April 27, 2018 03:48 pm David Mitchell – Reid Blackwelder, M.D., knows medical education. For more than 25 years, the former AAFP president has been training family physicians through his work in one role or another, from professor to residency program director to his current position as chair of the Department of Family Medicine at Quillen College of Medicine at East Tennessee State University.
Although family physician training covers a broad scope and FPs are qualified to offer comprehensive, continuous care, Blackwelder said a vital skill set is lacking from the curriculum in most programs: leadership and advocacy.
"This is a sad reality," Blackwelder said during the plenary April 26 at the 2018 AAFP National Conference of Constituency Leaders. "We don't prepare you for a key role in medical school education or residency education at all. You are seen as leaders and change agents, but you don't come out of residency naturally having this skill."
Blackwelder said family physicians all have things they would like to change about health care, but they may not appreciate their own ability to make a difference or know how to get started.
Former AAFP President Reid Blackwelder, M.D., left, speaks with Sukhjeet Kamboj, M.D., as Susan Osborne, D.O., listens. Blackwelder was the plenary speaker at the National Conference of Constituency Leaders April 26 in Kansas City, Mo.
"You do need to disrupt things," he said. "The status quo is not great."
Blackwelder said a good starting point is to focus on one advocacy issue at a time.
"This is really hard for family docs," he said. "We all want to do everything at once. The moment you're doing more than one thing, you're doing two things not so well. You might do them better than other people, but you're not doing any one of those things as well as you could if you put all your focus on that one thing. You have to be intentional."
He also stressed that it was critical for physicians to stay informed about the issues affecting health care by taking steps such as following the Academy's advocacy efforts and subscribing to the daily Family Medicine SmartBrief newsletter.
Family physicians can support the specialty, he said, by helping payers, policymakers and legislators understand its scope and breadth.
"Talk to payers about your practice and who we are as a specialty," he said. "People don't know who family physicians are. It's better than it used to be, but we have a way to go."
Blackwelder asked his audience how many of them have had a patient who was surprised that they do Pap smears. Many hands shot in the air.
"Maybe you even do OB," he continued. "How many of you who do OB have had a patient say, 'Who do you recommend as my child's pediatrician?' That's an easy one to answer."
Blackwelder urged family physicians to identify themselves as such, rather than as primary care providers.
"We are family physicians," he said. "Be a family physician. Be proud. If people say, 'Who are you?' you can't take five minutes or give a PowerPoint presentation. You have to say, 'Here's who we are.' Figure it out. What's your elevator speech? Why are we critical? What is it we do?"
Blackwelder said there is an abundance of data that shows having a regular source of comprehensive care and insurance coverage improves outcomes, but many decision-makers don't yet understand the difference that family medicine can make or the role the specialty plays. For example, Blackwelder said more patients with heart disease see a family doctor or internist than a cardiologist. Likewise, more patients with lung disease see a family doctor or internist than a pulmonologist. And more patients with orthopedic injury see a family doctor or pediatrician than an orthopedic specialist.
"We can be the answer," he said. "You need to be able to tell people what you can do for them and what they can get from you."
He said one problem is that many family physicians are not practicing the broad scope that their training allows.
"The moment we stop being who we say we are, we've got challenges," he said. "I know sometimes you're forced to do that. That's when others can do parts of your role. Nonpyhysician providers can't replace you unless you let them by doing less. Every team member is critical, but we're not interchangeable. I want you to be indispensable."
Too often, he said, family physicians don't understand their own value. For example, after Blackwelder became interim chair of Quillen's family medicine department in 2016, he did a review of the department's coding related to complexity of care. He found one group had left more than $300,000 on the table.
"It wasn't about extra work or documentation," he said. "It was about changing which box you circle. We have to value ourselves when we talk to people."
He said that at the state and national level, family physicians can build relationships with legislators and legislative staff and become their trusted advisors on health care matters. In-person visits are effective, he said, but emails and phone calls also are important, and using the AAFP's Speak Out tool can help members easily communicate with legislators on important issues. The Academy also has other tools and resources that can help members get involved with advocacy efforts, including a grassroots toolkit and the Family Medicine Action Network.
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