By Roland A. Goertz, M.D., M.B.A.
Three words describe the three years I have served on the American Academy of Family Physicians Board of Directors: challenges, changes and opportunities. In a brief three-year period, the board has dealt with everything from declining non-dues revenues to deciding how to optimally impact the best opportunity in over a decade to reform an ailing health care system. We live in an interesting time as family physicians in today’s health care system, and as such, my tenure on the board has been quite a journey.
After only a brief period spent enjoying the euphoria of a successful election, new board members are handed a packet outlining their first responsibilities. Meeting dates are placed on calendars and primers on the inner workings of the Academy are reviewed. You are thrust into a constant and voluminous flow of information distributed in multiple formats. If one has not already developed a method of efficient data management, interpretation and use, necessity quickly breeds invention as a board member.
It is this constant and always updated information that forms half of the core basis of what a board member does. The other half of the core is the discussions and interactions at board meetings and during conference calls, which lead to decisions on policies or directives about the use of resources on behalf of members. Our initial challenge was an unavoidable trend of declining revenues for the Academy.
Member organizations inevitably try to address projects or problems of the membership with any available resources. Because an association is not in business to make money but instead to represent its members, this is usually accepted and generally appreciated by membership. Trouble begins when the external business world abruptly changes, as it has over the last few years.
The Academy had relied upon investment and advertising income to fund many parts of AAFP. Revenues from both areas were sliding downhill quickly. In response, the board implemented a balanced operational budget, but doing so required an arduous reconsideration of AAFP’s strategic priorities and resource allocation. We focused on being fiscally sound without forgetting that we also had to continue trumpeting family medicine’s message.
We poured over member surveys for guidance as we winnowed the Academy’s strategic priorities from more than 10 in number to four: advocacy, practice enhancement, education and public health. Programs were pared and a difficult staff reduction of more than 50 valued employees was needed to get to a balanced operational budget. At the same time, planning and implementing a strategy to influence the rapidly approaching U.S. presidential election, addressing the decline in student interest in our specialty, and confronting the growing managed care and paperwork hassles that frustrated our members challenged the board.
I summarize our challenges as three imperatives: 1) To re-establish family medicine and primary care as the core element of the future health care system, 2) To work to change a sickness- and procedure-biased physician payment system, and 3) To address worrisome workforce issues. It was clear the Future of Family Medicine Project that evolved into the Patient-Centered Medical Home model, the National Demonstration Project and TransforMED as the overseer of the evolved projects, had to be maintained in hopes that results would support our model and the changes we want in the health care system. The board took seriously the membership directive to be aggressively involved in advocacy. The challenge was to do so with as much fiscal prudence as possible while being bold enough to make an impact.
A parallel advocacy strategy was developed. It took almost a year to create and launch the “Bold Champion Initiative,” a multifaceted project designed to impact our own members and to influence the 2008 presidential election. The initiative included a redesign of our long-standing emblem and a targeted media campaign featuring family medicine ads in national publications and broadcasts paired with more concentrated ads in media often read or heard by elected officials and their staff.
Academy leadership attended both major political parties’ conventions and Ted Epperly, M.D., AAFP President, was one of only four physicians invited to the White House Health Care Summit in March of this year. We learned how collaboration, particularly with those who have vested interests in health care but are not necessarily health care organizations, could amplify our advocacy efforts. IBM’s Paul Grundy, M.D., was particularly supportive and helpful with the Patient-Centered Primary Care Collaborative, which now boasts over 300 member organizations.
As I write, it is unclear what health system reforms will be enacted, but members can know that AAFP policies and requests for change have been and are continuing to be heard in Washington, D.C., and in states across the country. Academy leadership has worked hard to represent you the most aggressive way possible given available resources. The Patient-Centered Medical Home has become a recognized model discussed in many settings, and the need to make primary care and family medicine core elements of future care delivery is iterated by more policymakers than ever before.
My time on the board of the AAFP has been challenging and incredibly rewarding. I have learned much. My sense and hope is that what we represent and what we can do for our patients and all of America is just beginning. I ask you to continue telling your stories of care to all who might help change our system to what it needs to be. That includes our patients as well as elected officials. During my three-year tenure, I have never forgotten who I work for as a board member. I thank you for the privilege of working for you.