AAFP President Michael Munger, M.D., of Overland Park, Kan., can relate to his family physician colleagues regardless of their work environment. That's because of the variety he's experienced in a medical career that spans more than three decades.
After 31 years in practice, Michael Munger, M.D., has built strong relationships by taking the time to listen to patients like Thelma Maze; this longtime patient has much to discuss during her office visit.
For the first 16 years as an owner/member of an eight-physician family medicine group, Munger worked in the independent practice world with all the joys that brings -- plus the stress of dealing with overhead, meeting payroll and resolving human resources situations.
Also during his first 10 years in practice, Munger did affiliate teaching with a family medicine residency in Kansas City, Mo., covering the family medicine clinic at the program's sponsoring hospital for half a day each month, as well as spending one week a month conducting morning inpatient rounds with residents. The program's residents also visited the practice one day a week to do in-office procedures.
Now, as a physician in a health system-owned practice, Munger appreciates access to the plentiful resources that practice setting has brought but acknowledges the loss of control that also comes with that work environment.
In short, Munger understands what family physicians are going through. AAFP News recently visited Munger in his practice in Leawood, Kan., to learn more about what drives his passion and how he plans to lead the AAFP during his tenure.
Q. Why did you seek this top leadership role in the AAFP?
A. I have been involved with the AAFP my entire career. I have a passion for family medicine and for our patients. I believe my voice will continue to lead our organization in a direction that will benefit our members and, most importantly, our patients.
Q. What is your greatest strength as a leader?
A. First off, it's the ability to listen and to see all sides of an issue. Because of my varied background, I have empathy for physicians in all situations, and I can relate to the circumstance they're going through.
My goal, at the end of the day, is to always do what's in the best interest of our specialty and our patients.
Q. You'll be traveling a lot on behalf of the Academy during your presidential year and speaking about issues that impact family medicine. Can you name a topic that you expect will be prominent during your term as president?
A. I know our members are quite frustrated with the administrative complexity that is involved in the day-to-day practice of medicine. Look at electronic health records; they were promised to simplify practice, but many physicians will tell you that has not yet happened.
Much of our members' angst is tied to paperwork such as prior authorization requests from payers and that endless flow of forms that need attention. Family physicians are looking for relief from that overall burden and from tasks that hinder rather than help them with hands-on patient care. The AAFP recognizes their concerns and is working hard to make things better.
Q. Your electronic health record (EHR) system appears to increase efficiency in your practice. What important functions are still missing?
A. It's the lack of interoperability -- the fact that not all systems, not all practices are on the same EHR within our metropolitan area. When I need information from another physician or medical facility, too often, I have to pick up the phone or wait for a fax. It's very inefficient, and really is one of the biggest challenges. It leads to fragmentation and to the potential for gaps in care.
Q. Is there a particular "hot button" issue related to health care and family medicine that keeps you awake at night?
A. One of my real concerns is around payment reform. And it's a multilevel concern. Will we really see meaningful payment reform? Because if what develops is based on our historically undervalued fee-for-service RVU (relative value unit) system, then our revenue streams will continue via different methods, but family physicians will still be undervalued and underpaid.
I truly lay wake at night worrying about our members and their ability to survive in a value-based system -- especially our docs in small practices and in rural communities across the country. I recognize that family medicine practices are at different levels of readiness, and the AAFP aims to ensure that no practice is left behind when it comes to transitioning to value-based payment.
While still in the exam room, Michael Munger, M.D., discusses lab results and a care plan with his patient, Charles Paith.
Q. How do you respond to family physicians who are wary of stepping onto the value-based payment playing field and who have not yet embraced CMS' Quality Payment Program (QPP)?
A. The movement from volume to value is here, and the QPP is a very tangible step. In order to help ease that transition for physicians, CMS designated the first year of QPP as an opportunity for physicians to pick the pace at which they want to proceed.
In 2017, physicians can do as little as pick one metric for one patient just one time. Do that. Step up. Begin the process. Because the shift in payment is definitely moving in that direction, and the time to transition is now.
Q. Physician well-being is a hot topic nationwide. How can the AAFP help family physicians resolve some of the issues associated with this issue?
A. Physician resiliency is critical in today's fast-paced world of medicine. The AAFP is already engaged in providing resources to help family physicians identify if they are at risk of burnout and employing tools to help them maintain a sense of well-being.
But the most important thing the AAFP can do is to work on the drivers that lead to physician burnout; identifying solutions will remain at the top of the AAFP's priority list.
Q. What's the one big thing you want family physicians to understand about their AAFP?
A. We are a bipartisan membership organization. We're going to continue to advocate for our members and our patients based on our long-held principles around affordable and meaningful coverage for all. The AAFP will continue working to reduce administrative complexity in medicine and will keep pushing our messages out about the value of primary care and increasing the overall spend on primary care.
It doesn't matter who presides in the White House or what party controls Congress -- our message will remain the same. The AAFP's priorities are based on the needs of our members and our patients.
Q. What do you love about the specialty of family medicine?
A. The patients. Family medicine has allowed me to develop relationships and to take care of people over their lifespan. That experience is very special and has led me to become part of many extended families.
Many of my patients have been with me for 31 years. Every visit starts with, "Let's catch up with what's going in in your life," before we get down to what I call "hard medicine." It's all about relationships.
Q. How will you adjust to a new schedule that will reduce clinical time with your patients?
A. I've already cut back. Almost three years ago, I took on an administrative role in my health system, and that prompted me to reduce my clinical time. So, I've already gone through the painful process of cutting back my patient panel.
The other advantage I have in adjusting to the new schedule is the fact that I am based four-tenths of a mile away from AAFP headquarters in Leawood, Kan., and so days that would be considered travel days for other board members are days I can spend in the office. It's definitely a bonus.
Q. Can you tell me a little bit about your family?
A. I have the most wonderful wife and best friend a person could ever have in my wife, Donna. I have four wonderful children and five grandchildren. My family is my rock.
Q. What activities do you enjoy in your free time?
A. Free time? What's that? But seriously, I love to read, cook and garden. I have tomatoes and peppers and a little herb garden where I'll go to cut some fresh herbs to complement a "creative" dinner I'm working on.
I also want to get back to music. I haven't played my trumpet since I got on the AAFP Board of Directors, but when I'm finished with this current three-year rotation on the leadership level, I plan to pick my horn back up and add a new instrument; I want to learn to play the guitar.
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