Step 1: Get to it and through it
By Student Dr. Kendra
Step 1, the rite of passage for every medical student. It seems like torture to get to and go through, but it’s the one thing that can affect the trajectory of your whole career in medicine. It’s a daunting task but it seems like everyone — for the most part — has gotten through it pretty well. The journey to it and through it can be ugly, but hopefully, I can offer you some preparation tips that will successfully get you where you want to be. It can seem overwhelming, but focusing on your schedule and the resources available to you can help get past. I will outline my schedule, the resources I choose, and the review techniques that worked best for me.
A few things to note first:more
How the CCO model would address our nation’s health care crisis
By Jim Rickards, MD, MBA
Back in 2011, the state of Oregon was facing a massive budget deficit, primarily driven by rising Medicaid costs. Medicaid is government-supported health insurance for economically disadvantaged individuals earning up to 138 percent of the federal poverty level. About 25 percent of Oregon’s population, nearly 1 million individuals, are currently enrolled in Medicaid. This is a similar percentage to what is seen nationally. Not only did the deficit substantially impact the state’s overall budget for health care funding, but the potential impact on the lives of many Oregonians also weighed heavy on the medical community.
Typically, when states try to manage deficits related to Medicaid, they employ a combination of three strategies. For one, they will decrease reimbursement rates to hospitals and providers. This does not work very well because, ultimately, clinics will need to limit the number of Medicaid members they see since they are not financially viable, in turn creating access issues for patients. Second, the number and types of covered services can be restricted by the state. In Oregon, we had already employed the Prioritized List of Health Services for more than 20 years, which served as an evidence-based approach to prioritizing and limiting the availability of health care services. Limiting what was already on the list would not have been possible without denying many essential services. Finally, a state can decrease the number of individuals enrolled in Medicaid. This was not an option either, as Oregon was going to be an expansion state under the Affordable Care Act and would see its Medicaid population grow from 600,000 to a little over 1 million members within just a short time.more
The pace of American medical training
By Travis Bias, DO, MPH, DTM&H
In his commencement address at Kenyon College in 2005, the late author David Foster Wallace told the story of two young fish swimming along. They pass an older fish swimming the other way who greets them: “Morning boys. How’s the water?” As they swim on, one of the younger fish responds to the other: “What the hell is water?”
Feeling and appreciating your body of water takes experience, maturity, and occasionally someone else making you aware of your daily surroundings. It was not until a few years into my career as a family medicine physician that I realized the furious pace at which American physicians learn to swim, insulated in a system that operates in stark contrast to that of other countries around the world.more
Addressing Texas’ maternal mortality crisis
Janet Realini, MD, MPH
As is often the case in Texas politics, there was little agreement during the 85th Legislative Session on which steps are necessary to address the state’s many health care challenges. One area that did see agreement, though, was the recognition that far too many mothers in Texas get sick or die during pregnancy or within a year of a pregnancy ending. Unlike the decline of mortality rates internationally, U.S. maternal mortality rates have been increasing, and Texas’ maternal death rate infamously doubled between 2010 and 2012.
Thankfully, the Legislature moved during special session to extend the state’s Maternal Mortality and Morbidity Task Force, which plays an important role in identifying and addressing the core issues contributing to maternal death and severe illness.more
On the shoulders of giants
An excerpt from the inaugural speech of the new TAFP President
By Janet Hurley, MD
Greetings friends, colleagues, staff, and family members. It is my honor to stand before you as our next TAFP President. As I watched Dr. Elliott receive this medallion last year, I thought of all of the leaders in the past who have worn this medallion before us. I am honored to receive the responsibility today, acknowledging that this medallion has been around the necks of many giants along the way before me.
My first TAFP meeting was in the summer of 1997, ironically also here in Galveston. I was a student, wandering lost around the conference hotel. I was impressed to feel so welcomed by the TAFP staff and physician leaders, like Dr. David Schneider, who was among my first Academy mentors.more
Get your guide to restoring the American dream
By Tom Banning
Dave Chase, a friend of mine who was a longtime contributor to Forbes among other magazines, spent the better part of the last three years traveling the country documenting the multitude of failures of our health care system (pricing, contracting, lack of transparency, conflicts of interest), but more importantly identifying simple and tested solutions employers and some local governments have utilized to decrease their total health care spend.
His efforts have culminated in a compelling, must-read book, “The CEO’s Guide to Restoring the American Dream.” We’ve partnered with Dave on several physician–employer community events and in return, he has thoughtfully offered members and friends of TAFP a complimentary digital copy of his book. Below, I’ve provided a link to his TED Talk, “How Health Care Stole the American Dream,” as well as a link you can use to download a copy of “The CEO’s Guide to Restoring the American Dream.”more
What kind of system do we want?
By Tricia Elliott, MD
In his seminal book “The Signal and the Noise,” renowned statistician, Nate Silver, examines the world of prediction, investigating how we can distinguish the truth — the signal— from the noise, which he describes as a universe of ever-increasing information, relatively little of which is useful.
Any candid observer of the now nearly decade-long effort to reform our health care system will readily admit that the health care debate we’ve been engaged in has generated a lot of noise and useless information for political gain. Our elected leaders, on both sides of the aisle, have been busy creating this noise and are now trapped in a political vise of their own making. They’ve sadly left the public with a binary choice of whose health care solution is better, that of the Republicans or the Democrats.more
The 24-hour primary care clinic
A model whose time has come
J. Stefan Walker, MD
Luke Fildes’ portrait “the doctor” epitomizes the primary care physician that our younger selves aspired to become.That kind of doctor-owned practice is now slipping away as quickly as the business model supporting it. Where $300,000 per year is the new benchmark for employed primary care positions, the prospect of starting or joining a private practice only to tread water in a sea of acronyms (MACRA, HIPAA, HMO, ACO, etc.) for margins that barely cover overhead no longer makes sense to most family physicians. No wonder that in 2016, for the first time, less than half of American doctors partly or fully own their practices.
As the care of inpatients became a separate field, primary care was mostly sidelined into a 9 to 5 office job in a role now shared with mid-level practitioners, retail clinics, and telemedicine services. Unlike many other specialists still seeing patients during nights and weekends, primary care is now conspicuously absent in that important space, further putting pressure on family physicians to justify the level of reimbursement that can support independent practices. Now a rarity, small primary care practices — even those now thriving — risk succumbing to this tide of obsolescence, not unlike local department stores and indoor shopping malls.more
TAFP governance profile: Section on Maternity Care and Rural Physicians
By Jean Klewitz
Do you have a specific interest in rural medicine? Want to learn how to face challenges as a rural physician or a maternity care provider? This active section can help you work through those challenges. The integration of full-spectrum maternity care in rural family practices is their focus and they seek to create more opportunities for growth in these remote communities.
The section also works with AAFP’s Rural Health Member Interest Group and AAFP’s Reproductive Health Care Member Interest Group to provide opportunities for rural medicine and maternity care education, training, support, interest, and involvement for physicians, students, and residents.more
Interested in direct primary care? Ask your U.S. representative to sign on to the Primary Care Enhancement Act
By Jonathan Nelson
Direct primary care practices are cropping up across the country as physicians grow more frustrated by administrative burdens inherent in a fee-for-service third-party insurance market. But some regulatory obstacles block many people from joining DPC practices. The Direct Primary Care Coalition — of which TAFP is a steering committee member — has called on physicians to ask their representatives in Washington D.C. to sign on to federal legislation that would remove those obstacles.
In DPC practices, physicians charge patients a monthly, quarterly, or annual fee — like a retainer or membership fee — that covers a broad set of primary care services and patients typically enjoy greatly enhanced access to their physician. IRS rules interpret these DPC payments to be like paying premiums for health insurance rather than just a different way to purchase a set of services. Even though Texas and 17 other states have passed laws defining DPC arrangements to be outside of state insurance regulation, the IRS interpretation bars individuals with health savings accounts paired with high-deductible health plans from using their HSA funds to pay DPC fees.more
And the Family Medicine Interest Group Award winners are…
By Perdita Henry
Congratulations go to the family medicine interest groups at the University of Texas Medical Branch at Galveston, Texas College of Osteopathic Medicine, and the Paul L. Foster School of Medicine for winning the first annual Texas FMIG Program of Excellence Award. Last year TAFP’s Commission on Academic Affairs voted to create the award to celebrate and support FMIGs for their work to inspire medical students to consider the specialty of family medicine.
FMIGs are student-run organizations with faculty and departmental support. They provide a forum in medical schools for students interested in family medicine. FMIG programs across Texas applied for the new award and a subcommittee of the Commission on Academic Affairs reviewed the applications and selected the winning programs. Award winners receive cash prizes to help cover student travel costs to AAFP’s National Conference of Family Medicine Residents and Students.more
Get MACRA ready with QPP Now: AAFP enhances tools to help you avoid negative payment adjustment in 2019
By Jonathan Nelson
Amid the daily deluge of news about efforts to repeal Obamacare and the possible passage of the next iteration of health reform winding its way through Congress, it’s easy to forget the looming deadlines associated with Medicare’s Quality Payment Program. But don’t do it! We’re halfway through the year, which means you have only 6 months left to report at least one quality measure or activity in 2017 to avoid being penalized in 2019.
Your Academy has put together a wealth of resources to help you avoid that penalty and prepare for what’s to come. Bookmark this link in your browser and visit it frequently, as modules are being updated and developed as regulations are modified: http://www.aafp.org/practice-management/payment/macraready.html.more
Searching for balance and walking out the solution
By David Sabgir, MD
It was 11 years invested into medical training wasted. After doing my best for 11 years after college, I found myself totally ineffective at changing my patients’ behavior.
We’d had wonderful heart-to-heart talks. These conversations were real, full of great intention, and essentially worthless. As my patients came back for their six- and 12-month follow-ups, I realized I had not done my job. Their heart disease, which I knew to be 82 percent preventable, was not interrupted. It was a runaway locomotive. They were still sedentary and they hadn’t lost a pound. As a matter of fact, they were up 3 pounds. The weather had been too hot. The weather had been too cold. They knew they had to “get out.” This frustration didn’t repeat itself with one patient or a dozen patients, this was hundreds becoming thousands of patients. I was ineffective despite long, emotional conversations. One day, that was it. I refused to play this charade for what I hope to be a 30-plus-year career of trying to help others.more
Lawmakers have a second chance to face the reality of maternal mortality
By Perdita Henry
In a 2016 study published in the journal Obstetrics & Gynecology, researchers found that from 2011 to 2015, 537 Texas women died while pregnant or within 42 days of delivery, compared to 296 from 2007 to 2010. This doubling of maternal deaths made Texas the most dangerous place to give birth in the developed world. Maternal mortality was on the agenda for the 85th Legislature but many of the bills that would help us understand and identify the dangers facing new and expectant mothers were left to languish. Now with the Texas Legislature set to return on July 18 for a 30-day special session, they have a chance to do the right thing for Texas mothers.
The issue of maternal mortality is a concern all over the country but Texas unfortunately has the distinction of being the worst. In fact, Janet Realini, MD, MPH, president of Healthy Futures of Texas and chair of Texas Women’s Healthcare Coalition, spoke about her concerns during her Member of the Month interview. “Texas women have the highest maternal mortality rate of any state — higher than many third-world countries,” she said. “Preventive care and contraception are incredibly important in addressing this issue in two ways: preventing unplanned pregnancies that can stress women with health issues and serving as an entry to health care for women with health risks.”more
A prescription for community health: The importance of advocacy in medicine
By Lane J. Aiena, MD
As physicians we are tasked with the monumental privilege of helping people as our craft. We train for four years in our undergraduate education, four years in medical school, and an additional three years minimum in residency to be given this trust by our patients. From this education, we gain the ability to help the patient in front of us, but all too often we lose sight of our ability to help the community as a whole. As physicians we have the ability to treat not just the patient in front of us but the thousands of patients beyond our door that are affected every day by policy.
Recently I was able to do a rotation with TAFP in Austin. This rotation was set up after several advocacy trips to Washington D.C. piqued my interest in policy. I was fortunate to match to a residency, Conroe Family Medicine Residency, that is very active both in its community and at the national level. The main takeaway from my first trip was this: everyone in politics has an ask, but stories are what stick. Simply talking about what we do on a daily basis can be a huge vehicle for change. I wanted a way to learn how to more effectively “get my story out there,” and this rotation was the perfect way to do just that.more
Learning to lead
By Tricia Elliott, MD
Greetings Colleagues. I recently had the pleasure of attending AAFP’s National Conference of Constituency Leaders and the Annual Chapter Leader Forum in Kansas City, Missouri, two conferences packed with leadership training and opportunities. As I was returning home, I couldn’t help but reflect on how lucky we are to be part of such an active and engaged community of family doctors. To witness the energy and enthusiasm for learning and networking, to take part in lively debates, and to watch colleagues collaborate to craft policy ideas — the weekend was truly a joy.
Our Texas chapter was well represented throughout both conferences. We had 17 members attending, seven of whom were first-time attendees to NCCL and ACLF. Again this year, Texas sent a full delegation to NCCL, which means we had an official representative for each of the convening member constituencies: new physicians; women physicians; international medical graduates; minority physicians; and lesbian, gay, bisexual, and transgender physicians.more
Student and Residents elect new officers for 2017
By Perdita Henry
The Texas Conference of Family Medicine Residents and Students, held in conjunction with the C. Frank Webber Lectureship and Interim Session, drew a total of 24 residents and 54 med students. Participants received a warm welcome from TAFP President, Tricia Elliott, MD, learned more about challenges facing those living on the border of Texas from Adrian Billings, MD, and received a legislative update from our very own CEO, Tom Banning.
In addition to timely discussions and presentations, the Section on Residents and the Section on Medical Students met and held elections for various officer positions. Officer candidates had the chance to talk to their colleagues about their professional passions and how they would represent the resident and student TAFP members within the Academy.more
Going to TexFamMed? Here’s what you need to know
Thank you for registering for the 2017 Texas Family Medicine Symposium in San Antonio. We are looking forward to seeing you at this event. Here are some helpful tips to make your TexFamMed experience even better.
If you arrive on Thursday, June 1, you can check in at registration from 5-7 p.m. in the San Lorenzo Room on the lobby level.
Registration will open as scheduled on Friday, June 2, at 6:30 a.m., in the foyer of the San Antonio Ballroom. The conference begins Friday morning at 7 a.m. with our CME breakfast lecture.more
Texas to host AAFP Family Medicine Experience 2017
This year’s AAFP Family Medicine Experience will be held in San Antonio, September 12-16. If you’ve never attended, take the opportunity to experience FMX in your own backyard.
Choosing family medicine means you’re already strong. And that’s why FMX was created — to empower you to make yourself, your patients, and your specialty even stronger.
FMX exists to offer you:more
Past president of TAFP elected president of TMA
By Perdita Henry
On May 6, 2017 Douglas W. Curran, MD, of Athens was elected president-elect of the Texas Medical Association at their annual conference, TexMed. Curran, a former president of TAFP and the 1999 Texas Family Physician of the Year Award recipient, will become the 153rd president of the organization on May 19, 2018.
“I feel very humbled by this opportunity to serve the patients of Texas physicians as well as protect and preserve the integrity of our profession,” Curran said in a TMA press release. “The opportunity to serve as president-elect and ultimately president of this great organization will allow me to speak from the heart about the profession I love and the commitment to improve the health care of all Texans.”more
Physicians tell House committee: Independent practice for nurse practitioners is the wrong answer for Texas primary care shortage
By Jonathan Nelson
The House Public Health Committee took up several bills that would expand the scope of practice of nurse practitioners on a long day of business on Tuesday, April 25. The hearing had stretched into the evening before TAFP member Emily Briggs, MD, of New Braunfels was called to the podium to speak against House Bill 3395 by Rep. Four Price (R-Amarillo). The bill would grant nurse practitioners independent authority if they practice in a rural area that doesn’t currently have a physician.
“I’m a family physician in Comal County, which means I see patients in my office,” Briggs told the committee. “I also take care of them in the hospital, I deliver their babies, I take care of their babies after delivering them and I also take care of the rest of their family.”more
April is Autism Awareness Month
How Sesame Street models behaviors of inclusion
By Jean Klewitz
When the new Muppet character, Julia, a shy, artistic 4-year-old girl, made her debut on Sesame Street on April 10, 2017, you could tell there was something special about her.
In the episode “Meet Julia,” Big Bird is confused when Julia doesn’t respond to him. Throughout the episode, the characters of Sesame Street present the uniqueness and talents of their new friend to each other. The lively introductions to Julia provide a message of understanding for young viewers watching everywhere. “It’s just that Julia has autism,” Elmo says, “so sometimes it takes her a little longer to do things.”more
National Infant Immunization Week
By Perdita Henry
April 22-29 is National Infant Immunization Week and the Department of State Health Services and the Centers for Disease Control and Prevention offer several different ways to help you keep your patients’ parents informed.
The DSHS’s National Infant Immunization Week website features articles and offers printable, bilingual, materials such as the “Protect Two from the Flu” brochure, the “Pertussis Cocooning” brochure, and the “Hepatitis B Vaccine Can Save Your Baby’s Life” poster to assist you in educating your patients about the benefits of immunizations and how they keep those most at risk safe.more
C. Frank Webber Lectureship and Interim Session: We came, we saw, we conquered
By Perdita Henry
It’s the second week of April 2017 and that means TAFP just wrapped up Interim Session and C. Frank Webber Lectureship! It was great to see all of you for two days of business meetings and CME, but there was so much more that happened. In case you were busy with other important tasks, meetings, and networking opportunities, here’s some behind the scenes information.
This year’s CFW had 306 total attendees. Of our total number of attendees, 276 were physicians who had the opportunity to earn up to 17 AMA PRA Category 1 Credits™ and AAFP Prescribed Credits. More than 100 members helped shape Academy policy and discussed hot topics on a wide range of issues in committee, commission, and section meetings during Interim Session.more
Voting is a vital sign
By Matthew Brown, MD
My name is Matthew Brown, and I am a family doctor who has worked with the underserved in the inner city of Rochester for the past 12 years. In my position, I have seen what happens when people do not have access to primary and preventive care. I have seen people admitted for diabetic complications because they couldn’t afford their insulin. I have seen people diagnosed with end-stage cancer because they couldn’t afford screenings to catch it when it could have been treated. I have seen strokes, and heart attacks, and kidney failure, and a hundred other things because people had to choose between medicine and food. Between doctor’s visits and having a roof over their heads. Between what they needed in the long-term and what they needed right that moment.
Medical care shouldn’t be a political issue. I didn’t work so diligently in medical school and residency because I hoped one day I would get to lobby my congressman, or attend rallies, or research Supreme Court decisions. The reason I became a doctor was, quite simply, to help people who needed help. And I hope most of the people I’ve had the honor and privilege of serving would see that even if I failed, I was trying with all of my heart to do that.more
You're Invited to AAFP's NCCL
By Christina Kelly, MD
The American Academy of Family Physicians National Conference of Constituency Leaders will be held April 27 - 29, 2017 with a preconference day on April 26 in Kansas City, Missouri. This is the AAFP’s premier leadership and policy development event for underrepresented constituencies, which includes new physicians (physicians in their first seven years of practice), women, international medical graduates, LGBT, and minority constituencies.
At this leadership meeting, we gather every year for a purpose. We gather to: learn about how we can make a difference for our patients and our specialty, inspire each other to advocate, lead the way to action, and challenge our colleagues to join us in our efforts. A variety of issues are discussed at this meeting, such as patient barriers to quality health care that you want the AAFP to address, challenges within a variety of practice settings that you want fixed, or changes that need to occur to continually improve family medicine.more
Harris County TAFP hosts med student forum
By Jean Klewitz
As all members of TAFP are keenly aware, Texas and the nation suffer from a persistent shortage of primary care physicians. We need more family doctors. The Harris County Academy of Family Physicians is taking important steps to generate and cultivate interest in family medicine among medical students.
HCAFP met for their Second Annual Medical Student Roundtable on Wednesday, Feb. 3, to discuss the specialty of family medicine. Members welcomed students early in their education from Baylor and UT Houston to a swanky restaurant on the sixth floor of the John P. McGovern Texas Medical Center Commons Building for an evening of frank questions and enlightening discussion.more
A busy start to a busy year
By Tricia Elliott, MD
Greetings colleagues. Regardless of what you think about the first several weeks of 2017, you certainly can’t say they’ve been boring. With the inauguration of a new president and the installation of his administration, the uncertain future for the Affordable Care Act, and the start of the 85th Texas Legislature, we have a lot of big issues to keep up with.
As it turns out, “repealing and replacing Obamacare” is much easier said than done and anyone who professes to know how the president and Congress will proceed most likely doesn’t. AAFP continues to be an influential resource to policy makers in Washington D.C. In letters to President Trump and to the leadership of the House and the Senate, AAFP has defined its priorities: health care for all, delivery system and payment reform, health care affordability, a national health care workforce strategy that promotes the value of primary care, and the promotion of prevention and wellness.more
Senate Finance Committee Workgroup on Healthcare Cost hears testimony from state agencies
By Jean Klewitz
Health care costs are back on the docket as lawmakers finish the third full week of the 85th Texas Legislature. Sen. Jane Nelson, R-Flower Mound, has convened a workgroup to come up with ways to control rising health care costs for state programs and that group met for the first time on Friday, Feb. 3, hearing testimony from state agencies and a variety of stakeholders for more than six hours.
Orthopedic surgeon and chair of the Senate Committee on Health and Human Services, Sen. Charles Schwertner, MD, R-Georgetown, presided over the seven-member panel. “Health care costs in all these programs and across all our state agencies continue to skyrocket and crowd out other priorities like education, transportation, and public safety,” he said as he opened the hearing.more
Host a Shot Clinic with Help from TMA's Be Wise — Immunize
By Tammy Wishard
TMA has a way to help you boost local vaccination rates: Be Wise — Immunize Local Impact Grant. TMA is accepting applications until March 1 for grants of up to $2,500 to support local vaccination events. TMA member-physician practices/clinics, county medical societies, TMA Alliance chapters, and medical student chapters can apply.
The funds can be used for shot clinics to vaccinate children, adolescents, and/or adults. Applicants should apply for a grant at least four months before their event, and grantees have up to 12 months to use the funds. TMA will accept applications again on July 1 and Nov. 1 for shot clinics in late 2017 and early 2018.more
Attend AAFP Leadership Conference with a scholarship!
By Perdita Henry
Have you worked alongside someone who blew you away with their leadership skills? Are you a special constituency member who wants to make sure minorities, women, new physicians, LGBT+, and IMG physicians have a seat at the table? You’re in luck. Many of the inspirational and dedicated members of TAFP have made AAFP’s National Conference of Constituency Leaders and Annual Chapter Leader Forum a part of their journey to build the careers they always wanted.
Taking place April 27-29, in Kansas City, Missouri, AAFP members from across the nation will gather to discuss various issues, suggest policies and programs to AAFP, and receive leadership training.more
Bringing awareness to cervical health all month long
By Perdita Henry
January is Cervical Health Awareness Month, and our friends at the Texas Department of State Health Services Immunization Unit have gathered a plethora of resources to shepherd you through this month of patient empowerment.
Each year nearly 13,000 women are diagnosed with cervical cancer, an almost completely preventable form of cancer. The number of affected women by the disease remains high despite the availability of the vaccination and regular appropriate screenings, such as pap and HPV testing.more