President's Letter

Tags: presidents letter, q3 2019, rebecca hart, accomplishments, challenges, MOC, pilot program

Accomplishments and challenges in a busy year

By Rebecca Hart, MD
TAFP President

Greetings colleagues. As I reflect on this year so far, it’s been a whirlwind! We have seen major accomplishments, but huge challenges lie ahead. Let’s recap where we are on several issues.

Accomplishments: The 86th Texas legislative session ended with a few significant wins for family medicine. We retained our funding for the Family Medicine Preceptorship Program and Physician Education Loan Repayment Program. We successfully protected funding levels for existing residency training programs while the Legislature increased graduate medical education expansion funding by $60 million. And once again, we defeated challenges to our scope of practice and turned back efforts by nurse practitioners to practice medicine independently.

Among a number of public health victories, one stands out as a particularly exciting change. Gov. Greg Abbott signed into law Senate Bill 21 to stop the sale of cigarettes, e-cigarettes and other tobacco products to Texans younger than 21, except for those in the military. That’s a great win for the health of our patients! The law will take effect on Sept. 1.

Our thanks to TAFP staff and our advocacy team, and especially to those of you who took the time to testify for important issues at the State Capitol.

On the national front, a major win for family medicine doctors is that the ABFM is changing the rules on maintenance of certification (MOC). The ABFM, under the new leadership of Dr. Warren Newton, finally listened to us as we sternly brought to their attention the plight of the family doctor, struggling with over regulation and buried with fees and paperwork and burnout.

They approved a pilot program for MOC that involves a program of answering questions on our own computers, in our homes. This will allow doctors to finally opt out of the high stakes exam every 10 years, but instead, maintain board certification by answering 25 questions per quarter. I am pleased to report that the pilot program thus far is going very well. I was recently part of the Commission for Continuing Professional Development at the AAFP Summer Cluster and was able to hear Dr. Newton express how the pilot was going. “Very well,” he said!

Diplomates are loving the freedom to take the test questions at their leisure, anywhere they want, even in their pajamas if they so choose. The test is open book but you have to answer each question in five minutes. You get immediate feedback on whether you got the question correct, and the answer is explained. It’s actually a way to learn continuously!

You must answer 60% of the questions right to remain certified. And you can opt in or opt out. You can still choose the exam pathway. Of the pilot participants in the first cohort, 71% have chosen to go with the quarterly questions and 29% are going to take the 10-year exam. Since it’s going so well, we are hopeful the board will allow everyone to opt in to the program at the conclusion of the pilot. It’s not official yet, but the outlook is promising. Do I hear a “Hallelujah”?

Challenges ahead: I see three major crises challenging us now: 1) the opioid crisis affecting our patients and our practices, 2) the never-ending primary care workforce crisis in Texas and the nation, and 3) an embarrassing maternal mortality crisis in the United States. Let’s look at each of these and see how we are addressing each one:

The opioid crisis is in the news every day. AAFP has issued a statement that was highlighted in a recent issue of Texas Family Physician. We now have a toolbox available to help us manage patients in better ways. Organized medicine has responded very well to this crisis and already the number of deaths has gone down significantly.

The workforce crisis, the main issue I wanted to highlight in my presidential year, continues to be a huge issue for the state and our nation. But I am encouraged as I see the number of new medical schools and residency positions starting up, and even a new medical school (University of Houston) with a goal of graduating 50% of their students into primary care. We can’t get there fast enough.

The maternal mortality crisis is multifactorial, and to understand its causes is the subject of many articles and task forces around the country. The paucity of physicians delivering babies in rural areas is just one of the many issues. AAFP is taking this concern to Washington to highlight how the closure of so many rural hospitals has created huge deserts across the country with no maternity services. Mothers in some areas have to travel hours to get to a doctor. It’s getting worse, not better. But patients with such things as postpartum pre-eclampsia and postpartum hemorrhage are a large percentage of the deaths, and the American College of Obstetricians and Gynecologists is taking steps to begin training programs for nurses and doctors in all hospitals to ensure the early identification of these deadly complications. 

Of course, we have many other challenges to face such as access to care, Medicaid reform, the lack of insurance coverage for our patients, and the humanitarian crisis at the border. These are some of the things we continue to battle for you at TAFP. My thanks to the fantastic staff here at TAFP for taking up these challenges and for helping us achieve our accomplishments. And my greatest thanks to all the volunteer physicians who are actively involved in TAFP and AAFP and TMA and the local medical societies. It is YOU who make all this happen! 

Show up, be a part of it! Until next time, take care.

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