The AAFP's 2017 National Conference of Family Medicine Residents and Medical Students commenced here July 27 with an enthusiastic crowd attending the opening main stage event. The session, a panel discussion titled "Disrupting the Status Quo: Clinical Innovation in Primary Care," was sponsored by the Health is Primary(healthisprimary.org) campaign from Family Medicine for America's Health.
Jay Lee, M.D., M.P.H., second from left, talks about building leadership capacity in family medicine, as he and his colleagues (from left: Rushika Fernandopulle, M.D.; Sachin Jain, M.D.; Manisha Sharma, M.D.; and moderator T.R. Reid) serve as panelists for the opening event at the 2017 National Conference of Family Medicine Residents and Medical Students.
Moderator T.R. Reid, an author and journalist, told the audience that as family physicians, they would serve as the "linchpin" of the U.S. health care system.
"Our health care system is in turmoil. It's a mess; nobody knew that health care could be this complicated," he said. "Can we do anything about it?
"I think what we're going to hear right now, in this session, is that the answer is 'Yes.' But change in health care is not going to come from the top down in Washington, D.C."
"Today we're going to hear from four docs who are really part of that change," said Reid.
Manisha Sharma, M.D., of Memphis, Tenn., currently serves as director of community health and primary care at the CareMore Health System. She suffered an accident in her early 20s that left her with severe hip injuries, years of surgeries and way too much time time navigating a complex and broken health care system.
- Panelists at a discussion sponsored by the Health is Primary campaign urged attendees at the AAFP's 2017 National Conference of Family Medicine Residents and Medical Students to become agents of change to fix the broken U.S. health care system.
- Young physicians can help by joining and shaping innovative start-up practices and teaching Washington insiders what good health care looks like.
- Identifying the fundamental causes of patients' hospitalizations -- including social determinants of health -- will bring common sense back into health care.
Sharma left behind a career in music and dancing for her new calling -- family medicine. "I wanted to be that agent of change. I wanted to be a disrupter," she said. "I was going to be unapologetic about my mission and my vision, and I was going to look for places that were doing the same thing. So here I am today."
Sachin Jain, M.D., of Los Angeles, president and CEO of the CareMore Health System, drew a friendly laugh from the audience when he spoke of his training as an internist.
As an undergraduate, Jain started a homeless health clinic on Harvard Square in Boston. "That's what drew me to a career as a generalist," he said. When he finished training and began his job search, he realized "the big-name academic centers that have huge reputations for innovation … really didn't want to change. They were really focused on treating illness as opposed to preventing illness from happening in the first place."
Jain worked as a hospitalist for the Department of Veterans Affairs before landing at CareMore -- an integrated health care delivery system that is, he said, "focused on the care of frail and vulnerable populations, where physicians follow patients longitudinally across settings.
"And when patients have chronic diseases -- we actually spend more time with them, not less."
Jay Lee, M.D., M.P.H., of Venice, Calif., chief medical officer at Venice Family Clinic, roused the audience with his opening statement: "Hi. Who's ready for a revolution? You are that revolution, and we are here to follow your lead as we transform health care together."
Lee described four critical steps he discovered during his personal journey that could help physicians just starting out become agents of change.
- Understand yourself. For Lee, that meant serving with a nongovernmental organization in postwar El Salvador, "working side by side with Salvadoran physicians trying to make health better in a community torn up by a civil war." That premedical school experience "forever flavored who I am today in terms of being a family doc," he said.
- Show up. "What are you going to do with that experience?" asked Lee. His led him to change his specialty choice from pediatrics to family medicine. "I realized FPs look to go upstream and are kind of that glue in primary care between the patient and the community."
- Occupy ground. "That means getting really good at doing something and not giving up, really making an impact," said Lee. "It's believing in something, and not letting go of it because we know it's the right thing to do."
- Change the world. "That's really what the family medicine revolution is all about, and you all, by virtue of being here, are part of that revolution," he said.
Keep the Patient Perspective in Mind
Sachin Jain, M.D., served as a panelist during an event at the AAFP's recent National Conference of Family Medicine Residents and Medical Students. Jain told the audience he took a two-year leave during residency to work for HHS' Office of the National Coordinator for Health IT (ONC).
The experience gave him a different perspective on the challenges of working in Washington in any capacity. "One of my most embarrassing moments was at ONC where I started saying things that, when I reflected on them, didn't really make sense from the perspective of frontline physicians," said Jain.
"It's very easy to lose perspective on patients when you're not seeing patients," said Jain. "It's great to have physicians serving in Congress, but you stop being a physician the minute you stop seeing patients.
"One of our biggest challenges is making sure we stay connected to patients even as we take on other roles in the health care system."
Rushika Fernandopulle, M.D., of Boston, a co-founder and CEO of Iora Health, recalled a day some 15 years that ended like so many days before it -- staying late after the practice was closed to finish up notes after seeing 38 patients, many of whom had been double-booked.
Learning all the "points and clicks" in the practice's new electronic health record system didn't help on this cold, dark February day, he said. And then, a colleague who was there after hours with him looked up and said, "Rushika, every day I lose a little piece of my soul."
Fernandopulle said family physicians go into their specialty to help people. "They come to us and they have such amazing needs, and we can help them, but the current system won't let us do it," he said.
Fernandopulle described his health system, which has 35 practices in eight states. "We're taking great care of people. We're building teams around us and changing the process. We have (information technology) systems that work for us -- not against us. We're really changing the culture."
As moderator, Reid threw out questions, and panelists took turns responding. For starters, Reid asked, how do young physicians just beginning their careers and their families -- and often saddled with big debt -- resist being risk-averse?
"The greatest thing about being a doctor is that you can always get a job. When you graduate, pick up the phone and after about 10 minutes, you'll have a job," Fernandopulle said. "You'll feed your family. Your family will be fine. This is the time in your career to take some risk. Vote with your feet, start doing things the right way, and resist the temptation to say, 'I'll do that later.'"
Lee said physicians abdicated the moral responsibly to lead the system in the late 90s. "We saw that happen about 20 years ago, when people dressed in suits started to take over health care, and docs said, 'I'll just be busy seeing patients.'"
Jain explained how young physicians can change the system from the inside out. "The kinds of risk we're talking about are joining a start-up practice and being part of actually shaping it."
Or they might consider taking a leave from residency to work for the government and teach people in Washington what health care is really like. "You know what it's like to take care of a patient who can't afford insulin or who lives in a tough community," said Jain.
The panel noted that the average cost of care for a hospitalized patient is $2,500 to $4,000.
Jain said his organization was bringing common sense back into health care. "That means getting a doctor attached to the hip of some of our sickest patients" so the doctor can identify the fundamental causes of patients' hospitalizations.
Sharma noted that 100 percent of her patients in Memphis are on Medicaid. "I get to see the most disenfranchised vulnerable folks, and it's really eye-opening. I can talk to them all day long about the disease-centered factors of their diabetes and hypertension, but really the thing that matters to my patients is that they didn't eat for three days, or their son got shot two days ago in a drive-by shooting."
She stressed the importance of addressing these types of social impacts on health. "We've got to do the common-sense thing -- how do I get food for my diabetic patients? How do I get them in a safer neighborhood?"
The panel also addressed how to fill health care gaps by building partnerships with other people in the community. Lee put it this way: "Have the humility to know that you as a physician, or we as a group of physicians, don't have all the answers. Have a willingness to work with others."
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