Raymond “Robin” Feierabend, M.D. is retiring from the Department of Family Medicine after 32 years of service. Dr. Feierabend joined the faculty at the Bristol Family Medicine Residency Program in 1982 and became acting program director the following year. He was program director from 1985 to 1990 and again from 1998 to 2005. Dr. Feierabend taught about 200 resident physicians during his time at Bristol Family Medicine.
In 2010, he was named Director of Graduate Medical Education for the Department of Family Medicine and in this role mentored senior department leaders in revising and improving the process of resident education. He has truly served Northeast Tennessee and Southwest Virginia with integrity and heart, and provided us a fine example of a life of service.
A reception was held Aug. 12 to celebrate Dr. Feierabend’s many achievements and impending retirement. There were several notable speakers at the event, including Dr. Wilsie Bishop, Chief Operating Officer and Vice President for Health Affairs at ETSU, Dr. Robert T. Means, Dean of the Quillen College of Medicine, Dr. John P. Franko, Department of Family Medicine Chair, Dr. Greg Clarity, Program Director at Bristol Family Medicine Residency Program, and Dr. Feierabend’s wife Margaret.
Click here to read more about Dr. Feierabend’s career and dedication to family medicine.
Keeping It Real: Preceptorship Exposes Students to Importance of Rural Family Medicine
Roughly 20 percent of Americans live in rural areas, but only 11 percent of U.S. physicians live in those same communities. In fact, the Health Services and Resources Administration (HRSA) has designated more than 6,000 Health Professional Shortage Areas for primary care, and 67 percent of those are in nonurban areas. According to HRSA, it would take 17,000 additional primary care health professionals to achieve a ratio of one clinician per 2,000 patients in these locations.
So, how do we convince more medical students to first choose family medicine and then practice it in the places that need them the most?
I recently had the opportunity to talk to students during the Appalachian Preceptorship, which exposes students from around the nation to rural family medicine in Tennessee. Ten students from seven medical schools participated in the four-week program.
Let them experience it first-hand.
Nearly 30 years ago, Forrest Lang, M.D., retired vice chair of the Department of Family Medicine at East Tennessee State University (ETSU's) Quillen College of Medicine in Johnson City, created the Appalachian Preceptorship to introduce students to rural family medicine in a highly relevant and culturally sensitive way. Since then, hundreds of medical students from all over the country have come to Tennessee to experience first-hand the delivery of primary care in Appalachia.
It is critical that we find ways to connect with medical students early in their first and second years, and this year all of the students participating in the program were sophomores. We know that in the first 18 years of the program, more than 80 percent of the students who participated matched to residencies in primary care, including 60 percent who matched to family medicine programs.
Students are called to medicine to help people, and there is no better way to do so than practicing family medicine in rural, underserved America. In the Appalachian Preceptorship, students participate in one week of didactic sessions at ETSU before spending three weeks with a physician practicing in a rural Appalachian community.
These dedicated family physicians allow students to become part of their practices, and the students see patients, participate in the diagnosis and management of acute and chronic diseases, practice preventive medicine, and enjoy a wealth of other experiences.
The experience is invaluable for both the students and the preceptors. In fact, we dedicate significant resources at ETSU to connecting with our preceptors throughout the year, and we devote a special weekend session to allowing them to offer feedback on our educational methods and identify and address the resources they need.
Another key aspect of this program is the opportunity it gives us to show students that it is possible to not only survive but to thrive in small-town practices. Some of the preceptors are from individual physician practices, and most of the rest belong to small groups. The students are able to experience how health care is provided in these communities and to really understand the nature of physician-patient relationships. In addition, each of these preceptors and the communities in which they work are great examples of different types of patient-centered medical homes. This reinforces to the students that team-based care is not about having everyone located under the same roof; but rather the resources that are available within the community to care for its residents.
Another advantage of this process has been the chance it offers to expose students from all over the country to our school's residency programs. Almost every year, students who have participated in the preceptorship interview with at least one of our three family medicine residency programs. These are outstanding students, and we are frequently blessed that at least one of them matches with us. This is important because data from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care indicate that up to 75 percent of physicians will practice within 100 miles of their residency. In this way, the ETSU programs are consistently fulfilling their mission to provide rural family physicians for our patients.
On a personal note, I had the privilege of talking with students about a number of issues, including the importance of herbal medicine in Appalachian culture, bedside manner and patient-centered communication. I encourage each of you to consider how you can be a part of such a process in your community.
If you are academician, are there ways you could create student or even resident experiences that can mirror some of these goals of exposing students to underserved areas? If you are in private practice, is there a school or residency in your area that you could connect with to create a unique and transformative experience for learners?
Although we struggle nationally with physician pipeline issues, this is how we can walk our talk and directly influence students. This is a great opportunity to remember that the root word of doctor is docere -- to teach!
Reid Blackwelder, M.D., is president of the AAFP.
What's the best thing about working at East Tennessee State University? Our people-students, faculty and staff! Our quality reputation! Our beautiful campus! Our emphasis on caring for the needs of every member of the ETSU family! ETSU is a student-centered community of learning that employs more than 2,000 faculty and staff. Our personnel are a constant source of enthusiastic service that makes us a leader in regional universities.
When the doors open each morning at ETSU Family Medicine, Michelle Goodman, RN, Nurse Supervisor is there greeting employees, residents and faculty physicians as we ready the center to provide Patient Centered Medical Home care to our patients. As Supervisor, her door is always open as she is known as our “go-to” person. She is welcoming, patient, helpful, and just an overall exemplary staff member. She regularly rolls up her sleeves and assists the patients, physicians and residents by taking vital signs. She is our first line of defense for emergencies, safety and assistance. She provides a teaching atmosphere and sets an example for our nursing staff and residents by demonstrating effective communication skills with the healthcare team. Her compassionate and positive attitude is evident as she truly focuses on the care and treatment of our patients. She often worries about patients who may be having a difficult time and will call them after hours to see if they are doing okay. Her staff also experiences her care and compassion as she daily assists them, fills in for them when family emergencies arise, encouraging and supporting them, and providing the tools and information needed so they can be successful in their job roles. It is a pleasure and an honor to work with Michelle and we are so grateful to have her here at ETSU Family Medicine!
From Lyme disease and West Nile Virus to snakebites, sunburn and sunstroke, the perils of summer have arrived.
On Thursday, July 10, Dr. Raymond Feierabend of ETSU Family Physicians of Bristol and director of Graduate Medical Education for the Department of Family Medicine at East Tennessee State University’s Quillen College of Medicine, will give a talk at the Bristol Public Library about ways to make the summer safer.
Feierabend’s lecture is part of the Health Education Series 2014, which is hosted through a partnership between the Bristol Public Library, ETSU Family Physicians of Bristol and Wellmont Health Systems. The series is designed to help educate and inspire people to be more proactive about their own health.
The free event begins at 6:30 p.m. in the J. Henry Kegley Meeting Room. The Bristol Public Library is located at 701 Goode St., Bristol, Va.
For more information, call the Bristol Public Library at 276-821-6149.
In an effort to increase the number of primary care physicians who choose to practice in rural areas, the Department of Family Medicine has sought to have a greater influence upon high school students during a period which is critical to their career determinations. Rural high school students eyeing a career in medicine and the health sciences can get an early glimpse into the field by entering the 13th annual Rural High School Medical Camp, hosted by the James H. Quillen College of Medicine. The camp encourages the students to consider a career that previously may have appeared out of reach and gives them a set of experiences to guide them for preparation for entering medical.
The camp is from Sunday June 15-June 20, 2014. There are 27 high school students participating in the camp and 6 second year medical students serving as chaperone’s for the medical camp. Some of their favorite activities thus far are Pharmacy, Human Simulation Lab, Standardized Patient Lab, Phlebotomy, Gross Lab, Johnson City Medical Center, working out at the CPA gym, hiking Buffalo Mountain. The camp will end Friday with a suturing workshop and closing session with our College of Medicine dean, Dr. Robert Means and Student Affairs Associate Dean, Doug Taylor.
The families of the students are all invited for the closing session.
2015 camp will be in June next year.
Over the years, the Academy of Breastfeeding Medicine (ABM) has received significant leadership contributions from AAFP members, including past ABM officers Anne Montgomery, M.D., Julie Wood, M.D., and Tim Tobolic, M.D. AAFP member Anne Eglash, M.D., in fact, was a founding member of the ABM. But no AAFP officer had ever been invited to participate in the ABM's Annual Summit on Breastfeeding, even though our colleagues from the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics have routinely attended.
But this year, for the first time in the event's six-year history, all the specialties that care for newborns and mothers were represented at the recent two-day summit in Washington.
Family physicians, including president-elect Julie Taylor, M.D., M.Sc., (right) have played an important role in the Academy of Breastfeeding Medicine. I met with her at the recent Annual Summit on Breastfeeding.
This breakthrough represented an important opportunity for the AAFP because attendees at this event included not only representatives of the medical professional organizations noted above, but also leaders from CMS, HHS and other governmental agencies; federal legislators; representatives from such diverse stakeholder groups as the W.K. Kellogg Foundation, Kaiser Permanente and the March of Dimes, as well as academics, state health officials and others.
Unfortunately, many of these groups have not coordinated their efforts with one another and were not aware of other groups' activities. In particular, these other stakeholders were not familiar with the important work the AAFP has done in the areas of breastfeeding support, advocacy and policy. Therefore, I saw at least part of my role in attending the event as helping to break down existing silos.
I found it encouraging that everyone present seemed to readily recognize this need. We forged new relationships, connecting to the right people to improve our collaboration. In between agenda sessions, people were talking, exchanging cards, and sharing resources and links. I felt a great deal of enthusiasm and energy throughout the entire event.
Best of all, this summit provided me another opportunity to help other groups understand who family physicians are and what we do. I was able to point to our unique role in taking care of these special patients, noting that because we are the only specialty that truly does cradle-to-grave care, we have multiple opportunities to talk not only about breastfeeding, but also the many diverse issues relating to rearing children.
An especially important message for attendees to hear was about our ability to educate not just the mother, but also the father and, perhaps even more essential, the maternal grandmother! Family physicians are truly the medical specialists who can pull everything together after the blessed event, because we see both mother and baby together at subsequent visits. With this kind of postpartum follow-up, we can directly impact the sad decrease in breastfeeding rates that occurs after women go home from the hospital. At the time of discharge, about 75 percent of U.S. women are breastfeeding, but that rate drops to roughly 28 percent within a few weeks of going home.
Family physicians can take the lead in addressing this critical public health issue because we understand that breastfeeding is really a family matter, not just a personal one. We witness the powerful role of relationships within families and with our practices every day, with every patient.
The ABM has a number of resources to support breastfeeding, just as the AAFP does. One of our resources, the Academy's breastfeeding position paper, is even now being updated as part of a regular evidence review by our Breastfeeding Advisory Committee. That update likely will be published in the fall and will be accompanied by an education campaign aimed at helping to create breastfeeding-friendly family physician offices.
Other resources family physicians may find helpful include the Baby-Friendly USA initiative and its 10 steps to creating breastfeeding-friendly hospitals. Even for family physicians who don't work in hospitals or provide obstetric care, it's still important to advocate on patients' behalf to ensure that that the first exposure during and after delivery reflects strong support for "the first food" and not formula.
It's also worth noting that 28 percent of all medical students in this country are members of the AAFP, so we have a unique opportunity to begin emphasizing breastfeeding benefits early on regardless of what specialty each student eventually selects. Moreover, our residencies are working to become breastfeeding-friendly for our trainees. This new policy is the result of resolutions passed by the 2013 Congress of Delegates that initially were brought forward by our students and residents.
Finally, I was able to share the critical need for all of us to network better with each other. Even in this meeting that focused on an issue of common ground, I still saw evidence of our fragmented health care system. Different groups don't always share as well as they could. This is one of our challenges in these days of advanced communications technology -- we can forget the power of face-to-face discussions. That is one reason I am so eager to say "Yes!" to these kinds of invitations. Nothing can beat actually talking with people in person.
That said, we need to recognize that the mothers and families of today are different, and I challenged everyone at the meeting to get comfortable with social media because it's one more avenue to increase awareness about breastfeeding.
One final note: Just as family physicians were critical to the founding of the ABM, so we are to its leadership now. The current president of the ABM is Wendy Broadribb, M.B.B.S., a family physician from Australia. Julie Taylor, M.D., M.Sc., a family physician on faculty at Brown University, will be taking over next year. I look forward to future opportunities for the Academy to interact and grow together with other stakeholders on this important issue.
Reid Blackwelder, M.D. , is president of the AAFP.
June 3rd, 2014 9:56 am by Nathan Baker
East Tennessee State University researchers will be a part of the state’s continued efforts to reduce the number of babies born addicted to narcotics, awarded one of five grants in the state to study the problem of neonatal abstinence syndrome, or NAS.
ETSU’s Ivy Click, an assistant professor of Family Medicine at the James H. Quillen College of Medicine, and Nick Hagemeier from the Bill Gatton College of Pharmacy, are leading a one-year study funded by the Tennessee Department of Health to help better devise an education program for those able to prescribe and dispense drugs.
According to state DOH statistics, 386 infants have been born this year so far showing signs of NAS, which is defined by withdrawal symptoms that can occur in babies exposed to illegal or prescription drugs while in their mothers’ wombs.
That number is 22 percent higher than the same time period last year, continuing a trend that health officials are calling an epidemic-level health crisis.
“If you look at the statistics, we don’t see the problem going away,” Hagemeier said Monday. “It’s going to take work on multiple fronts to impact change, and I think the Tennessee Department of Health is asking some good questions and spending some money on good research.”
For the study, the two doctors plan to target four different groups: pharmacists, primary care physicians, pain management clinic physicians and those prescribing buprenorphine, a drug commonly used to treat opioid addiction.
Hagemeier and Click plan to ask the physicians how they talk to patients about the risks of NAS, especially when the patients are women in their prime childbearing years.
“We want to know if they’re educating them about the risks associated with these drugs and, even if they may not be pregnant, if they’re having conversations about contraceptive use,” Hagemeier said. “These are the kinds of things prescribers and dispensers should be talking to their patients about, we want to know if they are and how we can make those conversations more effective.”
Today, Tennessee Gov. Bill Haslam and other state health officials are expected to unveil a seven-point plan designed to curtail rising prescription drug abuse.
The plan’s revelation follows new guidelines set by a panel of physicians appointed by the state commissioner of health putting limits on doses doctors can prescribe, defining procedures for giving the drugs to women of childbearing age and setting new requirements for certification for pain medicine specialists.
Last month, Haslam signed a controversial bill into law that sets up penalties for women who birth children with NAS, allowing them to be charged with misdemeanor assault and face jail time.
Lawmakers say the law could help to encourage pregnant women addicted to prescriptions or illicit drugs to seek treatment, but opponents said similar laws did not work in the past, and could drive women away from seeking treatment at hospitals.
Hagemeier said the study is likely a part of the efforts planned by the administration, and he hopes more extensive surveys will be conducted in the future.
“We have a year to get it done, the end-date is next year,” he said. “My hope is we can use the results to help the state better understand how to best develop interventions and to seek additional funding to do a larger project.”
White House Invitation Shows Importance, Recognition of Family Medicine
In our advocacy efforts, we often talk about the importance of being "at the table" when important discussions are taking place. The Academy is getting a good seat at that proverbial table more and more often.
Last week, I had the opportunity to represent the AAFP at a White House event for the second time in less than 18 months. This most recent trip was prompted by an invitation to attend the president's Healthy Kids and Safe Sports Concussion Summit, which brought together select medical experts and representatives from collegiate and professional sports organizations to address this serious problem.
I attended the Healthy Kids and Safe Sports Concussion
My previous White House invitation stemmed from the first lady's request that an AAFP representative attend a meeting about Joining Forces (a national initiative to support military service members and their families) along with the representatives from the Department of Defense, the Department of Veterans Affairs and other stakeholders. At that meeting, we addressed the challenges of providing care to special groups within our armed services, including service women and veterans needing mental health services.
I'm pleased that the administration is demonstrating an increasing recognition of the critical, foundational role that family physicians play in our health care system. Concussions, traumatic brain injury, mental health and women's health needs are significant health issues. Unfortunately, it is common for legislators and administrators to view these issues strictly in terms of subspecialty services, which can easily lead to fragmented care.
Family medicine is the only specialty that doesn't limit itself based on organ systems, disease groups, specific problems or age of patients. Instead, we are on the frontlines of managing all of these issues in our patients every day. One of the Academy's goals is to help those in leadership positions better understand who family physicians are and what we can provide. The fact that the AAFP is repeatedly being invited to meetings like these indicates our message is getting through.
During his remarks at the concussion summit, the president mentioned that although U.S. emergency rooms see roughly 250,000 children each year for head injuries, that doesn't include the number of children who are taken to see their "family doctor." I appreciate his recognition that family physicians are instrumental in the care being provided to children for such health issues. We are able to address the acute issues of affected children and the appropriate concerns of their families. We can educate these families and discuss how to prevent these injuries.
Perhaps even more important are our relationships within our communities. Family physicians provide numerous community services in many different venues, and 40 percent of our members provide some sports medicine services. Many are right there on the sidelines to educate coaches and teams.
Moreover, the direct connection we have with patients allows us to be there for the challenges created when someone has a severe concussion and its sequelae -- such as post-concussion symptoms and even career- or life-changing events. We are the only physicians with the combination of comprehensive education, extensive training and skills to handle complexity that allows us to care for all of our patients’ needs and help manage the impact on their families.
One of the promises that our officers and Board made to all Academy members was to continue to advocate that we be at the table and, thus, off the menu for such keenly important health care issues. I think we are well on our way in this regard. Our invitation to, and attendance at, these high-level meetings allow us to continue to educate those in health and government administration not only about the need for family physicians to be right at the frontlines, which we already are, but also to be respected in that critical role.
Thank you for all of your service and for all that you do. More and more people are recognizing the important work family physicians have always done, and they are starting to value those contributions appropriately.
Reid Blackwelder, M.D., is president of the AAFP.
The free clinic in Mt. City was held on May 22nd. We have held the clinics since December 2012 and word is getting out based on the cars in the parking lot. Our clinic is becoming quite successful and feel we are making a difference in the community.
LEAWOOD, Kan. — The World Organization of Family Doctors (WONCA*) will celebrate World Family Doctor Day around the globe on May 19. First declared by WONCA in 2010, World Family Doctor Day is a day to highlight the role and contribution of family physicians in health care systems around the world.
Family medicine has long been the preferred model of care outside the United States and is the cornerstone of an ongoing, personal patient-physician relationship focused on integrated care.
“Family medicine is comprehensive in its focus — caring for an individual’s health across the life span,” said Julie Wood, MD, AAFP vice president for health of the public and interprofessional activities. “World Family Doctor Day highlights family medicine for adaptability, brings attention to the important work family physicians do, and encourages medical students to make a contribution in the global community by choosing family medicine as a specialty.”
Multinational employers and insurance companies are realizing more and more the importance of family physicians and their focus on a long-term patient-physician relationship, preventive care, chronic disease management and care coordination across sub-specialties.
WONCA has an impact on the world of family medicine and general practice through its World Council and its seven regional councils. In addition to its governance structure, WONCA has working groups on the classification of problems encountered in general family practice, rural practice, quality assurance, informatics, education, communications and publications, research, health behavior change, tobacco cessation, women and family medicine, mental health and respiratory diseases. Since inception many of these groups have carried out groundbreaking studies and research, and have produced a variety of important publications.
The American Academy of Family Physicians is a longstanding member of WONCA. The 115,900 AAFP members join with the126 WONCA member organizations in 102 countries to celebrate World Family Doctor Day.
###About the American Academy of Family Physicians
Founded in 1947, the AAFP represents 115,900 physicians and medical students nationwide. It is the only medical society devoted solely to primary care.
Approximately one in four of all office visits are made to family physicians. That is nearly 214 million office visits each year — nearly 74 million more than the next largest medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.
To learn more about the specialty of family medicine, the AAFP's positions on issues and clinical care, and for downloadable multi-media highlighting family medicine, visit www.aafp.org/media. For information about health care, health conditions, and wellness, please visit the AAFP’s award-winning consumer website, www.familydoctor.org.
* WONCA is an unusual, yet convenient acronym comprising the first five initials of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians.
WONCA's short name is World Organization of Family Doctors .
James H. Quillen College of Medicine graduation was held May 9th . Fourteen Rural Primary Care Track students graduated from the program. Many walked away with numerous awards and Rural Programs are very proud of each and every one of them. US News and World report ranked Quillen Medical School Rural programs 6th in the nation.
Modern Healthcare has announced 50 Most Influential Physician Executives and Leaders and we are proud to announce
our own Dr. Blackwelder is included in this prestigious list, please click to view the entire list.
Thursday was the last day of Rural Primary Care Track for the first year medical students. We decided to do something fun and went toWatauga Lake, Carolyn Sliger's cabin. We had a great picnic and weather was hot and sunny. Students and Faculty, Drs. Joe Florence and Jim Shine competed in the RPCT "Olympics" with a mean game of corn hole and washers. Champions were Wade Davis, MS 1 and Grayson McConnell, MS 1.
Two 4th year Rural Primary Care Track students traveled to Guatemala for their rural rotation in March. Laurie Bennie, MS 4 and Sean O' Connor, MS 4 presented their medical experiences and shared pictures to 20 first and second year medical students who are also vying potential international travel as fourth year medical students.
Dr. Joe Florence, Rural Programs Director certified 9 fourth year medical students and he is the only faculty who is certified to teach ACLS within the College of Medicine.
He also certifies second year RPCT students in the spring of their classes.
the certification course was a three day course on 4/15/14
and the certification course was on May, 06, 2014
Congratulations to the 4th graduating class of the STFM Behavioral Science/Family Systems Educator Fellowship
(http://www.stfm.org/CareerDevelopment/BehavioralScienceFamilySystemsEduFellowship). Shout out to Dr. Tom Bishop
of the ETSU Johnson City program, who was one of the graduates. And thanks to STFM leadership for the wisdom to support it,
and for being present to celebrate its ongoing growth. May,05, 2014
Wednesday Apr 30, 2014 Main
Medical Student Advocates Make Big Impression on Legislators at FMCC
When I sat down at my state's table at the Family Medicine Congressional Conference (FMCC) earlier this month, I was quite surprised to find two of my Quillen College of Medicine students already sitting there.
Melissa Robertson, left, and Jessica White, right, seniors at East Tennessee State University's James H. Quillen College of Medicine, met with legislators from their state -- including Rep. Marsha Blackburn, center -- during the Family Medicine Congressional Conference in Washington.
The AAFP provides two scholarships for students and two for residents to attend this annual advocacy event in Washington, which trains family physicians (and future FPs) to advocate for their patients and for family medicine. The AAFP Foundation also awards a student scholarship, so I thought perhaps these students -- Jessica White and Melissa Robertson -- had earned scholarships to attend. But as it turns out, they decided to make the trip from Tennessee at their own expense because they thought it was an important learning opportunity.
In fact, 55 students and residents from around the country attended FMCC this year. Their spirit and efforts give me great hope for our future.
FMCC provides a remarkable blend of advocacy education and skills development along with the chance to immediately put those learnings into action. On the first day of the conference, we heard from advocacy experts, representatives of federal health agencies, congressional staff and two legislators.
On the second day of the event, more than 200 students, residents and practicing physicians took what they had learned on day one to Capitol Hill to talk with legislators and staff about issues such as physician payment, education and workforce. One of the best parts of this conference is the opportunity to share personal stories with our legislators. There is no question these conversations have a big impact and are one of the reasons face-to-face meetings have such potential to make a difference in promoting our interests.
Legislators and congressional staff hear from the AAFP Board several times a year, but stories from members can be so important because they speak directly to legislators who are elected to represent their state and district and tell them how constituents are being affected by the various challenges family physicians face.
For example, Jessica and Melissa, two seniors who have matched into family medicine residency programs, were able to talk about important education issues during our visits. As we reviewed the key points from the previous day's advocacy training sessions, we realized their presence was especially serendipitous given their paths to family medicine.
Jessica matched in Asheville, N.C., just across the mountains from Quillen. She will join the family medicine residency at the Mountain Area Health Education Center (MAHEC), which is a teaching health center. These centers provide creative approaches to training family medicine residents based in the communities that most need them.
Under the Teaching Health Center Graduate Medical Education (THCGME) program established as part of the Patient Protection and Affordable Care Act, GME funds go directly to the centers. However, the THCGME program, which started in 2011, is only funded through 2015.
The program is now completing its third academic year, graduating its first cycle of residents and sending almost 300 primary care physicians into the workforce. It should come as no surprise, then, that extending funding for the teaching health centers program is one of the Academy's top legislative priorities during this congressional session.
Without such an extension, Jessica's residency program cannot guarantee her salary for all three years of her training. Accepting this offer represents a remarkable leap of faith on her part. It also provided a great example to the people we talked with about the importance of extending funding for these programs.
Melissa is a nontraditional medical student and former elementary school teacher, so she brings a critical, real-world perspective to both medicine and medical education. She came to the AAFP's National Conference of Family Medicine Residents and Medical Students two years ago and got the advocacy bug there. During that conference, she was elected to the Society of Teachers of Family Medicine's Board of Directors and now is serving her second term.
Melissa, who matched to our East Tennessee State University residency program in Bristol, has a real knack for asking common-sense questions that help cut through administrative layers. Her particular path has made advocacy issues such as student debt and the primary care salary gap extremely important in her world.
Together, the three of us considered the day's congressional visits and how to tell these stories in meaningful ways. First up was Tennessee Tuesday, which is a weekly breakfast during which Sens. Lamar Alexander, R-Tenn., and Bob Corker, R-Tenn., welcome everyone visiting from our home state to Washington. They are always excited to meet their constituents and were especially eager to meet these medical students.
Next, we met with Rep. Marsha Blackburn, R-Tenn. Jessica's family lives in Blackburn's district, so this connection immediately lent relevance to our advocacy stories in a way that had not happened in my previous conversations with the congresswoman. Our legislators certainly pay attention to their constituents, and we were able to get some unscheduled time and a photo opportunity with Blackburn.
Moreover, during a subsequent meeting with Blackburn's health aide, we were able to talk about topics in a totally different light because of the students' circumstances. This latter meeting also showed Jessica and Melissa the critical role legislative aides play in setting agendas for elected members of Congress.
We then met with Rep. Phil Roe, M.D., R-Tenn., who represents Quillen's district. Originally, we had been scheduled to meet his legislative aide, but when he heard there were two medical students from his district present, he immediately made time to meet with them. In fact, their stories were so compelling that he asked if we would walk to the Capitol with him because he had to vote, but he did not want to cut short his discussion with Jessica and Melissa.
Jessica's story about her uncertain financial situation at the residency program in North Carolina grabbed Roe's attention in a way my previous discussions with him could not, in part, because Christ Community Health Services in Memphis is one of more than a dozen residencies that are expected to start receiving THCGME funds beginning in the 2014-15 academic year.
As a nontraditional student who made a huge financial sacrifice to become a physician later in life, Melissa's story also sparked his interest immensely. He specifically asked her about her medical school debt and how that influenced her and other classmates in their specialty choice.
Roe also took notice when Melissa addressed another of our advocacy points -- the need to renew and increase commitments to GME, such as through Title VII funding, and to consider how we can increase the number of students choosing primary care specialties.
As he prepared to walk to the Capitol, Roe asked Melissa and Jessica whether they would come back to his office after he returned from the vote because he wanted to talk more with them.
After we finished talking with Roe, I left for a media interview and then headed out of town for the Minnesota AFP meeting. By this point, Melissa and Jessica were seasoned advocates, and I knew our messages were in good hands and would be heard in powerful ways. They went on the next visit on their own and later went back to Roe's office.
The three of us texted about the overall experience later, and we made plans to improve how we present the need for advocacy to students and our residents. In fact, Melissa is meeting with the Quillen Family Medicine Interest Group this week to talk about how to prepare for the Academy's resident/student conference scheduled for Aug. 7-9 in Kansas City, Mo. That is the "pay it forward" concept in action.
So, what can you do to pay it forward? In addition to the scholarship opportunities mentioned above, the Association of Family Medicine Residency Directors sponsors 10 scholarships for residents to attend FMCC. But we could do more. Family medicine residencies, departments of family medicine, state chapters and even individual practices can help send students and residents to FMCC. Exposing students and residents to advocacy, a critical part of how we can improve the care of our patients, can pay huge dividends for those FPs-in-training and for our specialty.
Reid Blackwelder, M.D., is president of the AAFP.
Dr. Jason Moore and Dr. Reid Blackwelder took two of the top honors at the 2014 Caduceus Club Awards banquet on April 25th.
Dr. Moore was selected as Outstanding Attending in Family Medicine. Dr. Blackwelder was awarded Mentor of the Year.
Outstanding Residents awarded were Dr. Shyam Odeti, PGY 3, Johnson City Residency Program, and Dr. Travis Groth, PGY 3, Kingsport Residency Program
Several faculty, residents and staff were nominated for categories such as outstanding attending, outstanding resident, outstanding staff and mentor of the year. The event, held at the Carnegie, is student led and organized. Quillen students in all classes select the nominees and winners in all categories.
Family Medicine Caduceus Nominees:
Outstanding Resident (nominees) –
Bristol Residency Program -- Drs. Andrew Becker, Ricky Bhimani, Brian Daniels, Barnabas Hines, Bob Schwendeman, Jennifer Smithers
Johnson City Residency Program -- Dr. Chenna Kummathi
Kingsport Residency Program – Drs. Travis Groth, Brandon Lancaster, Isaac Miller , Rodolphe Taby.
Outstanding Attending (nominees)–
Bristol – Drs. John Culp, , Jim Shine and Tom Townsend. Jason Moore
Kingsport - Drs. Reid Blackwelder, Peter Bockhorst, Mark Brummel, Mark Dalle-Ave, Beth Fox, Paige Gilbert-Green, Erin Harris
M1 Professor of the Year (nominee)– Dr. Jason Moore
Subspecialties Outstanding Attending (nominee) – Dr. Jason Moore
Mentor of the Year (nominees) – Drs. Joe Florence and Jose Velasco, Reid Blackwelder
M1/M2 Staff of the Year (nominees)– Connie Clyburn, Carolyn Sliger
M3/M4 Staff of the Year (nominee) – Connie Clyburn
Clerkship of the Year (nominee) - Family Medicine
April, 28, 2014
A group of ETSU folks visited Mt. City TN. Dr. Wilsie Bishop, Vice President of operations, Dr. Robert T. Means, Dean College of Medicine, Dr. Wendy Nehring, Dean College of Nursing met with several second and third year medical students to see what their projects were in the community and how they have benefitted from being in a rural community and giving back.
Several Johnson County residents and dignitaries were invited and showed their support for the students being in the community. A suture workshop followed.
Wednesday, April 23
The graduating class of 2014 Rural Primary Care Track students were recognized and congratulated on a job well done over the past 4 years in medical school. We gathered at the home of Kaye and Joe Florence. Words of encouragement were given by Dr. Joe Florence, Dean Robert Means, Carolyn Sliger and Connie Clyburn. Fourteen students will be graduating May 9th in the RPCT program and we wish them luck with their residency's and future careers.
The AOA residency program, which is integrated within the three family medicine residencies, was well represented at the 2014 American College of Osteopathic Family Physicians Convention in March. Dr. Joann D'Aprile-Lubrano, the AOA Program Director, joined five residents in attending this national event held in Philadelphia.
Dr. Heather Carter, a third year resident at the Bristol Residency Program, presented a poster titled "The Health of Healthcare." She along with fellow Bristol residents Drs. Brian Daniels and Robert "Bob" Schwendeman, plus Johnson City resident Dr. Elizabeth Saylor Lucas and Kingsport resident Dr. Travis Groth, learned new Osteopathic Manipulative Therapy techniques.
Before the convention, Drs. Carter and Daniels each completed and passed the Practical OMT Exam necessary for obtaining certification by the American Osteopathic Board of Family Physicians.
If you consider yourself as healthy as the proverbial horse, you should still get a yearly check up. But with all the different kinds of doctors, which one should you see? Dr. Leigh Johnson, from Quillen College of Medicine, is here to help us make that decision.
Years of hard work, and a lot of studying, paid off for dozens of graduating medical students across the county.
Learned the use of fire extinguishers and work place safety. The presenter set a test fire and everyone had to extinguish the fire using fire extinguishers, also we all learned how to properly pull the pins and aim to get the best results in putting out fires.
Dr. Fox putting out fires for fire safety in Kingsport
March 25th, 2014 10:37 pm by Max Hrenda
Tennessee High School sophomore Victoria Good listens for simulated breathing in the Human Patient Simulation Laboratory during ETSU's Health Careers Leadership Summit Tuesday evening.
This week, area high school students were offered a chance to learn the mechanics — sometimes literally — of how a medical school class operates.
On Tuesday evening, a select group of 40 students from regional high schools participated in East Tennessee State University's Health Careers Leadership Summit at the Academic Health Sciences Center of the Quillen College of Medicine.
please click the title to see the full article.
Gold Humanism Honor Society
Quillen College of Medicine Chapter
We are pleased to inform you that Dr. Travis Groth was recently elected into the Gold Humanism Honor Society. The Gold Humanism Honor Society (GHHS) honors senior medical students, resident physicians, and faculty for demonstrated excellence in clinical care, leadership, compassion and dedication to service. Election to membership in the GHHS is a significant honor.
Each year, resident physicians chosen to receive the Gold Foundation Humanism and Excellence in Teaching Award are inducted into the GHHS chapter at QCOM. Third and fourth-year medical students select six residents for the Humanism and Excellence in Teaching Award based on their commitment to teaching and compassionate treatment of patients and families, students, and colleagues.
We are proud to have physicians of Dr. Groth's caliber at ETSU. Congratulations on attracting highly qualified and humanistic physicians into your residency program.
For This State Chapter, It Truly Is a 'Family Affair'
One of the characteristics that truly defines family physicians is that we recognize everything is about relationships. We certainly understand this when to come to our patients.
I worked with a medical student recently, and she was impressed by how much I knew about patients I hadn't seen for months. I told her that it's because we family physicians know our patients, and we value their stories. This is how we help take care of folks and how we put everything into context. It's one of the things that make family physicians special.
We walk our talk in so many other ways, too. This relationship aspect is something I see regularly, and thoroughly enjoy, as I travel around the country and talk with Academy members. One of my responsibilities -- it's an opportunity, really -- as AAFP president is to attend state chapter meetings. Often, I am there to install new officers, provide educational opportunities and update members on what the AAFP is doing for them.
But I think what I am really doing is reinforcing the power of relationships. The connections I am making are phenomenal. Many of the physicians I see at chapter meetings are people I have met at other meetings because we often travel the same paths. However, each state chapter also has physicians who are not involved at the national level. These are the dedicated family physicians on the front lines who are often coming together for their own networking and education.
Behind all of this activity are the chapter executives who do outstanding work for their members. These are truly compassionate and remarkable individuals who help each chapter be the best version of what it can be.
I recently traveled to South Lake Tahoe, Nev., for the Nevada AFP's annual meeting. I was invited to the chapter's meeting last year, but I had to cut that trip short to make an unplanned, but very important, other meeting. I was thrilled that the Nevada AFP asked me and my wife, Alex, to come again this year. We were eager to get the full experience this time.
What was remarkable is that you would never know that this actually is a small chapter. A large number of people attended the very well-put-together CME sessions in a beautiful location. However, what was most powerful to me was how much of a family affair this event was. The moment I arrived, executive director Brooke Wong welcomed me into her bustling command center.
Brooke is a staff of one, but her family provided plenty of help to make the meeting run smoothly. Her young daughters helped with a silent auction. Her husband, Conrad, provided IT support and took photographs. He was everywhere, making sure that the CME came off without a hitch and documenting all of the events.
At registration, Brooke's mother and father greeted people with a smile, offered chocolate and signed attendees up for all of the various events.
As soon as we walked in, we were part of the Nevada AFP family. There is truly no better example of the power of relationships than what occurs at these chapter meetings.
Thanks to all of the chapters I've had a chance to visit, and I look forward to those coming up. It is an incredible opportunity, and I value being a part of each of your families.
Reid Blackwelder, M.D., is president of the AAFP.
First year medical students Pooja Jagadish, Brandon Seaver, Gorcia Svalina and Greg Wykoff talked to Daniel Boone High School Medical Therapeutics class under the instruction of Crystal Fink. The students brought organs from the medical school discussing each organ, its use, placement and how to take care of our bodies through good nutrition and exercise. The medical students provided power point presentations to cover the subject for the high school students.
March 11, 2014
Logan Williams, Quillen College of medicine, second year medical student, presented his research on Prescription Drug Abuse at the Primary Care and Prevention Research Day held at the Millennium Friday February 21st. Rebekah Rollston and Caryn Brehm both second year medical students, also helped with the research and were in attendance to support Logan who did a great job on his presentation.
Friday Feb 21, 2014 Main article
Building the Family Medicine Pipeline
When I was running for AAFP President-elect, I said during a question-and-answer session at the Congress of Delegates that I would try to say yes to every opportunity that came my way. This can be daunting because there are so many opportunities to represent the Academy each week.
However, being president truly is a once-in-a-lifetime experience, and I have tried hard to follow through on my promise. I do everything I can to jump at invitations from state chapters, to medical student functions and other opportunities to meet with AAFP members all over the map.
Family Medicine Interest Group advisers discuss ways to increase student interest in our specialty during a recent meeting in Nashville, Tenn.
I recently had one such opportunity on my way back from the Nevada AFP meeting. I was invited to stop in Nashville, Tenn., to be a part of a dynamic workshop for Family Medicine Interest Groups (FMIG) faculty advisers. This leadership summit was an opportunity to bring together medical school and residency faculty and staff from all over the country who serve in adviser or support roles to the student-run FMIGs at their own or an affiliated medical school. One of the most important reasons for doing so is to develop relationships and create a sense of family in this group.
There is a significant turnover in this group because the role of student group adviser often falls to the newest faculty member in a department. In fact, many of the folks present had been involved with their FMIG's for less than a year. This makes it important for us to bring people together so we have an exchange of information as well as support systems for this incredibly important work.
FMIG's are remarkable. There is a great deal of direct student leadership involved for each medical school's group, with a select group of medical students elected or appointed to serve in roles to connect and coordinate between FMIGs. The AAFP recently selected its 2014 FMIG Network Regional Coordinators, who hail from Arizona, Illinois, Missouri, Pennsylvania, and Washington, D.C. These dedicated students work tirelessly to share information with FMIG student leaders at each institution and to provide opportunities for those leaders to connect and share best practices, much like what was done at the FMIG Faculty Adviser Summit.
The advisers all play different roles in this process, depending on their institution, environment and engagement of leaders. They have the responsibility for finding ways of sharing the excitement and passion for family medicine with students during their first two years of medical school, through the FMIG and other department efforts.
Most FMIG's are mainly made up of, and led by, first- and second-year students. Third-year students are on their clinical rotations and have less free time, and fourth-year students have often already committed to specialties. The group of advisers focused some of its discussion on how to keep third- and fourth-year students engaged in FMIGs to help support a family medicine specialty choice among the third-years and to use the fourth-years as mentors for the junior students.
This is a huge and critical aspect of addressing our pipeline challenge. The more we can tell medical students about the joys of family medicine, the more we may maintain their interest as they begin choosing specialties. In these challenging times, the message that our country truly needs primary care physicians is one that medical students need to hear, alongside the message of what's in it for them, which is the opportunity to have the greatest impact on population health and a specialty that provides variety, excitement and deep patient relationships.
This meeting allowed us to discuss the frustrations and the opportunities of a rapidly changing health care system and environment. I promised to take what I heard from the advisers back to the AAFP Board of Directors to help inform our deliberations related to developing our workforce pipeline.
I hope all of our active members work with medical students when given the opportunity. When students are early in their training, they are eager to see true patient encounters. At the same time, we have to recognize how impressionable students are. We need to make sure that our love of our patients and our thankfulness for the opportunities to answer our calling is what comes through. The more we do this, the more students will see that no other specialty creates the opportunities to get to know patients, make a difference and to truly impact families the way family medicine can.
Active AAFP members who would like to be connected with an FMIG faculty adviser at a medical school in their area may contact student interest strategist Ashley Bentley. Thanks for being a part of the learning process.
Reid Blackwelder, M.D., is President of the AAFP .
Faculty, staff and students representing Quillen College of Medicine and the Department of Family Medicine attended a reception Feb. 18 to honor Dr. Reid Blackwelder on his recent election as President of the American Academy of Family Physicians (AAFP).
More than 100 well-wishers greeted Dr. Blackwelder at the event held in Stanton- Gerber Hall on the VA Campus. Dr. Wilsie Bishop, ETSU Vice President for Health Affairs and Chief Operating Officer, offered comments about Dr. Blackwelder's achievements and contributions to the University. Dr. Ken Olive, Interim Dean of Medicine and Dr. John Franko, Chair, Family Medicine also spoke at the event. Rounding out the program, Dr. Blackwelder thanked the group, and recognized his wife, Alex, for her support throughout his career achievements.
Dr. Blackwelder is a Family Medicine physician at ETSU Family Physicians of Kingsport and serves as Director of Medical Student Education for the Department of Family Medicine. He received his M.D. degree from Emory University School of Medicine and completed his residency and a teaching fellowship at the Medical College of Georgia.
The AAFP represents over 110,600 physicians, residents and medical students. It is one of the largest medical organizations in the country. Learn more at http://www.aafp.org/home.html
Feb/ 17/ 2014
ETSU Family Physicians of Bristol and ETSU Family Medicine Associates in Johnson City are open Mondays until 6:30 p.m.
ETSU Family Physicians of Kingsport is open Thursdays until 6:30 p.m. Please call for an appointment.
Thursday Feb 06, 2014 Main article
I recently attended a meeting of the Family Medicine Working Party, which is a convocation of the seven organizations that represent our specialty.
These groups are led by outstanding family physician volunteer leaders, and these biannual meetings allow these leaders to ensure each organization is aware of what the others are doing. Often, a focus area for one group affects the other groups as well. Even if our initiatives don't directly overlap, it is important to hear updates about what is happening.
It also is a great opportunity to talk about some of the remarkable things that we see in family medicine. I was particularly inspired by a story from James Puffer, M.D., the president and CEO of the American Board of Family Medicine (ABFM). One topic that we routinely review with the ABFM is the process of maintenance of certification, and the exam all diplomates are required to take. This conversation allowed us to review the commitment to lifelong learning that has exemplified family medicine.
It is important to recognize that when family medicine began as a specialty, we were the first and only specialty that challenged our members to continue to recertify. Other medical specialty organizations had lifelong certifications in place that allowed a physician to take one exam, one time. Our specialty's founding fathers knew that lifelong learning was a critical aspect, and that certifying only one time would not guarantee that a physician was at the top of his or her game throughout his or her career. We now have data showing that recertification maintains a knowledge base over time, whereas taking a single exam one time allows a person's knowledge base to decline.
However, the inspirational part of this story has to do with a group of family physicians who continue to recertify well into their 80s and even 90s. In fact, the oldest family physician who recently sat for the recertification exam was 93. Puffer personally calls all of these physicians to let them know their scores and to ask an important question. He was especially pleased to call the 93-year-old physician to inform him that he had indeed passed. Puffer asked the man if he was still practicing. The family physician replied that he had not practiced for many years. So, Puffer asked why he was recertifying. This member said that he could not imagine letting his certification lapse. He has always been board-certified, he said, and he always would be.
I think this comment is a testament to something unique about family physicians. This is a dedication to true lifelong learning. This member is going to continue to challenge himself to learn more about his craft even though he is no longer practicing. It also speaks to the pride and work ethic of this member that I think exemplifies family physicians. We recognize that board certification means something. We recognize that in family medicine, we have made a commitment to continue to challenge ourselves to be the best that we can be in order to give the best possible care to our patients.
This kind of story challenges me to continue to do everything I can to help our organization be the best that it can be so it can serve members like this extraordinary family physician in the way they deserve. I hope that I, too, am continuing to recertify until it is time for me to go to my next great adventure.
Reid Blackwelder, M.D., is president of the AAFP.
Several members of our Family Medicine Department recently attended the 40th conference of the Society of Teachers of Family Medicine (STFM), January 30 – February 2, 2014, in Nashville.
Faculty members, Beth Fox, MD, Kingsport Program Director, and Ivy Click, EdD, presented at the meeting.
Dr. Fox presented the Symposia: Utilizing Simulation to Prepare the Next Generation of Physicians and Health Care Providers
Dr. Click presented the Peer Paper, Completed Project: Practice Predictors of Graduates of a College of Medicine with a Rural Primary Care Mission.
Dr. Reid Blackwelder, AAFP (American Academy of Family Physicians) President and Medical Student Education Director for ETSU Family Medicine, connected with educators from around the country at the conference welcome reception. The duties of his new role keep him traveling nationally to help promote the cause of Family Medicine in all arenas. He also worked with Dr. Click on the project she presented on behalf of their team.
Connie Clyburn, Family Medicine Education Coordinator and Carolyn Sliger, MSEH, Rural Programs Coordinator attended a new coordinators track of sessions that was launched at the STFM Conference. Connie and Carolyn had the opportunity to network with more than 77 other student education coordinators from medical schools across the country, which is the largest group of its kind to attend STFM. A wealth of information, tips and ideas were shared among the members and they plan to continue connecting through email and social networking.
STFM was founded in 1967, with 105 members, and has grown to nearly 5,000 teachers of Family Medicine. Among the members are medical school faculty, preceptors, residency program faculty, residency program directors and many others who are involved in and committed to Family Medicine education.
The implementation of benchmarking local healthcare-associated infections have brought into light the high price patients pay when there is lack of knowledge, understaffing, and nurse burnout is found in a facility. According to the Centers for Disease Control and Prevention, "approximately 1.7 million hospitalized patients annually acquire infections while being treated for other conditions, and more than 98,000 of these patients (or 1 in 17) will die as a result of the acquired infection" (Cimiotti, Aiken, Sloane, & Wu, 2012, p. 486).
Healthcare facilities are being monitored with "standardized data on healthcare-associated infection (HAI), which can be used not only to track internal performance but also to compare local data to national and international benchmarks" (El-Saed, BALKHY, & Weber, 2013, p. 323). Years of research and maintaining accurate records have implicated central lines, foley catheters and clinical practice leading to hospital acquired infections when hospitalized for other reasons (Cimiotti, Aiken, Sloane, & Wu, 2012). Nurses seem to be the target "although little evidence is available to explain this association" (Cimiotti, Aiken, Sloane, & Wu, 2012, p. 486), nurses are now being monitored with stricter charting rules, patient care sepsis tools, and classes for central line care which need to be checked off by staffing supervisors before a nurse may perform central line care on the floor. Any floor with a dialysis patient must contact our floor for a certified dialysis central line trained nurse to obtain access. The World Health Organization (WHO) list "poor knowledge and lack of basic infection control measures" ("WHO," n.d., para. 14) as well as "understaffing" ("WHO," n.d., para. 14) on their Fact Sheet list for reasons. The implementation of these stricter guidelines throughout our hospital have aided in decreasing hospital-acquired infections of central lines hospital wide.
The dialysis floor I work on implemented the CLABSI and CAUTI check off sheets to assist in the prevention of sepsis and dual invasive procedures from having to remove infected or clotted central lines and replace in a different location for dialysis and antibiotic treatments. This process prolongs hospital stay, increases frustration, and leads to placing the patient at risk for another infection. Over the last four years our rates of infection have dropped 22% to our dialysis unit. Strict guidelines and classes are mandatory in implementing cap care, tube changing, and dressing changes. The Dialysis supervisor will conduct classes and one by one check off individuals who are to be qualified with extending care to these patients. Personal research has shown that when time is given for training and then proper care implemented the risk of infection has decreased. Those who do not qualify and LPN's are to leave the central line care to the nurses who are certified. The implementation of these guidelines have not only increased patient care but also assisted with hospital benchmark compliance.
The issue of nurse burnout has risen in our facility due to understaffing. The workload hence doubles for the nurse during the filled capacity times with the total care patient. Bathing, linen changes, oral care, assistive feeding, and ambulation fall to the nurses to maintain. The workload of answering call lights on our floor is a demanding routine, as I am sure that is the case in each facility, due to incontinence, bathroom assistance, and family related issues has the nurse working quickly and at times washing hands can be forgotten in a hurry to reach another patient in need. According to Cimiotti and associates, "urinary tract infections are the most common health care-associated infection, and some previous studies have linked these infections to nursing care" (2012, p. 487). Burnout can occur for anyone under such demanding workloads leading to unintentional mistakes.
With more research, funding, and placement of advanced nurse practitioners assisting with patient care these issues will hopefully ease the workload by placing less acute care patients with outpatient assistance allowing for the in-patient hospital loads to decrease; hence decrease nurse burnout and the spread of hospital acquired infections. Healthcare cost to patients and insurance companies will decrease and patient centered care will be valued even more by the patients and their families.
Katherine Astaneh is a MSN student and a practicing BSN
Editor's note: During the AAFP's Scientific Assembly in San Diego, a panel discussion on practice transformation generated far more questions than the panelists could answer in the time allotted. This is the second post in an occasional series that will attempt to address the issues members raised -- including the valuation of care management fees -- during the panel.
The AAFP has been advocating for years that a designated care management fee should be paid on a per-member, per-month basis as part of a blended payment model that also includes enhanced fee-for-service and performance-based incentives.
Family physicians always have done what is needed to care for our patients. We answer phone calls and e-mails, review and compile information from subspecialists, coordinate care transfers in referrals and in the hospital, handle prior authorizations, and ensure so many more aspects of making sure our patients get the care they need are covered. Although all these factors are critical for good patient outcomes, none of them generate payment for family physicians doing this important work.
The AAFP is pushing for payers to recognize the value inherent in care management services. Although we are seeing progress in this area, our efforts are complicated because of the amount of confusion -- and disagreement -- regarding what care management services should include and what they are worth. The Academy is working to define patient care management so that these services can be understood and valued appropriately.
For example, the AAFP's Robert Graham Center for Policy Studies in Family Medicine and Primary Care has conducted a literature review that considered more than 600 studies that offered evaluations of care management fees and reimbursement in care management and/or care coordination. Sixty-one articles were deemed relevant for inclusion in the review.
The range of fees found in that review was striking, with a low of 60 cents per beneficiary per month in one demonstration to a high of $444 per beneficiary per month in a congestive heart failure program. Some payers are offering $2 to $4 per beneficiary per month. Obviously, these low numbers are unacceptable.
Some disagreement exists as to what dollar amount per beneficiary per month would be most appropriate to properly value the work required to provide high quality care, but we are working on a process to help make these critical decisions.
The Graham Center's work will be used as the basis for a concise document that defines what the AAFP considers to be the essential elements of care management fees. That document will be vetted in February during a meeting of the Academy's Commission on Quality and Practice.
The next step will be for the health care advisory firm Avalere Health LLC -- which has been working with the Academy on payment issues since 2012 -- to value the AAFP's definition of a care management fee. That valuation, the definition and the underlying literature review then will be used to create a policy document on the valuation of care management fees. That document is expected to be presented to AAFP Board of Directors later this year.
When the work is done, we'll have one seamless document we can take to payers -- both public and private -- and say, "Here is what we do for our patients. This is what care management means. It should be valued and paid for, and this is a reasonable care management fee."
The document also will be used to help AAFP members evaluate contracts that include care management fees.
We'll keep you updated on our progress.
Reid Blackwelder, M.D., is President of the AAFP.
Happy New Year! This really should be a good new year.
Of course, there are always challenges. However, things are moving in some outstanding directions for family medicine. It is exciting that people around the country -- the media, policymakers and others -- are continuing to talk about primary care. What is even more exciting is that it seems the understanding of what primary care is and who provides it continues to become more focused. Moreover, seeing family physicians as the foundation of primary care in our health care system is a discussion that is really ramping up now, and it's long overdue.
It may seem hard to believe, but the sustainable growth rate (SGR) formula may finally be repealed this year! As the calendar year changes, support for the current bicameral and bipartisan effort to repeal the fatally flawed SGR remains strong.
This effort is critically important in and of itself. However, it also has been a huge roadblock for discussions about many other issues that are essential to continuing to transform our health care system. Other needed reforms related to things such as payment, graduate medical education and workforce have in many ways been delayed or derailed because so much time and energy has been needed to deal with the SGR.
I am encouraged, and excited, by the possibility of being able to carry our other important messages forward knowing that we can have some meaningful conversations about them on Capitol Hill.
We continue to see increasing interest from medical students in family medicine. We are seeing an increase in applications from U.S.seniors at my medical school, and many of my peers have reported similar trends. It looks to be a strong class.
Now, we need to have the important discussions about continuing to find ways of changing medical school education to emphasize family medicine and better address the social mission that should be a determining factor in a graduate's specialty choice.
We also need to address the problem posed by the combination of increasing number of U.S.medical school graduates and the cap on the number of residency spots that are supported by Medicare. We will continue to move efforts forward to not only increase the cap, but to push for the majority of the new positions to be in true primary care, especially family medicine.
And, I am pleased that payment reform is moving forward. It is certainly not happening quickly enough, and the issues of the salary gap, overvaluation of some procedures, and the inherent difficulties of the fee-for-service system still exist. However, CMS has signaled its recognition of the valuable services we provide in coordinating our patients' care bycreating new care management codes that allow us to get paid for things that we have always done and will always do.
Moreover, we have data from researchers at the University of Texas Health Science Center at San Antonio that demonstrate the increasing complexity of the kind of care we provide. These data, which we are providing to CMS, will help show this difference objectively and drive home the need for further payment reform that better values the care we family pysicians provide for our patients. As more and more of our patients have multiple medical conditions, the case we make is increasingly critical.
Our unique and comprehensive education and experience is becoming better recognized and appreciated. A recent patient survey has made it clear that patients value and appreciate us. They want to see their family physician for their health care needs, and they want that family physician to be the leader of their health care team. This validates what we have been saying for more than 10 years. The patient-centered medical home (PCMH) succeeds in meeting the quadruple aim: improving patient outcomes, improving patient satisfaction, improving physician satisfaction, and doing so at lower costs. A core contributor to the success of the PCMH is the role of physician-led teams.
In short, the messages that we have been giving for years finally are being heard and understood. There always will be challenges, but those also can be opportunities.
Thank you for all you do, including your dedication to our patients, our communities, our profession and our country. Your efforts have helped get family medicine to where it is and where it will be. It is an honor to serve with you. I look forward to an exciting new year as we continue to move health care transformation forward in our country.
As the way we deliver care to our patients evolves, I'm eager to further define who we are and where we are going as a specialty. Pleasefollow me on Twitter to see where I think family medicine is going, and use the hashtag #WhereFMisGoing to join the conversation with our colleagues.
Reid Blackwelder, M.D., is President of the AAFP.