Justin V. Bartos, MD
TAFP President

As the newly inducted president of TAFP, I want to reflect on the past and present and share my vision of the future of family medicine as well as the academy.

There has been a great deal of concern expressed from our leadership and others in our specialty about the future of family medicine. The concern is manifest by the number of residency slots failing to fill at match, shrinking reimbursement, and the high level of indebtedness that medical school graduates must overcome. Together these factors, and others, may deter medical students from choosing family medicine.

The counter response is that there are more residencies than ever before and the actual number of people graduating continues to rise. I have more applicants for positions at my clinic than at any time in my 16-year career. 

I have looked over the horizon and I see a healthy specialty with ever-increasing demand for our services. I see new technologies that will expand our capabilities. I see an opportunity to shape the future of our profession.

My Past

I would like to explore the path that leads young men and women to choose family medicine as a specialty by reflecting on my own path. “Mentoring” seems to be a popular buzzword these days in our specialty and in corporate America, but for me the more important term is “role model.” Have you ever heard the rhyme, “What kind of church would my church be if all the members were just like me?”

Young people are disenchanted by indifference, greed and corruption. They seek those that are honorable, conscientious and committed.

In the 1960s in La Grange, Texas, I met my role model. He treated my asthma in the middle of the night. He removed my appendix; he repaired my lacerated heel and my fractured arms. When I was in high school, he organized a small medical explorer scout society, which met infrequently, but did take a trip to Houston, to the Texas Medical Center, to Baylor School of Medicine and St Luke’s Hospital to see Denton Cooley perform heart surgery. Things were never the same. I now had a vision of the future and the path I would follow.

Herb Smith, M.D. inspired me to follow this noble path. In fact, five students at La Grange High School during that time became primary care physicians. I should have realized this was not an ordinary man or physician.

When I attended medical school in Galveston, I was inspired by Paul Young, M.D., chair of the Family Practice Department, who was considered a leading family physician at the time. But the person that became my role model was Barbara Thompson, M.D. She interviewed me, served as my faculty advisor and as my preceptor during my formative years in Galveston. Her dedication to her profession and her patients was unsurpassed and it made a strong impression on me and on my future.

I met many dynamic individuals in Galveston, other specialties looked attractive for a time. However, one program stood out, the Family Practice Residency Program at John Peter Smith Hospital led by Bruce Jacobson, M.D., a physician whose reputation as a provider in the community and a program director preceded him. I never had the opportunity to practice in Northeast Tarrant County when Bruce Jacobson was there, but I still have patients that recall his commitment to serve.

From residency, I followed another great man who was a former residency director and an icon in the Northeast Tarrant County medical community. David Pillow, M.D., first introduced me to the local Tarrant County Academy of Family Physicians. He raised the bar for me to compete. This man still loves his work and his patients with enthusiasm. He’s a tough act to follow.

My journey was complete and it had little to do with loans or technology or even the TAFP. It was driven primarily by the role models I met on my path to family practice and my desire to emulate them.

We must all grasp opportunities to serve as role models for young people in our communities, colleges and medical schools. We can help shape the family physicians of the future. Through our foundation scholarships, we can provide these young people the support they need to reach their goals.

Our Present

Through the evolution of the health care system and the dedication of our predecessors to be comprehensive, caring and cost-effective providers, family physicians have been placed at the focal point of the health care system. Access to care begins with the family physician.

Along with this responsibility, we have endured a stifling amount of oversight and intrusion. The very entities that entrusted us with the task of providing high quality cost-effective care, big business and the health insurance industry, have now become our greatest adversaries.

Physicians may be the greatest problem solvers in the world but we are continually frustrated by policy decisions made by others with less knowledge and less long-term commitment than we possess. We view our role as a life-long commitment. Health plan administrators view their role as business administration.

I often feel as if I am in the center of an enormous vortex and I am sitting with a patient trying to focus on solving their problem. Flying around me are a multitude of issues—contracts, specialty networks, hospital networks, referrals, formularies, reimbursements, co-pays, E & M codes, liability, and the list goes on. This debris frequently strikes me as I attempt to deliver quality care.

It’s amazing that anyone receives more than a cursory or superficial exam with so many other things to worry about. Time and staff involved in administering a visit explodes. Costs to deliver care rises. Satisfaction for patients and physicians declines.

How have we responded to this? Individually we have attempted to rectify the problems by joining groups or IPAs to contract on our behalf, but we have frequently been misled by false promises, unexpected turns in expenditures or unrealistic contracts, which have caused many groups and IPAs to fail.

We have turned to our academy looking for answers. We look to the Legislature and the courts for relief.

I came to the TAFP looking for assistance over 10 years ago. I realized that it was incumbent upon me to become part of the solution to help direct the future of medicine.

Our Future

The first annual session I recall attending was in San Antonio, Texas in 1989. The Tarrant County Chapter was to receive an award for the largest increase in membership. I listened to Jim Martin, M.D., give an address that sounded wiser than his years. He spoke of remembering who we are and why we chose this great profession. He spoke of the importance of our relationships with our patients and remembering how blessed we truly are personally, socially and economically when compared to others in our society.

Jim foresaw the importance of the political process in determining the future of medicine, the importance of the TAFP Political Action Committee and the importance of liaisons with other businesses and associations.

I encourage any of you that have positions in other businesses groups or service organizations to inform the membership staff and to expand your role to become spokesmen and women for the TAFP within these organizations.

This spring I had a chance to listen to a “futurist,” Leland Kaiser, and he said the way to create your own future is to have and state clear intentions.  To see the end before you begin.

In the future, you will see our academy align our political forces with the Texas Medical Association. Our leadership and our legislative department will continue to work closely with the TMA to expand our influence.

We will pursue a coalition of physicians that share common interest in primary care—pediatricians and internal medicine physicians. Their organizational staffs will complement our own.

Together we will face new challenges from old enemies, such as medical professional service taxes, the growing medical malpractice crisis, inadequate funding for graduate medical education, and defending against scope-of-practice expansion by others.

During the next year, you will see a great deal more activity from the PAC as it continues the vital work of electing candidates who are supportive of our practices and our patients’ well being. Having friends in the Texas Legislature and the courts is critical to a successful future. Your support of TAFPPAC is an investment in your patients, your practice and the health of your community. Encourage your families and employees to use their most powerful weapon, their vote, to elect pro-medicine candidates.

The grass roots must join our fight. Through our Key Contacts Program we will forge new relationships with candidates running for office. Each of us, our families, our staffs, and health care workers of all types must step forward to let the public and our elected officials know that their investment in health care has paid off with extended lifespan and improved quality of life, but there is more to do and many still underserved.

Let your elected officials know that collectively the members of the TAFP are one of the largest employers in the state. Let them know that the overwhelming majority of funds paid in professional fees flow directly into salaries and expenses and into local communities.

Lloyd Van Winkle, M.D., immediate past president of TAFP, spoke of a virtual army of physician officers and health care workers dedicated to delivering compassionate care and defending the rights of patients to receive and physicians to deliver appropriate care without constraint. Through a communication network involving e-mail, phones and faxes we can disseminate information and facilitate quick responses on both local and state levels whenever our right to deliver appropriate care or operate our practices is challenged.

I call this the TBM Network, for Take Back Medicine. Included in this group are our families and friends, staff and their families and all members of the health care team. We can demonstrate how putting patients first and business second makes for better medicine for all patients in this state and the country as well. We’ll find ways to get the information to as many we can. Check out page 48 in this quarter’s issue of Texas Family Physician for the first installation of TBM Network News. When it’s time to create a groundswell of support on an issue, we will use the TBM Network to make things happen.

I also expect to see other changes in the health care arena. Patients will become more empowered and demand and assume more control over their health care. The Patients Bill of Rights is just one example. Individuals are pursuing new innovative technologies such as electron beam tomography and virtual colonoscopy. They are spending more on alternative medications and herbal treatments than proprietary medications.

Prepare yourself to deal with a demanding consumer who expects more. Invest in yourselves through advanced education and in your practices to deliver these new technologies and services that will shape the future of medical care.

But do not forget to give. Give to your patients, your employees, your communities and especially to those less fortunate because those that give also receive.

I wish to close with a statement that is part of a personal mission statement I wrote recently that pertains to this organization. Using the talents that God has bestowed on me and the principles of commitment, integrity, passion and compassion, I am committed to furthering my profession and providing the ultimate environment for family physicians to flourish and deliver health care to the people of Texas in the future.

There are three things I hope to impress upon you and all of our colleagues during my term as president: be a role model, become politically active, and expand your capabilities in order to be successful in the future.