A Champion for Family Medicine

The first indicator of what a patient can expect from North Hills Family Medicine can be found in the framed art that adorns a cream-colored waiting room: each calming print of white houses and pastel flowers hangs slightly askew. Follow the pattern of tilted framed signs through a white door, down a narrow hallway and into the nurses’ station, and it’s easy to spot the cause.

A team of nurses, medical staff and physicians, including TAFP’s 2006 Family Physician of the Year, Erica Swegler, M.D., zips around the office of the fast-paced, fast-growing family medicine practice in Keller, Texas. A patient hears a voice say, “please follow me,” from behind a mountain of files, and is whisked into an exam room.

She has just enough time to glance at posters displaying new medicines, preventive recommendations and organ system diagrams that plaster the walls of the room before Swegler and a staff nurse, Staci Narramore, C.M.A.N.C.T., walk in. Then the fun begins.

With a speed that rivals some auctioneers, Swegler dispenses wellness tip after wellness tip in a slight Chicago accent. She covers everything in a few minutes from current research to upcoming checkups, pausing every few breaths to address any of her patient’s concerns. The patient, Clara Dudley, 87, has seen Swegler for years and expresses that she never feels nervous about discussing her health with the physician like other patients might with their doctors. Today Dudley is with her daughter, Martha Watson, who sits in the room listening with a Ziploc bag of her mother’s prescription medicines in hand.

“She’s so busy, she’s just a white coat flashing around,” says Dudley of Swegler, adding that every moment she spends in the exam room is “quality time.” “She tells you everything you need to know before you go.”

After swirling around the exam room, Swegler sits down and continues to talk to both Watson and Dudley, turning the Ziploc bag over in her hands and making notes on the back of a few of her business cards. When Swegler leaves the exam room, it is noticeably quiet. Narramore laughs, asks Dudley and Watson if they have any more questions and completes the patient education part of the exam. The deluge of information is not uncommon for Swegler and the nursing staff often teases the physician for it.

“Dr. Swegler is a lot of fun,” says Stacy Beaver, site manager at the practice. “We always joke that patients need a tape recorder because she gives them so much information. She’s a wealth of knowledge.”

Swegler’s patients appreciate her broad knowledge of medicine and thorough and thoughtful style of practice. In a nomination letter for Physician of the Year, two of Swegler’s patients, Bob and Betty Straub, wrote, “While the recent trends in medicine have pushed many doctors’ offices to an ‘assembly line’ nature, Dr. Swegler will always take the time to make sure we understand her plan of treatment and will address any concerns we may have.”

It isn’t surprising, then, that the family physician’s reputation around town has increased the demand for her time—Swegler often books routine physicals months in advance—or that she has loyal patients who will sometimes travel an hour or more to see her. Some days, Kimberlie Schissler, M.A.N.C.T., will post signs notifying patients that Swegler is behind schedule, but says “patients know that if she’s running late, she’ll spend the same amount of time with them.” One tilted sign above a large scale reads, “Due to the nature of our practice, we give our patients the utmost in care and service. Please excuse any delay. We will give you the same careful attention as soon as possible.”

For that reason, Swegler’s staff barely sees a dull moment whether the physician is in the office or not. She even added another nurse to the team to keep up with the fast pace and now works closely with two floor nurses and a desk nurse.

“I’ve been a nurse for 18 years and I like the way she takes care of patients: very thorough,” says Rose Bruton, L.V.N. “It makes it busy for us, but she’s always looking for ways to make care better.”

The nursing staff also appreciates Swegler’s expertise and willingness to teach, which they say has allowed them to learn more about nursing.

“All doctors are different, but I have learned more from her than from any other,” says Schissler, who has been with Swegler since May 2006. “I know even more now than I did fresh out of school.”

Beverly Lovell, practice administrator, describes her as “the total package; very warm and caring and reassuring when she gives her diagnosis.” Lovell is also one of Swegler’s patients.

“I normally wouldn’t see one of the physicians in the practice, but I couldn’t pass her up,” Lovell says. “As my physician, she is very thorough. I’m just confident; I know when she evaluates my health, it’s from outcomes studies on medications and other sources. She’ll cite statistics to me and as a manager I appreciate that.”

Originally born in Ohio, Swegler moved to Chicago, Ill., after first grade and lived there until graduating high school with a class of 951. She decided to leave the Midwest and attend the University of Dallas after her parents encouraged her to visit the small liberal arts school, which she describes as a “school for leaders.” Swegler saw the required 66 hours of liberal arts education and the opportunity to spend a semester at the Rome, Italy campus as a way to get a well-rounded education. Liberal arts training “teaches you how to think,” she says.

After her first year in college, Swegler knew she wanted to be a physician, though she had considered pursuing both environmental science and engineering. She was awarded a bachelor’s degree in biochemistry and continued on to the University of Texas Medical School in Houston. During her first interview with the school, she told them that she would be a family physician, though she hadn’t even met one at that point.

“Intrinsically I knew it was right and it was reinforced by the fact that I liked every discipline and couldn’t see myself restricting to one,” Swegler says.

Her decision was further reinforced by a mentor she had during medical school. Swegler asked to be assigned to a female family physician with children and there was only one on staff at UTHSC at the time: Amanda Schnee, M.D.

“Dr. Schnee was a wonderful individual: friendly, very caring, concerned about the whole person—the stereotypical family physician,” Swegler says. “Also, she loved what she did, but was involved with her family.”

Schnee taught Swegler to keep things in perspective regarding the academic medical environment and real-life clinical medicine and to focus on what was ultimately important to her. Schnee’s example as well as family medicine’s basic principles brought these things together for Swegler.

“Family medicine married my love for science, my desire to interact with people and ability to teach—it’s been a true blessing to be able to do it,” she says.

By following a preventive style of medicine with emphasis on quality, what she calls the antithesis of “treat and release” acute medicine, Swegler works with the patient to find the root cause of the problem and develop a treatment plan to avoid future complications.

When she first started, Swegler was the only one of eight family physician/general practitioners in a community of 17,000 people with a preventive focus, not acute. She wanted to incorporate this focus into the nature of her community and future clinics like North Hills and drive expectations to continue that practice. Thomas Diver, P.A.-C., joined North Hills one year after Swegler and recognizes her as the innovator of the office.

“She pushes a lot as far as getting things done and getting equipment in the office which is making the practice more conducive to quality patient care,” he says.

Justin Bartos, M.D., partner at North Hills, agrees with Diver, recognizing that the office would be slower to adopt the new measures without her. He also credits some of her dedication to prevention to her interactions with TAFP.

“Because of her involvement in TAFP, she’s the individual in the clinic who promotes quality and evidence-based medicine into protocols,” he says. “She’s passionate about quality and evidence-based medicine, continually initiating new ideas and instrumental in adapting new quality measures.”

Bartos continues, “She drives a lot of motivation, inspiration and ideas through the Academy and looks to the Academy for standards as well as standard literature.”

Swegler joined TAFP shortly after completing a family medicine residency at the University of Texas Southwestern Medical School in Dallas and after beginning a solo family practice in Denison, Texas.

“Within six months of going into solo practice, I realized that if I wanted to see changes in the system, especially appropriate reimbursement for family medicine and appropriate respect for the specialty, I would need to get involved, have my voice heard and work for the changes I thought were needed,” Swegler says. “In my community [in 1987] family physicians were paid $11.84 by Medicare for a 99213 when an internist was paid $24 for the same office visit.”

Swegler quickly stepped up as a leader of her local chapter at one of the first meetings she attended: when they asked for a volunteer to serve as the Red River Chapter representative to the TAFP Board of Directors, she raised her hand. That year they also needed a chapter president, for which Swegler also volunteered. She held the position for four terms.

Though she sometimes thinks that she may be too involved, Swegler’s husband Paul says that she is a natural leader.

“There was never any question that she would be involved; I always encouraged her,” he says. “We discussed it and talked about the commitment and made sure she knew what she was getting into.”

When she moved to the group practice in Keller, she continued her leadership path at the Tarrant County Chapter, holding the offices of program coordinator, president, and all others in between. In 1998 she moved to the state level and joined the TAFP executive committee, later becoming president for the 2004-2005 term.

“Different physicians use different pathways to round out their practice,” says Bartos. “Her pathway is to immerse herself in the Academy. The Academy serves to recharge us and renew our passion for what we’re doing. It’s reaffirming to see what others are doing.”

She no longer serves on TAFP’s executive committee, but keeps busy by maintaining her membership with several other health care policy groups. She currently serves on the AAFP Commission on Quality, the American Heart Association Medical and Scientific Advisory Committee for Texas and as the TAFP representative to the Texas Department of State Health Services Texas Cardiovascular Quality and Patient Safety Initiative, the Texas Council on Cardiovascular Disease and Stroke, and the Texas Medicare/Trailblazer Carrier Advisory Committee.

“Dr. Swegler is the epitome of the physician’s physician,” wrote a nominator from the Tarrant County Chapter on her Physician of the Year form. “She is a quiet, un-assuming role model for her colleagues. She offers continuity [of] care, yet finds time to assume offices in organized medicine. She is a dynamic voice for quality patient care, and a strong voice for the specialty of family practice.”

Her interest in medical policy, health policy legislation and patients’ rights led her to pursue a Medical Management Certificate from the University of Texas at Dallas School of Management in 1998. Swegler was one of 44 physicians from around the country—and one of only three family physicians—in the inaugural class. The program, for physicians only, gives the students a grasp of the business world and how it pertains to medicine. Swegler said it has helped her as a leader and the understanding of business she gained has been worthwhile to the management of her practice.

“She’s very committed not only to her patients’ health but the health of patients statewide and nationally,” says practice administrator, Lovell.

She helps maintain the health of the Keller community outside of her regular practice by trading in her white coat for a navy polo and matching khaki baseball cap on many Thursday and Friday nights during the fall. While serving as the team physician for the Keller High School football team, she keeps a doctor’s bag filled with basic medical supplies with her on the sideline and watches over the student athletes with Evan Poer, the team’s trainer. In between referee whistles and cheers from the crowd, the two chat about possible health concerns for the athletes and how to prevent any problems. Most of the time the games go without incident, but with the nearest emergency room 25 minutes away, Poer recognizes Swegler’s important role to the team.

“She may just stand and watch the game, but to have her license here and her ability to suture—it’s perfect,” he says.

Swegler has enjoyed football since her championship days as quarterback for the Demons, a college flag football team, so she took the opportunity to serve the community by volunteering to be the team physician. The physician before her had decided to retire his post right around the time that her own kids, daughter Jennifer and son Andrew, were entering high school, and she decided to become involved.

“There is a difference between living and working in a community and just working in it,” said Swegler. “It’s hard to participate in some other community services, but football fits my schedule in the evening.”

With her son Andrew leaving high school soon, Swegler may pass on the post and concentrate on increasing her involvement in AAFP. Swegler says that she sees things moving forward across the board for family medicine, but a continued effort is needed to incite permanent, positive change. One of her mottos, and perhaps what inspires much of her work is, “If not you, who? If not now, when?” With her expertise as a physician, innovator and teacher, Swegler will continue to drive medical policy, preventive medicine and quality-based initiatives forward in the interest of patients and the specialty.

Physician and patient advocates expect that employers and health plans will continue to push their version of transparency, but TAFP President Doug Curran remains optimistic. “If we play our cards right through the transparency process, we’ll come out as a really valuable asset for health care in Texas.”