Tuesday Apr 11, 2017
Go Ahead, I'm Listening
"In my mind, I'm going to Carolina"
One of the most important aspects of this blog, as it is with other AAFP communications, is the feedback provided by each of you. Your feedback plays an important role in shaping the advocacy and policy activities of the AAFP. Your comments serve as the "canary in the coal mine," in some respects, which allows us to gauge the mood, sentiment, and overall feeling of our membership on any given issue, at any given point in time. Sometimes the canary doesn't come out, sometimes it does.
I have a colleague who is a master of the PDSA (Plan-Do-Study-Act) Cycle(deming.org) (tip of the hat to AAFP senior vice president of education Clif Knight, M.D.) and the value of creating a continuous cycle of evaluation, planning and action. My attention span limits me to one of these activities at a time, so I decided to choose "evaluation." As part of this evaluation, I decided to look at the comments provided in response to my postings since the 2016 presidential election -- about four months. During this time period, I have covered a variety of topics that range from purely political topics, such as the elections; to more wonkish topics, such as the Medicare Access and CHIP Reauthorization Act (MACRA) implementation and the Patient Protection and Affordable Care Act (ACA); to practice management topics such as administrative and regulatory reform.
Your comments regarding these issues fell into three large categories:
- the AAFP does not represent me or my views;
- administrative burden; and
- the ACA isn't working and should be repealed.
There were secondary issues, such as direct primary care, single-payer, graduate medical education, scope of practice, and a few pithy comments on elected officials. But overall these three themes were dominant. In this posting, I am going to take a deep dive into the first of these three. In my next posting on April 25, I will explore the second and third issue.
"The AAFP doesn't represent me or my views," was the most common theme during the past four months. In most cases it was in reference to a single issue (e.g., the AAFP does not represent my view on single-payer or ACA repeal) and not a definitive statement on the full scope of AAFP's member services. However, there were some pointed comments regarding our advocacy efforts with respect to solo and small practices.
The AAFP represents a diverse membership. The diversity of family medicine is its strength, and diversity is also a key to our future. Diversity should be celebrated, but we also must acknowledge that it requires some patience and it forces us to be honest about the fact that there may be issues where our membership disagrees. Maintaining a focus on a common goal is important to balancing these differences.
The AAFP mission statement directs us to "improve the health of patients, families, and communities by serving the needs of members with professionalism and creativity." Put more frankly, our goal is to support and advance policies that allow each of you to provide the highest quality of care to your patients in a practice environment that provides you professional satisfaction and financial remuneration that reflects your skills and services. This is our common goal.
The most common comment received was, "the AAFP never asks what I think." I recognize that many of you share this sentiment, but I can assure you that we do want to hear what you think. Each year, since 1992, the AAFP has conducted a member satisfaction survey whereby we ask a sample (5,000) of our membership to share their views and opinions on a variety of policy, education and membership issues. This year, we made the survey available to all members. If you haven't yet taken the survey, there is still time through the end of this month.
The survey's findings are collected, dissected and discussed to determine what we can do to better serve our members. I can assure you these reports do not go on the shelf. They drive work (lots of work) on your behalf. The survey has been issued annually for more than 20 years, so it plays a key role in helping us identify trends in the professional and practice challenges facing family physicians. By following "trend lines" we can develop and advance solutions before "trend" transforms into "crisis."
The second most common comment in this category was, "the AAFP does not represent my views on this policy." AAFP policies are established and reaffirmed by the Congress of Delegates (COD). The COD is a representative body that meets annually to develop and set policy, and to elect your officers and members of the AAFP Board of Directors. Each year, the COD considers resolutions that aim to establish policy on relevant issues. You can read and comment on the 2017 resolutions in advance of the COD and communicate your support, opposition, or concerns. (None have been submitted yet for the Sept. 11-13 event in San Antonio.)
I would encourage you to first communicate with your state's elected COD delegates on policy issues under the purview of the COD. You also should feel free to reach out to your state chapter on important issues. The elected delegates from your state are your voice at the COD.
If you prefer to communicate with a national representative, then you should feel free to contact any member of the AAFP Board at any time to share your views and opinions.
The COD represents you and it benefits from engagement and diversity of opinion. If you are interested in participating in the COD, please use these resources.
These are the mechanisms in place for you to communicate your views and opinions -- through our official representative body, the Congress of Delegates; through our elected leadership, the Board of Directors; and through our annual membership survey. You also should continue to comment on the various AAFP blogs and AAFP News on specific issues. You also can engage with the AAFP via social media at @aafp on Twitter(twitter.com) and on Facebook(www.facebook.com). If these communication channels don't suit you, you can email me. I want to hear from you.
I thought it would be fun to address a few specific comments:
- "You are not a physician."
Yes, this continues to be a source of disappointment for my parents. Despite my lack of medical credentials, I have traveled this road for several years and, in my opinion, have a pretty good understanding of family medicine and the health care system.
- I have been told, "You are a shill for liberal policies," AND "You are a shill for conservative policies."
I try to stay fair and balanced.
- "You just write what CMS tells you to write."
I do attempt to share information from CMS with our members, but I can assure you CMS doesn't always like what I have to say. They tell me so.
- "The AAFP forgets who pays its bills."
I never lose sight of who and what matters. We might disagree from time to time, but your interests are my interest.
- "You pick on Texas too much."
I will never stop (after all I am an Oklahoma fan!)
Thank you for your continued membership and your support of this blog. Most importantly, thank you for what you do for your patients, your community and our country.
I leave you with Sir Winston Churchill, who said, "A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty."
I see a lot of opportunity.
Posted at 07:00AM Apr 11, 2017