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What's
in
the
Cards?
by
Jonathan
Nelson
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Would
you
like
to
have
your
future
told?
What
about
the
future
of
your
medical
specialty?
Here’s
a
better
question
–
how
would
you
like
to
help
shape
the
future
of
your
medical
specialty?
Get
ready,
because
the
time
for
change
is
at
hand.
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On
March
30,
Annals
of
Family
Medicine
published
the
recommendations
of
the
Future
of
Family
Medicine
Project,
an
exhaustive
two-year
examination
of
the
specialty
of
family
medicine
and
its
relation
to
the
U.S.
health
care
system.
The
32-page
journal
supplement
and
the
five
accompanying
task
force
reports
represent
the
culmination
of
efforts
by
the
Family
Practice
Working
Party
and
the
Academic
Family
Medicine
Organizations.
These
organizations
include
AAFP,
AAFP
Foundation,
American
Board
of
Family
Practice,
Association
of
Departments
of
Family
Medicine,
Association
of
Family
Practice
Residency
Directors,
North
American
Primary
Care
Research
Group
and
Society
of
Teachers
of
Family
Medicine.
In
January
2000,
vigorous
discussion
at
a
meeting
of
the
Family
Practice
Working
Party
about
perceived
problems
with
the
direction
and
position
of
the
specialty
set
the
stage
for
the
project’s
genesis
and
within
a
year’s
time,
a
planning
committee
had
been
appointed.
The
charge
given
the
project
was:
“To
develop
a
strategy
to
transform
and
renew
the
specialty
of
family
medicine
to
meet
the
needs
of
patients
in
a
changing
health
care
environment.”
After
months
of
planning,
gathering
data,
polling
focus
groups,
analyzing
research
and
imagining
countless
possibilities,
the
report
is
finally
out.
Of
course,
now
the
real
work
begins.
The
project
recommendations
include
the
creation
of
a
“new
model”
of
clinical
practice
for
family
medicine,
redesigning
the
way
new
family
physicians
are
trained,
developing
a
“basket
of
services”
that
patients
can
expect
to
access
from
family
doctors
and
marketing
the
specialty
so
that
family
medicine
is
understood
by
the
general
public.
Implementing
the
recommendations
will
mean
addressing
problems
the
specialty
faces
in
academic
health
centers.
It
will
mean
encouraging
physicians
to
use
electronic
health
records
in
their
clinics
and
to
offer
their
patients
asynchronous
communication
pathways
like
e-mail
and
voice
mail.
The
transition
will
be
a
long
process
and
it
will
ultimately
require
changes
in
physician
reimbursement
structures
and
other
systemic
relationships
involving
the
entire
health
care
system,
but
the
project
leaders
are
excited
and
eager
to
get
started.
“We
are
moving
forward
with
vision
and
purpose,”
says
TAFP
member
James
C.
Martin,
M.D.,
of
San
Antonio,
chair
of
the
FFM
Project
Leadership
Committee.
“The
FFM
Project
has
provided
the
specialty
with
a
compelling
vision
for
the
future
and
it
is
now
up
to
organizational
leaders
and
practicing
family
physicians
around
the
country
to
take
the
lead
in
transforming
health
care
in
this
country.”
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In
February
of
this
year,
TAFP
got
a
sneak
preview
of
the
project
recommendations
when
Martin
and
several
other
project
leaders
came
to
Austin
for
the
Future
of
Family
Medicine
in
Texas
Conference.
About
70
of
family
medicine’s
leaders
in
Texas
attended
the
two-day
conference
moderated
by
Sarah
Thomas,
AAFP
Director
of
Communications.
The
meeting
was
conceived
by
TAFP
President
F.
David
Schneider,
M.D.
“The
idea
for
this
conference
came
from
a
discussion
I
had
with
[TAFP
Executive
Director]
Jim
White,”
Schneider
says.
“We
sat
down
to
brainstorm
strategic
planning
for
the
TAFP
and
realized
very
quickly
that
we
couldn’t
do
strategic
planning
without
taking
into
account
the
FFM
project
…
This
project
promises
to
significantly
alter
what
we
do
as
family
docs,
but
only
if
we
make
that
happen.”
Martin
kicked
off
the
conference
with
an
overview
of
the
FFM
project
from
its
inception.
He
detailed
the
concerns
that
led
to
the
project’s
creation,
including
frustration
with
the
organization,
financing
and
quality
of
the
U.S.
health
system,
a
lack
of
public
understanding
about
what
family
medicine
is,
and
uncertainties
about
the
specialty’s
education
model.
“Despite
its
30-year
history,
neither
the
general
public
nor
health
care
professionals
understand
all
that
family
medicine
represents,”
Martin
told
the
audience.
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Declining
student
interest
in
family
medicine
was
another
major
concern
the
FFM
project
sought
to
address.
According
to
AAFP,
the
number
of
U.S.
medical
school
graduates
choosing
family
medicine
is
down
almost
50
percent
since
1997.
Fewer
than
10
percent
of
U.S.
medical
graduates
become
family
physicians.
To
begin,
the
FFM
project
leaders
had
to
embark
upon
a
daunting
and
unforgiving
examination
of
their
own
specialty.
Family
medicine
would
have
to
go
under
the
microscope.
The
team
hired
Siegle
and
Gayle,
Inc.,
of
New
York
to
conduct
a
comprehensive
research
campaign,
which
included
focus
groups
of
family
physicians,
patients,
third-party
health
care
payers,
advocacy
groups,
benefits
managers,
Medicare
and
Medicaid
decision
makers,
nurse
practitioners,
medical
residents
and
students.
“Going
in
I
really
had
a
fear
that
as
we
started
the
21st
century
and
with
Internet
and
people’s
knowledge
of
health
care,
they
would
say
the
role
of
the
family
physician
is
done,”
Martin
said.
“Great
job,
doc
on
‘Gunsmoke,’
you
did
what
you
needed
to
do,
but
we
don’t
need
you
any
more.
All
we
need
is
the
Internet
and
the
Yellow
Pages
and
a
list
of
sub-specialists.
What
we
found
out
is
that
people
still
very
much
want
a
personal
physician
and
a
long-term
relationship.”
The
research
findings
are
detailed
in
the
report
and
online
at
www.futurefamilymed.org.
After
the
research
portion
of
the
project
had
been
completed,
Siegle
and
Gayle
representatives
led
the
FFM
team
in
an
analysis
of
the
data,
proposed
strategies
and
laid
out
five
challenges
they
say
face
the
specialty:
-
Generating
understanding
of
family
medicine;
-
Organizing
individuality;
-
Winning
respect
in
academic
circles;
-
Making
family
medicine
an
attractive
career
option;
and
-
Addressing
America’s
obsession
with
science
and
technology.
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The
FFM
team
created
five
task
forces
to
sift
through
the
data
and
address
different
aspects
of
the
conundrum.
Attendees
at
the
FFM
in
Texas
meeting
heard
presentations
from
each
task
force.
Here
is
a
list
of
the
task
forces
and
their
charges:
Task
Force
1: Identify
the
core
attributes
of
family
practice,
reform
family
practice
to
meet
consumer
expectations,
and
determine
systems
of
care
to
be
delivered
by
family
practice;
Task
Force
2: Determine
the
training
needed
for
family
physicians
to
deliver
core
attributes
and
system
services;
Task
Force
3: Ensure
that
family
physicians
deliver
core
attributes
and
system
services
throughout
their
careers;
Task
Force
4: Determine
strategies
for
communicating
the
role
of
family
physicians
within
medicine
and
health
care,
as
well
as
to
purchasers
and
consumers;
and
Task
Force
5: Determine
family
medicine’s
leadership
role
in
shaping
the
future
health
care
delivery
system.
“As
the
task
force
chairs
came
to
me,
they
said
we
can
complete
the
charges
you
gave
us
and
we
can
make
recommendations,
but
if
we
can’t
change
the
way
family
physicians
are
valued,
we
are
wasting
our
time,”
Martin
told
the
audience.
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Larry
Green,
M.D.,
chair
of
Task
Force
One
and
director
of
the
Robert
Graham
Center,
described
for
attendees
the
“New
Model”
of
care
called
for
by
the
FFM
project.
He
began
by
listing
the
five
core
attributes
of
family
medicine
Siegel
and
Gayle
gleaned
from
discussions
with
family
physicians.
These
are:
-
Deep
understanding
of
the
dynamics
of
the
whole
person;
-
Generative
impact
on
patients’
lives;
-
Talent
for
humanizing
the
health
care
experience;
-
Natural
command
of
complexity;
and
-
Commitment
to
“multi-dimensional
accessibility.”
“The
public
is
hungry
for
these
attributes,”
Green
said,
“as
the
current
health
care
system
becomes
more
fragmented
and
impersonal
and
the
public
is
confused
and
unaware
of
what
family
medicine
is
and
what
it
represents.”
He
said
this
is
the
key
context
for
imagining
the
New
Model
of
practice.
As
Green
described
it,
the
New
Model
is
based
on
the
concept
of
a
personal
medical
home.
It
will
be
patient-centered
rather
than
physician-centered
and
it
will
offer
open
access
to
patients.
The
New
Model
will
offer
a
defined
“basket
of
services”
that
patients
can
anticipate
and
while
some
practices
may
choose
to
augment
the
basket,
Green
doubts
services
will
be
reduced
from
the
standard.
The
New
Model
will
involve
a
multidisciplinary
team
as
the
source
of
care,
and
that
care
will
be
evidence-based
rather
than
experience-based.
Green
said
technology
would
have
to
play
a
major
role
in
the
New
Model.
“The
task
force
thinks
there’s
no
reason
to
start
on
a
new
model
of
practice
unless
you
insist
on
installing
an
electronic
health
record
into
it
as
its
backbone
and
unless
you’re
willing
to
accept
asynchronous
communication
as
an
essential
part
of
practice.”
This
point
led
to
many
questions
later
in
the
evening
as
several
of
the
attendees
shared
concerns
that
such
a
heavy
focus
on
the
implementation
of
EHRs
and
technology
ignored
the
reality
that
these
systems
are
often
too
expensive
for
many
practicing
physicians.
Other
attendees
raised
questions
challenging
the
idea
that
the
New
Model
is
much
different
from
the
status
quo.
But
the
major
question
hanging
over
the
conference
as
the
first
day’s
discussion
ended
was
about
money.
How
would
any
of
the
changes
discussed
so
far
change
the
way
the
U.S.
health
care
system
reimburses
family
physicians?
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Presentations
on
the
second
day
of
the
conference
would
demonstrate
that
this
question
was
a
high
priority
for
the
FFM
project.
Attendees
learned
about
the
project’s
recommendations
regarding
the
marketing
of
family
medicine
to
the
public,
to
health
care
payers
and
to
the
academic
health
centers.
They
heard
some
of
the
ways
residency
programs
might
be
changed
to
support
and
teach
the
New
Model.
Then
they
heard
from
Steve
Spann,
M.D.,
chair
of
the
Department
of
Family
Medicine
at
Baylor
College
of
Medicine
and
the
chair
of
the
newly
appointed
FFM
Task
Force
6,
the
charge
of
which
is
to
explore
economic
models
that
would
sustain
the
New
Model
of
practice.
Spann
asked
the
audience
to
think
about
several
questions
involved
in
the
economic
model
that
are
seminal
to
the
rollout
of
the
FFM
recommendations.
What
is
the
target
median
income
that
family
medicine
would
need
to
attract
medical
students
and
keep
family
doctors
happy?
In
imagining
the
New
Model’s
multidisciplinary
provider
team,
what
is
the
optimal
ratio
of
physicians
to
midlevel
providers,
like
physician
assistants
and
nurse
practitioners?
What
well-reimbursed
procedures
could
family
doctors
perform
that
would
improve
health
care
value?
What
value-added
services
do
physicians
currently
provide
without
reimbursement
that
could
be
billed
in
the
future,
like
e-mail
communications
and
referrals?
What
type
of
business
organization
will
it
take
to
implement
these
changes
—
a
franchise
model?
A
cooperative
model?
“And
finally,”
Spann
asked,
“here’s
where
the
rubber
meets
the
road,
if
such
an
organization
could
provide
the
necessary
products
and
services
in
a
turn-key
fashion,
would
your
practice
subscribe
for
some
monthly
fee
—
probably
a
fixed
percentage
of
your
practice
revenues
—
if
there
was
good
evidence
that
this
would
positively
affect
your
bottom
line?”
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The
attendees
then
broke
into
small
groups
to
consider
ways
TAFP
could
help
with
the
implementation
of
the
FFM
recommendations.
In
two
different
small
group
sessions,
members
generated
numerous
ideas,
scrawled
and
scribbled
across
poster-size
sheets
of
paper
and
hung
on
the
walls
of
the
conference
hall.
By
the
end
of
the
conference,
the
atmosphere
was
heady.
“It’s
been
very
exciting,”
Martin
said.
“You
can
tell
by
the
body
language
and
the
conversations.”
He
said
he
was
glad
that
the
response
was
so
positive,
especially
since
the
conference
was
the
first
time
the
FFM
team
had
exposed
the
project
to
a
group
of
rank-and-file,
practicing
physicians.
As
he
closed
the
conference,
Schneider
told
the
attendees
that
the
conference
had
greatly
exceeded
his
expectations.
Weeks
later,
he
acknowledged
that
the
specialty
has
a
long
way
to
go
to
reach
the
envisioned
future.
“The
group
[of
conference
attendees]
came
up
with
a
lot
of
great
suggestions,
but
it
will
take
work
to
make
those
happen
—
work
from
all
of
us
together,”
he
said.
For
TAFP,
that
work
began
this
March
at
the
Interim
Session
meeting
in
Round
Rock.
As
each
committee
and
commission
met,
they
found
a
list
of
recommendations
from
the
FFM
in
Texas
conference
on
their
agendas.
Members
began
working
through
those
and
finding
ways
to
make
some
of
them
happen.
Some
of
the
first
actions
TAFP
will
take
involve
identifying
ongoing
efforts
that
align
with
the
FFM
recommendations
and
coordinating
those
efforts.
For
example,
TAFP’s
Commission
on
Academic
Affairs
intends
to
gather
information
on
projects
at
medical
schools
and
residency
programs
around
the
state
designed
to
increase
the
number
of
medical
students
entering
family
medicine.
The
Commission
on
Membership
and
Member
Services
will
conduct
a
survey
to
better
understand
EHR
utilization
among
TAFP
members.
FFM
initiatives
promise
to
feature
much
more
prominently
at
July’s
TAFP
Annual
Session
and
Scientific
Assembly.
Now
that
the
FFM
report
is
finally
published,
it’s
time
for
family
physicians
across
the
country
to
examine
it
and
decide
if
they
will
buy
into
the
recommendations
or
not.
As
Jim
Martin
said
to
the
attendees
of
the
FFM
in
Texas
conference,
“We
can
make
strong
recommendations,
but
if
we
don’t
implement
them,
then
it’s
been
an
academic
exercise
that
will
become
just
a
footnote
in
history.”
Get
a
copy
of
the
March/April
2004
Supplement
of
Annals
of
Family
Medicine,
or
download
it
from
the
Web
at
www.annfammed.org.
For
more
context,
read
the
task
force
reports,
which
can
also
be
downloaded
from
the
Annals
of
Family
Medicine
Web
site.
And
keep
your
eyes
and
ears
open
for
your
opportunity
to
shape
the
future.
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5
Major
Challenges
Facing
Family
Medicine
Generating
an
understanding
of
family
practice
Despite
its
30-year
history,
neither
the
general
public
nor
health
care
professionals
understand
all
that
family
practice
represents.
Organizing
individuality
There
is
significant
variance
in
practice
scope
from
one
family
physician
to
the
next.
As
a
specialty,
family
medicine
has
deliberately
resisted
specific
definition
from
the
beginning.
Winning
respect
in
academic
circles
Family
medicine
suffers
as
a
result
of
not
having
gained
the
respect
and
resultant
endorsement
of
key
academic
institutions.
Some
medical
schools
feel
that
family
medicine
will
bring
neither
money
nor
recognition
to
the
school;
as
a
result,
they
neither
support
the
specialty
nor
encourage
students
to
pursue
it.
Making
family
medicine
an
attractive
career
option
Issues
requiring
attention
include:
inadequate
remuneration,
little
recognition
in
the
medical
field,
managed
care
challenges,
quality
of
care
yielding
to
pressures
to
increase
the
quantity
of
visits,
and
specialists
thinking
general
internists
are
better
diagnosticians
than
family
physicians.
Addressing
the
obsession
with
science
and
technology
in
the
United
States
Family
medicine
is
associated
with
neither;
some
people
think
family
physicians
are
old-fashioned
and
cannot
handle
more
critical
health
issues.
There
is
a
conspicuous
absence
of
family
medicine
breakthrough
research.
Source:
Task
Force
1.
Report
of
the
Task
Force
on
Patient
Expectations,
Core
Values,
Reintegration,
and
the
New
Model
of
Family
Medicine,
Annals
of
Family
Medicine,
www.annfammed.org,
Vol.
2,
Supplement
1,
March/April
2004 |
|
| |
FUTURE
OF
FAMILY
MEDICINE
ONLINE
Future
of
Family
Medicine
Web
site
www.futurefamilymed.org
Future
of
Family
Medicine
Report
in
Annals
of
Family
Medicine,
Vol.
2,
Supplement
1,
March/April
2004
and
Task
Force
Reports
www.annfammed.org
Preliminary
FFM
Research
Results
in
Family
Practice
Management,
November/December
2003,
“Family
Medicine
Takes
Center
Stage”
www.aafp.org/fpm/20031100/43fami.html |
|
|