Celebrate family medicine

And invite the entire country to your party

By Erica Swegler, M.D. TAFP President

Earlier this year, I heard an esteemed colleague say that in the biological world, the health care sector would be called a cancer. This is an appropriate analogy. With all the skepticism, negativism, and cynicism about health care in general, it is refreshing to see evidence emerging in this past year that finally proves what family medicine has alleged all along: family physicians provide higher quality, lower cost care. Unfortunately, had I not been involved with the TAFP and the AAFP, I might not be aware of this evidence. Why not? Family medicine should be broadcasting this positive news in every possible forum to the public and to our fellow family physicians.

In March of 2004, the journal Health Affairs published an article commonly called the “Dartmouth Study” in physician circles. In the study, two Dartmouth economists found that there is an inverse relationship between the number of primary care physicians (general internists and family physicians) and the cost of care to Medicare beneficiaries, and a direct relationship to the quality of medical care. Said differently, the states with the highest number of primary care physicians had the lowest cost of care and the highest quality per Medicare beneficiary while the states with the lowest number of primary care physicians had the highest cost of care per Medicare beneficiary and the lowest quality of care.

In the online edition of Health Affairs for the week of March 14, 2005, researchers from Johns Hopkins School of Public Health and New York University report a study showing that communities with the highest number of family physicians have the highest longevity. A higher ratio of specialists to population does not improve mortality rates. Inappropriate tests and procedures, and inadequate access to affordable care were cited as possible reasons why higher specialist ratio does not correlate with lower mortality. Imagine that! Interestingly, I don’t recall much about these findings in our own family medicine literature, although an article appeared in the Oct. 12, 2004 online issue of Forbes.

The above highlights the need for a public relations campaign marketing our specialty. We are a large part of the solution to the growing cancer of the U.S. health care industry, but the public has to know this and demand it. I am happy to say that TAFP now has a mechanism in place to actively promote family medicine. Our second state-wide initiative will be to coordinate implementation of the TMA Foundation’s program, Hard Hats for Little Heads. During May, which is National Bicycle Safety Month, approximately 30 family medicine clinics across the state will be hosting helmet giveaways where they can present safety information to their communities. To date, the TMA’s program has distributed approximately 9,000 helmets in its 10 years of existence. Through the Academy’s initiative, family physicians can both market themselves and emphasize that family physicians care for infants, children and adolescents, as well as help the TMA Foundation distribute as many as 3,000 helmets in one month. How great is that! A special thanks to all our TAFP members who stepped forward to volunteer their clinics and their time to promote this event. Look for more events along this line, hopefully one or two each year, which will stimulate community awareness of family medicine and its benefits. Let our light shine from the hilltops, not be covered under a basket!

Now on to other topics that are important to the economic survival of family physicians. As this column goes to press, medicine and in particular family medicine, won a victory in getting the Integrated Care Management for Texas Medicaid passed out of the House Appropriations Committee and the Senate Finance Committee instead of the HMO-only model. The war is not yet won, but a major battle has been won.

Regarding potential taxes, the funding issues for education are understandably the paramount issue for this legislative session. The House passed a bill despite our desire to avoid a tax. It has become clear that all businesses will be paying a tax. Thus it was thought best to ask for a reasonable tax credit for Medicaid, Medicare and CHIP care provided by the individual physician. Under this scenario in the House version, anyone doing 15 percent of their gross billing in Medicare, Medicaid or CHIP would find the sting of the tax essentially neutralized. This position is one many of our members and the Primary Care Coalition could support and it was successful on the House side. There remains a lot to do on the Senate side. Look for very important information on these and other issues to come to you in future editions of TAFP’s electronic newsletter, QuickInfo, or by fax. Lastly, thanks again for all you do for your patients and thus the health of the state of Texas. Thanks so much for the opportunity to serve. It is proving to be every bit the wonderful experience I thought it would.