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The Energy and Courage to Try New Things: My Memories of STFM Conferences Over the Years

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John Frey, MD

I have been attending STFM meetings since 1972, when I went to my first meeting as a resident, and have missed only three since that time. Those first meetings are all a jumble in my memory but mostly I remember feeling as if, somehow, I had found sanctuary, at least for a few days each year. Everyone was busy with the work of starting a career without a roadmap, making it up as we went along and comparing notes at the annual meeting. I suppose I had the idea that STFM meetings would have “the answers” but as one of my early residents said, it took me a few years to realize that there were no “answers”, just more questions and that was as it should be.  I would go home with my head full of possibilities. Fortunately, that feeling has never left me.

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Pre-Existing Conditions and the Potential Cost of Repeal and Replace on the Medically Underserved

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Michael Castellarin, MD

In March of 2010, the Affordable Care Act (ACA) became the most significant change to the US healthcare system in almost half a century. This January, health care reform again entered the national conversation as discussions to repeal and replace the ACA ensue. One of the most influential provisions of the ACA was the pre-existing conditions clause which led to a ban on medical underwriting, thus providing health insurance coverage for a multitude of people previously ineligible unless covered by an employer.

As a family medicine intern training at an urban federally qualified health center (FQHC), I care for the medically underserved; a population defined by their complex health care needs and lack of financial resources which, prior to the ACA, left this group particularly vulnerable to medical underwriting. As health care policy shifts once again, the importance of pre-existing condition coverage must be realized and must be protected, particularly for those less fortunate.

Prior to the passage of the ACA, the practice of medical underwriting was commonplace in the individual health insurance market. Common ailments such as diabetes, heart disease, and obesity left patients uninsurable. Those insured through an employer avoided underwriting but oftentimes those in medically underserved populations were forced to shop for health insurance on the individual market because of unemployment or low wage employment without employer-sponsored insurance.

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Feed a Discipline (With Research Questions): Become Shark Bait

Winston R Liaw, MD, MPH

Winston R Liaw, MD, MPH

Research is to see what everybody else has seen and to think what nobody else has thought.

  • Albert Szent-Gyorgyi

Each year, my colleague, Alex Krist, and I sit down with our Virginia Commonwealth University family medicine residents to brainstorm potential research topics for their scholarly activities, and each year, we encounter a similar series of events. Initially, there is silence (frequently prolonged and often deafening) followed by musings about their lack of research experience. Then, a brave soul offers a question that has been plaguing her. A classmate asks a similar but related question. The conversation reminds a third resident about a different question he always wanted to answer. By the end of the hour, we have a list of fascinating, important questions.

  • Do calorie counters improve patient outcomes?
  • Why do our patients use the emergency room next door when our walk in clinic is open?
  • Has the new patient portal affected the volume and type of phone calls we receive?
  • Are patients at the community health center interested in doing video visits?

Your STFM Research Committee thought that family medicine residents and faculty nationwide may similarly have pressing questions to answer but lack the means to do so. Initially conceived by STFM Research Committee members Tammy Chang and Rob Post, we launched a session at the 2016 STFM Conference entitled: “Shark Tank for Family Medicine: Real-time Feedback for Primary Care Research Ideas”. During the workshop, seven participants pitched research ideas to three “sharks” (well-established primary care researchers). The sharks provided real-time feedback and then selected participants to mentor over the year. For those of you not tuned in to pop culture, our workshop is based on the TV show Shark Tank where contestants pitch business ideas to established entrepreneurs and winners receive funding and mentorship.

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