On a mid-May morning, with an AAFP News editor in tow, AAFP President John Meigs, M.D., of Centreville, Ala., strolled through the corridors of Bibb Medical Center on the way to his medical practice inside the hospital.
AAFP President John Meigs, M.D., shares a light moment with his patient Rosia Morrow during a follow-up office visit.
The short journey took some time. That's because Meigs constantly ran into people he knew, mostly patients who wanted to stop and chat with a man they consider a friend who also just happens to be their family physician.
That's the way it is for this rural physician who's been practicing medicine in his hometown for nearly 35 years -- just blocks from where he graduated high school.
Later, Meigs sat down during a rare break in his jam-packed day to chat about his life's work and the new challenges he'll face as he guides the AAFP through the next 12 months.
Q. How will your background as a solo physician in a small rural community help you connect to AAFP members?
A. I still consider myself a real working family physician. I still see patients. I still have that private practice perspective -- that's my mindset, that's the way I look at things even though my practice merged with the hospital in 2013. Now that I'm employed, I do understand some of the frustrations of employed physicians.
It really is my intent this year to represent everybody, not just a certain subset of family physicians.
Q. How has your shift to employed physician status changed your perspective?
A. Well, I'm no longer the boss, and I have to go through a bureaucracy to do things and sometimes I get frustrated by the bureaucracy. And now there are a lot of committees that have to approve things. When I was private, I decided what EHR (electronic health record) I wanted to buy, and I decided what kind of pens to write with. Now I have to put in a special request to get my pens. It's a minor little thing, but it illustrates the point.
But I still have my patients. I mean I'm still seeing the same people I've been seeing for almost 35 years. The best part about it is I don't have to do the payroll and the accounts payable and all those kinds of things I did when I was in private practice. I frequently did those things at one o'clock in the morning because there wasn't time to do it during the day.
AAFP President John Meigs, M.D., has an easy manner that immediately puts young Keltyn Watkins at ease on the exam table.
Q. Speaking of EHRs, what next steps are needed to make the promise of health information technology a reality for physicians in practice?
A. The first big challenge moving forward with EHRs is solving usability issues for physicians who are busy every day taking care of their patients. The second is making interoperability between users and different systems a seamless process.
There are a lot of people working to fix these problems, including AAFP experts who know what physicians need.
Q. Why did you seek the top leadership role in the AAFP?
A. I've been involved in organized medicine almost my entire career. I like being involved. When I see patients, I can make a difference with that person one-on-one, but maybe as AAFP president, I can make a difference that affects lots of patients.
Most family physicians face a mountain of bureaucracy, administrative trivia, regulatory burden -- whatever words we want to call it -- every day. I see the presidency as a place to use the bully pulpit to call attention to things that just aren't right -- that interfere with practicing medicine and come between family physicians and their patients.
Q. What are your greatest strengths as you step into this top leadership role?
A. I discovered a long time ago that l learn a whole lot more by listening than by talking. I actually like to hear the different sides of an issue, take the best of all the ideas and then formulate a solution that will be best for whatever problem we're trying to deal with.
I like to think I'm open-minded. I get along with most folks. And I don't take dogmatic positions on issues that keep me from listening to someone who disagrees with me.
Q. I know you're passionate about the expansion of teaching health centers. How will increasing their numbers help solve the nation's physician workforce issues?
A. The majority of health care is delivered in the ambulatory setting, not in the hospital. Despite successful new pilot programs funding teaching health centers, a lot of graduate medical education (GME) is still hospital-centric, and GME funding goes to those hospitals. So we have this maldistribution of physicians on a couple of levels.
Number one, we have a maldistribution in terms of specialty; this country has more subspecialists than primary care physicians when the real need is for more primary care. And then we've got too many physicians doing the wrong thing in the wrong place. Keep in mind that most residents end up practicing within 50 to 100 miles of where they trained. Well, if we train them all in the urban medical centers, then we're going have that glut of physicians working in the urban medical centers.
We need primary care physicians trained to work in an ambulatory setting, willing to work in a rural community or in areas of need such as urban underserved areas and communities served by the Indian Health Service. And teaching health centers can do that.
Q. Value-based payment is the hottest of topic of the day. How do you respond to colleagues who say they're worried about getting left behind during implementation of the Medicare Access and CHIP Reauthorization Act (MACRA)?
A. I know MACRA implementation is going to take up a lot of time during my presidency. I know the Academy has a lot of work to do to get family physicians ready for the future.
But I like to remind family physicians that the AAFP monitors the regulatory process at every opportunity and offers our comments, criticisms and suggestions to the folks writing these regulations. It's important that every physician has a path to success in these new payment models.
Q. Is there a place for small independent family medicine practices in this new era of health care?
A. There'd better be! There are still a lot of family physicians who love running their own practices and without them, a lot of patients -- especially those in rural communities -- wouldn't have easy access to a primary care physician.
Q. What do you love the most about family medicine?
A. My patients. I've found throughout the years that when I get frustrated with everything else going on, I can go into an exam room and talk to a patient and remember why I love my job. It's important work to listen to people and take care of them.
Q. Is there a downside to moving into this position as AAFP president for a one-year term?
A. I regret being less available to my patients because of commitments to the AAFP. I will lose patients. They'll forgive me once if I'm not available to see them, but after two or three times, they'll just move on to someone else. That will be difficult, because I'm a family physician at heart.
Q. What keeps you awake at night?
A. I know that family medicine is the answer to problems with our health care system and it seems like some folks still don't understand that. The AAFP has to keep talking about the value of family medicine until that message sticks.
Q. On a lighter note, word has it that you're a college football fan. Do you root for a particular team?
A. The Alabama Crimson Tide. Is there anyone else? At Board meetings, when we have guests, we'll go around the table and introduce ourselves, and I'll say, "John Meigs, Centreville, Ala., and if you don't know where Centreville is, it's 30 miles from the home of the Crimson Tide. Roll Tide!"
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