, we will continue to help family physicians understand and implement the various components of the patient-centered medical home.

Q. What factors will most influence physician payment in the coming year?

A. The biggest factor will be the sustainable growth rate formula. If Congress is unable to fix the broken Medicare payment system, then physicians face a potential shortfall of more than 30 percent in Medicare payment, and that will be disastrous for patient access and for physician practices. Both Democrats and Republicans understand the payment system is broken, and we have to help them find a solution that represents a long-term fix to the SGR.

Beyond that, as the value of primary care is showcased in PCMH practices -- and the evidence on lower costs and higher quality care rolls in -- enhanced payment for family physicians must follow.

Q. What needs to happen in Washington and at the state level to make America's health care system work better for both physicians and their patients?

A. Our state and federal legislators need to hear the real-life accounts of family physicians and their patients so that the decisions politicians make are based on what's best for the people, regardless of the politics.

Q. We hear a lot about what's wrong with America's health care system. What is working well?

A. We are seeing positive results in the form of healthier patients and lower health care costs where the patient-centered medical home model of care is in place. For instance, good health care is being delivered through the Group Health Cooperative in Seattle; via a network called Community Care of North Carolina; and by an integrated delivery model in Grand Junction, Colo., that focuses on team-based care and patients' needs.

These are just examples. From coast to coast, America is awakening to the value of primary care.

Q. What steps can be taken to alleviate concerns about a shrinking primary care physician workforce?

A. Medical educators and health care policy experts know that we need to have more medical students going into primary care, as well as additional primary care residency slots available to residents. The good news is that others are beginning to understand this too. In fact, eight U.S. senators have tasked the Institute of Medicine (IOM) with work that will evaluate the entire graduate medical education system.

Our Academy will be there helping the IOM understand the issues as we move forward with a rational workforce policy for our country -- a policy that produces the kinds of physicians that America needs.

Q. You are well known as the co-founder of the Tar Wars tobacco-free education program that has reached more than 8.5 million children in 50 states and 16 countries. As you contemplate that program's success, what thoughts come to mind?

A. I'm really proud of how the Academy has grown Tar Wars to be a truly effective and nationwide program. After 25 years, we should celebrate Tar Wars' past success and look forward to its future growth.

The tobacco industry continues to adapt the way it markets to children, and we need to find partners who will work with us to counter those destructive messages with effective tobacco education for our children.

Q. You have worn many hats in your career as a family physician, but what brings you the most joy in your work today?

A. It's so fulfilling to go to Washington and represent family medicine. But it is equally important to come home to Colorado and reconnect with my patients. I've had 25 years of practice here, and it brings me joy to sit quietly and listen to my patients' concerns and to know that I can help them. I also teach in a residency program, and I love seeing bright talented residents evolve into bright talented family doctors.

I have one last thought to leave with my colleagues. There is a fair amount of uncertainty in health care right now, but I want family physicians to remember that when we go to work each day, we have the honor and the privilege of sitting down as partners with our patients.

We must never let the business of medicine -- or the hectic pace of our daily work -- overshadow the difference we know we're making in the lives of our patients.