Q&A With Jack Westfall, M.D., M.P.H.

New Director Brings Rural Perspective to Graham Center

February 11, 2020 03:04 pm David Mitchell

Jack Westfall, M.D., M.P.H., the new director of the AAFP's Robert Graham Center for Policy Studies in Family Medicine and Primary Care, is bringing nearly three decades of experience as a clinician, educator and award-winning researcher to the position.

Jack Westfall, M.D., M.P.H.

It's a good match. Westfall has authored or co-authored 130 research articles in multiple peer-reviewed journals and contributed to numerous books. The Washington, D.C.-based Graham Center(www.graham-center.org) has published hundreds of papers, policy briefs and one-pagers during the past two decades, emerging as one of the nation's most respected voices on issues related to primary care.

Westfall will bring his insights to a panel discussion on rural care Feb. 13 in Washington during the Rural Health Disparities Summit,(www.ruralhealthweb.org) which is hosted by the AAFP, the American Heart Association and the National Rural Health Association.

AAFP News recently spoke with Westfall about his vision for the Graham Center.

Q: You practiced in rural communities for decades. How will you apply that experience to your work at the Graham Center?

A: Rural practice taught me how to be a family doctor. How to be pragmatic, solve the local problems and engage the local people. I hope to bring that to the Graham Center, to make sure the work we do is relevant to the local practicing family doctor or other primary care clinician, whether that is in Yuma, Colo., or downtown D.C.

Second, I hope to engage both the practicing members of the AAFP and their patients and community members in the work of the Graham Center. Our patients and AAFP members have been solving their local dilemmas for years. How do we take advantage of that broader collective knowledge to solve some of the wicked problems we face in family medicine?

Q: Some members might not be familiar with the Graham Center. How does the center's work apply to a typical family medicine practice?

A: The Robert Graham Center seeks to create and curate evidence that informs policies aimed at supporting family medicine and primary care. The Graham Center aspires to address head-on the wicked problems we face in health care: workforce, payment reform, access to primary care, resilience and burnout, social drivers of our patients' health and ill health.

AAFP Supports Chapters' Rural Health Summits

As part of its Rural Health Matters initiative, the AAFP has awarded three $15,000 grants to support rural health summits that will hold this fall.

Dates and other details are expected to be announced April 24 during a panel discussion at the AAFP's Annual Chapter Leader Forum in Kansas City, Mo.

The South Dakota AFP plans to convene stakeholders in partnership with the South Dakota Area Health Education Center for a discussion of topics such as telehealth, workforce recruitment and retention, obstetrical deserts and challenges facing rural critical-access hospitals. According to the South Dakota Department of Health, 57 of the state's 66 counties have a health professional shortage and 48 are medically underserved.

In Kansas and Colorado, 26% and 13% of residents, respectively, live in rural communities, but Kansas has lost five rural hospitals in the past decade and Colorado has lost nearly double that amount. Those states' chapters, along with the University of Kansas Medical Centers in Kansas City and Wichita, are planning a joint event that will focus on issues such as physician recruitment, Medicaid expansion and its impact on hospital finances, collaborating with other specialties, advocacy, and the impact medical schools can have on improving care in rural communities.

Missouri and Illinois are planning a joint event to discuss maternal mortality, obstetrical deserts, physician workforce and other rural health issues.

Q: What is your vision for the Graham Center? How does it affect the practicing family physician and/or specialty as a whole?

A: We want to be the go-to source for the policy issues facing our members. I got an email from a member out west who is finding that the local hospital system is recruiting his patients for their annual Medicare wellness visit. He is missing out on that opportunity to spend extra time with his long-time patients. He wondered if others might be facing this loss of continuity due to large hospital systems seeking to game the Medicare benefits.

The Graham Center is doing the research to see what kind of problem this might be in his community and across the United States. The Graham Center has the unique ability to identify local problems and analyze the state and national impact. We hope more practicing family physicians will ask us(www.graham-center.org) the questions they have.

Q: What are your thoughts on integrating different research resources of the AAFP, such as the Graham Center, the National Research Network and HealthLandscape?(www.healthlandscape.org)

A: I spent 20 years in Colorado working with the High Plains Research Network,(medschool.cuanschutz.edu) a practice-based research network in rural and frontier eastern Colorado. Practice-based research is a wonderful tool for research in family medicine without placing too much burden on any one physician or practice. The HPRN has over 50 small primary care practices, and the physicians, nurses and PAs are eager to help identify clinical problems and questions and work with the HPRN staff to implement local solutions. So, I am keen to work with the National Research Network to consider how to partner our efforts: primary care policy and family medicine clinical practice research.

It really is exciting to see the growth and maturation of both the Graham Center and the National Research Network. The access to practices and family physicians afforded to the NRN will help the Graham Center begin to engage our AAFP members in our policy work, as well.

HealthLandscape is a tool to help us figure out how this all fits across communities, states and the nation. Sometimes a map is just what we need to help us find our way.

Q: Workforce is a big issue. What role, if any, will the Graham Center play in the Academy's Rural Health Matters initiative?

A: I have an interest in making sure rural communities have the best family doctors. Rural health care has been a fragile enterprise for centuries; this is not a new problem. Too often policymakers try to create a policy that works in the city and simply apply it to the rural. That just won't work.

Rural communities have been solving problems for centuries, but this physician workforce problem has been too tough for rural communities to do alone. There are other factors, incentives and business implications that make rural health difficult to do alone. So, I am hoping that the Graham Center can work with rural communities to identify the local solutions and work to create the evidence that might support policies to build on those local solutions. I don't want to just apply a broad urban Band-Aid to rural America and hope it heals the wound. I think we can do better if we pay attention to our rural members' ideas and solutions.

Q: You're moderating a panel discussion at the Rural Health Disparities Summit. What key issues will you be covering there?

A: The National Rural Health Association is a wonderful partner with the Graham Center. We are facilitating a conversation about enabling primary care practice in rural communities. Rather than just focus on recruiting a few doctors for a couple of years, we want to consider local, state and national policies that truly enable rural practice. Payment, family and professional connection are just some of the topics we want to discuss, identifying some bright spots across the country and some innovative ways to connect family doctors to the land.