Justin V. Bartos, MD, TAFP President

 
In November, I left the front lines for a few days and traveled to Albuquerque, N.M. I wish it was all for pleasure, but I attended a meeting sponsored by the AAFP Commission on Legislation and Governmental Affairs for information and planning on the national front. The trip offered me some time for reflection and invigoration.

The battles at the state legislative level look formidable. The economic downturn will place significant strain on state budgets while legislators must find additional revenue sources to make up for anticipated budget shortfalls. Demand for social services will increase sharply with very little expectation for expanded access or additional funding for state Medicaid programs. Spikes in medical malpractice liability premiums are resurfacing as a major crisis again, and allied health providers and chiropractors keep trying to pass legislation that would grant them the equivalent of a medical degree without the experience of attending medical school and a three-year residency.

I had the chance to reflect on how daunting the practice of medicine has become. Frequently I find myself explaining to patients where I am spending additional time or staff resources on administering their care—dealing with formularies, laboratory hassles, referrals to a specialist, or fighting to have claims paid in a reasonable period of time. Everyone involved in the delivery of health care admits that the time spent on actual patient care has been compromised by these hassles, but everyone also struggles with how to eliminate the bureaucracy. The future appears overwhelming with the new privacy and security regulations of the Health Insurance Portability and Accountability Act bearing down on us.

All is not lost, however. Family physicians from across the state are heeding the call and stepping up to help change the way health care is delivered to ensure our patients get the highest quality of care available.

Role Models

TAFP President-elect, Robert Hogue, M.D., canceled his clinic on Oct. 16 and flew to Austin to testify before the State Board of Pharmacy regarding implementation of Senate Bill 768. In the closing days of the 77th Legislature, the pharmacy association, led by the retail pharmacy chains, added an amendment to SB 768 changing the way brand name and generic medications are prescribed and dispensed in Texas. This was an attempt to give pharmacists further freedom to substitute generic medication.

The amendment eliminated the two-line prescription format we have used successfully the past two decades. As drafted, the proposed rules would have required physicians to write “brand medically necessary” on every prescription for which the physician wished to have the brand-name medication dispensed if a generic was available. Telephonic prescriptions would have required a handwritten statement to follow within 30 days. The proposed rules would have also severely restricted the ability of physicians to transmit prescriptions electronically. These proposed rules directly contradicted one of the solutions proposed as a response to the Institute of Medicine’s Medical Errors report, which is to eliminate all hand-written prescriptions.

Fearing the new law and the proposed rule changes would not protect our patients, Dr. Hogue testified on behalf of the TAFP that the rules would compromise patient care and safety by creating substantial confusion and probable miscommunication between the physician and the pharmacist. He stressed that limiting electronic transmission of prescriptions would not be compatible with current and inevitable technological advances and therefore would increase the possibility of medication errors. Following the hearing, the Texas State Board of Pharmacy agreed to rewrite the proposed rules. Thanks to Robert for his testimony.

Doug Curran, M.D., of Athens, Texas, has made two trips to Austin to represent the TAFP before the Texas Midwifery Board, which recently proposed rules to change and expand midwives’ standards of practice. Dr. Curran testified that the draft rules do not require any physician-midwife interaction, any pediatric support or any obstetric support. The proposed rules eliminate or modify many of the statutory requirements for midwives to refer to a physician when a patient develops a complication during their prenatal care. He told them it is not acceptable to rely on 911 or emergency medical services for backup. He commented that the committee draft rules dramatically and inappropriately expand the definition of a normal pregnancy and fail to delineate indications where treatment by a physician or someone acting under the supervision of a physician, is necessary. Dr. Curran explained that the TAFP will do everything it can to help support the referral process between midwives and physicians when complications arise, and patients must receive appropriate referrals when the outcome of the pregnancy and an infant’s life lie in the brink. Thanks to Doug.

Political activism and another role model

 Linda Siy, M.D., president of the Tarrant County Chapter, organized a seminar for the residents at John Peter Smith Hospital, which focused on the importance of organized medicine and political advocacy. The keynote speaker, Sen. Mike Moncrief of Fort Worth, gave the residents some insight into the rules of the political process. He described the need to develop relationships with elected officials to help drive legislative process, which ultimately creates public policy. Without relationships, very little happens. Other presenters included myself; Tom Banning, TAFP staff; Tom Hancher, M.D., TMA President; the president of the Tarrant County Medical Society, Jim Norman, M.D.; and Robin Sloane, executive director of the Tarrant County Medical Society.

The seminar was the first of its kind and more will be scheduled over the next several months to help educate residents and medical students on the importance of being involved. Thanks to Linda for leading the charge.

Other family physicians like my friend David Lawson, M.D., of Colleyville, Texas, are stepping forward to lead family medicine into the future. Dr. Lawson and his associates learned of the dramatic increase in malpractice insurance premiums when their group renewed their policy recently. They have decided to begin setting up meetings with their elected officials to help them understand the medical malpractice problems we all face.

Expanding your capabilities

When I attended the AAFP Annual Session and Scientific Assembly in Atlanta, the future of family medicine was a hot topic. Discussions focused on trends moving away from managed care in favor of a more patient-oriented model of health care delivery. I heard ideas like:

• open appointments or access;

• a team approach to health care with physician managers;

• access to care through secure Web site messaging or even Internet visits;

• services like ultrasound at the initial point of care;

• family practice physicians performing routine screening colonoscopy;

• new technologies—total body scanning—particularly for the lung, heart, or colon;

• payment structures such as swipe cards; and

• online payment for total primary care needs.

At the AAFP meeting in Atlanta, I witnessed a ballroom overflowing with dedicated, passionate family physicians from across the country debating and working to shape the face of medicine in the future. The Congress of Delegates elected our own Jim Martin, M.D., of San Antonio, Texas, as president-elect. Jim preaches the importance of the political process in the future of medicine and I am excited about a Martin presidency. I am proud of the Texas chapter’s success in supporting such a gifted leader.

The academy also passed a proposal for universal access to basic health care for all U.S. citizens. However, the Congress recognized that there were exceptions to some of the provisions as written. They believe it is a starting point. There will be many other proposals from other interested parties, such as the American Medical Association, the business community and others. This proposal needs further refinement. Please send your comments to AAFP.org.

As the practice of medicine continues to evolve, it is imperative that physicians are directing how health care is delivered. I commend my colleagues for their leadership as they step up to protect patients and defend the practice of family medicine. Together we can make our voices heard and shape America’s health care delivery system. I hope in the coming year, all of our members take up the call and join in the effort to shape the future of family medicine.

Now I’m back on the front line taking care of my patients and fighting the hassles, but I’m still on the campaign to Take Back Medicine.