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Wednesday Jun 05, 2019
FPs Steer the AAFP With Plenty of Ways to Influence Course
Wednesday Apr 17, 2019
Make Your Voice Heard; Take the Member Survey
The AAFP Member Satisfaction Survey plays a key role in directing Academy resources to meet family physicians' needs. AAFP President-elect Gary LeRoy, M.D., urges members to take advantage of this opportunity to make their voices heard.
Tuesday Apr 17, 2018
Make Our Voices Heard on Continuing Board Certification
AAFP President Michael Munger, M.D., provided comments at a recent hearing about continuing board certification. In this Leader Voices Blog post, he urges family physicians to weigh in via a survey from the American Board of Medical Specialties.
Tuesday Jun 27, 2017
Reflecting on 70 Years of Leadership and Innovation
Friday Nov 18, 2016
Bare Necessity: Communication Is Critical in a Crisis
Wildlife lessons learned since a move to the small frontier community of Valdez, Alaska, have taught John Cullen, M.D., that communication is the key to survival. Brown bears and grizzlies have plenty to say about techniques for getting through life's difficulties to those who know how to listen.
Wednesday Sep 21, 2016
Encouragement Is Key to Developing Physician Leaders
Thursday May 26, 2016
We're Getting the Media to Spread the Word About Family Medicine
We've posted in this blog before about the importance of working with the media to share public health messages and to educate the public and policymakers about complex health issues. We have shared stories about what Academy leaders are doing nationally while also encouraging members to work with the media at the local level.
Last year, the AAFP decided to take an in-depth look at our media outreach and get a professional assessment of how we're doing. The results, which were presented to the Academy's Board of Directors this month, are encouraging.
The AAFP contracted with GYMR, a Washington, D.C.,-based communications firm that specializes in health care and social issues, to perform a yearlong analysis of media coverage of the AAFP and a number of its peer organizations: the AMA, American College of Physicians, American Academy of Pediatrics (AAP) and American Osteopathic Association (AOA).
The intent of the analysis was to determine how well the AAFP was performing in 26 strategic, targeted media outlets, including large daily newspapers (such as the Los Angeles Times), national publications (such as USA Today), wire services (such as the Associated Press), trade media (such as Medical Economics) and policy outlets (such as Politico). We also wanted to know how well our message was being relayed and how our coverage compared to that of our peers.
The Academy's public relations staff receives media requests and also pitches story ideas to contacts. The result is that the AAFP is mentioned in hundreds of media outlets each month. Looking at only the 26 targeted outlets, in fact, the AAFP is a constant presence, with an average of 38 mentions a month -- 23.5 in health care trade publications, 11 in national media outlets and 3.4 in policy-related outlets.
GYMR also analyzed numbers by mission area. Nearly a third of the articles that mentioned the AAFP dealt with practice advancement. That's good news, because it's critical for policymakers to know how issues such as payment, regulations and administrative burdens affect physicians and their patients.
Twenty-eight percent of the articles that mentioned the Academy had to do with health of the public issues, such as electronic cigarettes and breastfeeding. AAP also did well in this area because of the interest in children's health care issues. We can work to educate the media about the fact that family physicians care for the entire spectrum of age groups, and family physicians care for millions of children, particularly in rural and underserved areas.
To break it down a different way, a quarter of the education and a third of advocacy articles in the analysis mentioned the AAFP. There are many more stories here we can tell, including the fact that our nation's graduate medical education system is not producing an adequate number of primary care physicians.
Interestingly, the AAFP accounted for 25 percent of all quotes in the hundreds of stories that were considered, more than any other primary care group. Academy representatives were quoted in 63 percent of the stories that mentioned the AAFP, nearly double the rate of the AAP and far more than the AMA and AOA.
The analysis also looked at who should be quoted. Some health care organizations use a staff member as a spokesperson. On the other hand, the president is the official spokesperson of the AAFP. One reason the Academy is frequently quoted is because each year, the organization has a new person who can share fresh stories and practice perspectives with reporters. Rather than a policy wonk sitting behind a desk, we have practicing family physicians talking about how important issues affect us, our patients and our colleagues. On an almost daily basis, I'm telling reporters stories that start with, "I have a patient who …"
Family physicians have a unique ability to tell stories and connect issues to patients. We can humanize important health messages and make them easier for the public to understand. Ultimately, we are getting the right messages to the right people on behalf of family medicine.
You can join us by sharing stories in your own community, whether it be at the Rotary Club, a Boy Scout meeting or with your local newspaper. We can help the public understand the importance of issues such as immunizations by speaking out. In the process, we expand public awareness of family medicine, who we are, what we do and what we offer the health care system.
Wanda Filer, M.D., M.B.A., is president of the AAFP.
Wednesday May 18, 2016
Can Mindfulness Meditation Deliver Us From Burnout?
What do you do for fun? This is an important question I have started to ask patients so I can get to know them better and assess whether they find joy in their lives. I appreciate that the absence of joy can be a significant contributor to absence of personal health and sense of wellness.
I often wonder if we should be asking our physician colleagues the same question. A recent survey of nearly 36,000 physicians found that 63 percent of family physicians suffer from at least one symptom of burnout, an increase of 12 percent in just three years.
Not surprisingly, the same survey, which was published in December in Mayo Clinic Proceedings(www.mayoclinicproceedings.org), found that physician satisfaction with work-life balance was falling nearly as fast as burnout was rising. The percentage of family physicians who were satisfied with their work-life balance in this survey was roughly 35 percent, which was down from 50 percent in the previous study done three years earlier.
Although the AAFP, its constituent chapters and other physician organizations are working hard to address the many drivers of burnout that exist in our external environment -- including electronic health records, reimbursement and administrative burden -- it also is important that we, as physicians, ask ourselves what else we can do to survive and thrive amidst the current chaos.
A growing body of evidence points to mindfulness meditation and practicing the principles of mindfulness-based stress reduction(www.webmd.com) as a key answer to this important question.
Back in 2013, there already was ample evidence that mindfulness meditation could help people reduce stress when researchers at Carnegie Mellon University used MRI scans to show that the process, after just eight weeks, appeared to shrink the amygdala and thicken the prefrontal cortex(journals.plos.org). In other words, participants' connection to their fight-or-flight response got weaker as their attention and concentration improved. Researchers reported that the scale of these changes correlated with the amount of time spent on meditation.
Earlier this year, a research team that included the authors of that 2013 study found that mindfulness meditation stimulated areas of the brain that may help control emotional reaction and attention and decreased blood levels of interleukin-6, which is associated with inflammatory disease risk, meaning the process may protect participants' from emotional distress and decrease inflammation(www.biologicalpsychiatryjournal.com).
Yet another study published last fall in the Journal of Continuing Education in the Health Professions(journals.lww.com) found that participants' heart rate, blood pressure and Maslach Burnout Inventory scores improved after eight weeks of mindfulness meditation, and results continued during a 10-month followup period with low attrition and high compliance rates.
Not surprisingly, I'm hearing more and more about mindfulness wherever I go. Daniel Friedland, M.D.(supersmarthealth.com) recently gave a presentation on how mindfulness can play a role in leadership during the AAFP's Annual Leadership Conference. And Renee Crichlow, M.D., an assistant professor in the department of family medicine and community health at the University of Minnesota in Minneapolis, recently presented the evidence for using mindfulness meditation to prevent burnout at the Minnesota AFP's annual meeting.
Skeptics might be reluctant to invest time on something they aren't sure about, and maybe you aren't comfortable with the idea of sitting in the lotus position and getting in touch with yourself. The good news is there are plenty of free resources to help you get started(itunes.apple.com) and you can practice mindfulness meditation in whatever position is comfortable for you in just few minutes a day.
As this short video on the basics of meditation from Happifyhealth.com says, meditation is simple, secular, scientifically validated exercise for your brain(www.youtube.com). Another short YouTube video from Happify explains why mindfulness is a powerful tool for your well-being(www.youtube.com).
If meditation isn't for you, there are other options to reduce stress and build resiliency. A Minnesota community that lost two physicians in a short time period -- including one to suicide -- started a Bounce Back campaign(www.bouncebackproject.org) that aims to improve physician and public health by making the community a happier place. The initiative encourages people of all ages to perform random acts of kindness.
Family Practice Management recently published a three-part series by family physician and burnout expert Dike Drummond, M.D., that covers recognizing symptoms and causes of stress, reducing stress and work-life balance. All three articles are eligible for AAFP Prescribed CME credit for one year from the date of publication.
I appreciate that none of these tools is going to improve reimbursement, make payers more reasonable about prior authorizations or improve the interoperability of our electronic health records systems. However, these tools can help us be the best we can be in our "inner space" while we struggle to eliminate the challenges and burdens that occupy the "outer space" of our practice of medicine. After all, if we can't take care of ourselves, we won't have anything left to care for others.
Lynne Lillie, M.D., is a member of the AAFP Board of Directors.
Thursday Apr 07, 2016
Rural Recruiting, Retention Proves Daunting
I went to college in St. Louis, med school in Cleveland and residency in the Houston suburbs. If you had asked me back then where I would be living when my training was complete, I never would have guessed a rural mountain town on the West Coast. But this city girl has grown to love rural medicine.
The beautiful scenery, family life and the ability to be present in the day-to-day functions of our home were the main reasons my husband and I first decided to leave an urban environment for a much quieter setting, but my desire to work with the underserved translated naturally to this new setting, as well.
| Here I am talking with patient Gail Ruby during a recent office visit. Unfortunately, I'm leaving my rural practice in California because of the local hospital's lack of support for primary care.
I quickly realized that the struggles related to poverty and access don't discriminate based on location. Many of the same health challenges I saw in med school and residency infiltrate our small community, and my patients can attest to my value as a family doctor in the clinic, the hospital or in the operating room.
With so much that I have gained from being in rural practice, it pains me to have to leave. My contracted hospital has not been able to provide a work environment that supports me as medical director, and I find myself once again giving preference to work over family. That was the problem that led me to move from a big city environment in the first place.
Before I arrived here, there were only two obstetrical physicians covering more than 15,000 patients for 18 months. During the last five years, our community lost four physicians, including three family doctors. I am the only young primary care physician in town, and most of the practicing physicians are nearing retirement. So, as a new physician working in a great community, I am concerned by the ever-demanding needs of a small practice, little support and lack of new hires into the area.
Although my family loves this close community, I find myself sinking deeper and deeper into the inefficiencies of a practice that does not support physician leadership. More importantly, I realize that the hospital recruitment has been ineffective, and my work-life balance has suffered as a result.
Sure, there are alternative practice models, like direct primary care. However, it is difficult to limit a practice panel when a community is already suffering from attrition of physicians. One could open up his or her own solo practice, but the start-up costs and overhead can be prohibitive. Frankly, when faced with $100,000 of debt -- or more -- coming out of residency, it is intimidating to think of incurring even more debt to start a business.
The truth is that in small towns, the local hospital is the main financial resource for recruitment and retention of physicians. Factor in that most new physicians are looking for some kind of employment model, and the cost of recruiting usually cannot be absorbed by smaller practices. Despite the important role of primary care, especially in small communities, I find myself often defending my value -- to the community and the hospital -- as a family physician practicing obstetrics.
The cost of recruiting a family physician is roughly $100,000(www.aspr.org). But what is the value lost when you lose a family doctor? Research shows that having a family doctor cuts costs in unnecessary testing, reduced hospital readmissions and better continuity of care(www.annfammed.org). We also know that family doctors generate revenue for affiliated hospitals, to the tune of $1.5 million in annual revenue per FTE(medicaleconomics.modernmedicine.com).
Although doctors and hospitals functioned in a more segregated way in the past, it is now almost expected that hospitals collaborate with physicians in order to provide better population medicine. This is certainly a paradigm shift in focus and priorities, and at least where I live, is not well-received by the corporation that owns my local hospital.
One thing is certain. Traditional recruitment models have not attracted any doctors to my town in at least the last five years. Something has to change.
Leaving my town has real consequences in how medical care will be delivered, especially in relation to obstetrical care. We know that if rural communities lose their hospitals, it is a sentence for increased maternal-fetal deaths, more high-risk deliveries, more inappropriate home births and a loss of economic stability to the community. It also leaves the door open to poor health outcomes for the chronically ill.
So what is the answer? How do we appeal to young physicians and encourage them to invest in these areas? The answer may be much simpler than you think. If you build it, they will come.
Young physicians are looking for a place in which we can thrive both personally and professionally. As I continually stressed to my hospital, new recruits want to know that the people who work in that setting are supported, that innovation is welcomed and that the management or corporation is forward-thinking. We also want to be compensated appropriately for the level of work and expertise we offer. The new recruit wants to be in a place that supports and upholds the importance of the physician's role in the delivery of patient-centered care.
We aren’t afraid to work hard, but we don’t want to do so in vain. Although this is not unique to a rural setting, the financial component is amplified due to lack of resources compared to larger cities with larger markets.
My colleagues here tell me that these expectations represent quite a change in mentality from even 10 years ago, when physicians did not require as much from corporate entities. I’m not completely sure how this shift occurred, but part of the answer lies in the increased demand for data sourcing and the challenge of electronic health systems that do not communicate with one another. Couple that with reduced reimbursement rates for primary care, and we have a good start to answer that question.
Call it a generational change of mind or maybe a realignment of priorities. However you want to label it, this trend isn’t going away. Gone are the days when a person would work without being afforded respect and validation. As innate servant-leaders, family doctors have a tendency to gloss over those business aspects, but I hope our savvy new physicians will push all stakeholders into the right direction. I hope that we will return to a world where a family doctor is able to choose whatever practice model fits his or her lifestyle best, whether that is running a small business or as an employee.
My family will miss the community we have grown to love, but moving is the price to pay in order to have a continued presence in my home. As we prepare to move to another community with a small-town feel, I can definitely say that being part of a rural town has left us with a great impression of family life. I hope that my departure creates the pressure the local hospital needs to revamp strategies that will attract and keep primary care alive in this area. When my family returns to visit, I pray that the medical scene will beat to a different tune.
Marie-Elizabeth Ramas, M.D., is the new physician member of the AAFP Board of Directors.
Thursday Mar 31, 2016
Women in Leadership Build Support for Other Female Physicians
At a recent family medicine meeting, I took pride in the fact that this year the AAFP president, the speaker of Congress of Delegates and the president of the AAFP Foundation are all women. That's a rarity given that Wanda Filer, M.D., M.B.A., is only the third female president in the Academy's 69-year history.
I believe we’ll see more female physicians on the forefront of leadership in the future. When I graduated from medical school, women accounted for roughly 10 percent of the U.S. physician work force. Today, the number is closer to one-third(www.fsmb.org).
| Women in leadership positions in family medicine include, from left, AAFP President Wanda Filer, M.D., M.B.A.; myself (speaker of the AAFP Congress of Delegates); and AAFP Foundation President Evelyn Lewis&Clark, M.D., M.A.
In family medicine, the trend is even stronger. More than 40 percent of AAFP members are women, and the numbers are higher among our youngest physicians. Fifty-four percent of family medicine residents are women, and 57 percent of our new physician members are women.
As our percentage of membership increases, so does our representation. Three dozen presidents and presidents-elect of our constituent chapters are women. And nearly 50 women serve on AAFP commissions. Female physicians should feel empowered by the changes we are experiencing.
Despite the advances women have made, obstacles remain. A recent Medscape survey(www.medscape.com) indicates that female physicians still earn far less than our male counterparts. Illinois AFP President Alvia Siddiqi, M.D., recently launched our chapter's Women in Leadership Member Interest Group(www.iafp.com) to address such disparities. The group's first event, held in late February, aimed to help women improve their contract negotiating skills.
Siddiqi said the chapter's intention is to "provide an open forum to discuss issues relevant to female family medicine physicians, including contract negotiations, balancing career and family lives, and career development." The group will encourage female physicians to participate in leadership and offer opportunities for mentoring, and personal and professional development through education and other programming.
On a broader scale, Michigan AFP President Kim Yu, M.D., recently started a social media effort to connect female family physicians across the country. Yu launched Physician Moms in Family Medicine(www.facebook.com) on Facebook in January, and the group had 800 members within a few days. It now has more than 1,100.
Only family physicians can join the group, Yu said, because she wanted members to have a place "to ask their questions within the safety of our own specialty."
"It has been eye opening to hear directly from physicians on topics from ABFM certification questions, celebrating when someone becomes an AAFP fellow or delivers a baby, how to deal with threatening patients, interesting or difficult cases, how to teach circumcision to residents, favorite board review courses, info on FQHCs, best CME courses, procedures, or sharing about our favorite conferences," Yu said.
Yu said her goal for the group is to provide a venue where women can find a community to share their joys and difficulties and support each other.
The group is open to women who are not mothers, but Yu said it will keep its name so women know they also can "discuss issues that affect us as physician moms, not just as physicians."
Yu also hopes the group can encourage its members to become more involved in advocacy for their patients and the specialty.
As Women's History Month comes to a close, I'd love to hear what other chapters and groups are doing to provide mentoring and resources for female family physicians.
Finally, I want to remind you that the National Conference of Constituency Leaders will be May 5-7 in Kansas City, Mo. That event, which provides a platform to five AAFP special constituencies -- women, minorities, new physicians, international medical graduates and physicians interested in gay, lesbian, bisexual and transgender issues -- is co-located with the Annual Chapter Leader Forum.
Javette Orgain, M.D., M.P.H., is speaker of the AAFP Congress of Delegates.
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