By Dale Ragle, MD
TAFP President, 2014-2015
This will be my final letter to you as TAFP president. It has been an honor and privilege to serve you and our outstanding organization.
This is an exciting and challenging time for family medicine. Health care reform and the sustainable growth rate repeal are expanding the rolls of the insured and will transition us from a volume-based payment system to a quality-based system over the next several years. Some analysts are concerned that increasing the number of insured may strain our health care system in the absence of increasing the physician workforce. While increasing the insurance rolls will generally increase access to care in the younger population, the resultant strain on our health care system could make it more difficult for certain vulnerable populations, such as elderly patients already on Medicare, to access the health system. This effect could be magnified in our state, which has about a 20 percent uninsured rate, unfortunately the highest in the nation.
However, I believe that fragmentation of our health care system contributes to access problems as much as the possibility of not having enough physicians. Fragmentation involves patients seeing multiple physicians and using multiple imaging centers, labs, and hospitals. Not all patients with congestive heart failure need to see a cardiologist; not all patients with COPD need to see a pulmonologist. Not all patients with both conditions need to see both specialists. Specialization and subspecialization has led much of our population to believe “the more specialized, the better.” I’m sure most of us have been asked about a referral to a dermatologist for grade I or II acne. As family physicians we need to be diligent in educating our patients about the breadth and depth of our specialty. This should be done not in a spirit of limiting personal choice, but to show them the benefits of one physician caring for the whole person.
We must remind our patients with multiple comorbidities that they can often be cared for by one competent and well-trained family physician as well as or better than by multiple specialists. We are certainly a more cost-effective option. To do this it is important that we all practice to the full extent of our training. This will become important as we move from a payment system based on volume and procedures to one that rewards quality disease management and population health. There are probably not enough family physicians in Texas to provide this level of care to everyone if all of our state’s uninsured were to suddenly gain coverage. However, I believe that increasing our ranks with just a few more well-trained family physicians who practice to the full extent of their training would go far in relieving the physician shortage.
Because of our reputation of putting the patient first, we are well-respected among most policymakers and payers. As a patient-centered and community-centered specialty, family medicine is in a unique position to step up to the plate and help shepherd our health care system through these changes. The thought of this energizes and excites me. However, for us to be a part of the solution in this way, there must be more of us. We must advocate for more family medicine training to policymakers and create a bigger pipeline of family physicians. If there are not enough of us to meet the needs in the future, patients and access to care will suffer. I encourage each of you to develop a relationship with your state representative, state senator, and congressional representative. Communicate to them the value of family medicine, our patient-centered approach, and remind them of the need to increase our ranks in the future to fulfill the health care needs of our state and nation.
For those of you who are less active in our organization, I encourage you to become more involved. Attend your local chapter meetings. I would also encourage you to attend the annual and interim state meetings. Almost all committees and commissions are open for attendance. If you would like to join a committee or commission, contact TAFP headquarters and our staff can help you gain appointment.
Family medicine is at a crossroads. We must continue to distinguish ourselves with a sustained focus on the welfare of our patients, providing quality evidence-based care, and positioning ourselves to be a part of the solution. If we do this, we have a bright future ahead.