Our Nation’s Primary Care Academic Infrastructure: What Is Needed to Protect it During Obamacare “Repeal and Replace?”

 

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Hope Wittenberg, MA Director, Government Relations

When one thinks of the repeal of the Affordable Care Act (ACA), the major tax and coverage provisions required by insurance come to mind. Efforts by the new Trump Administration and Congress to repeal the ACA will obviously have a tremendous impact on these features of the law.

What is less known is other provisions of the law, many of which have an impact on academic family medicine–they affect workforce or primary care research, or both. These issues do not have large constituencies behind them–we may be alone or in slim company trying to maintain key portions of the law that impact our academic infrastructure.


Academic Primary Care Provisions in the Affordable Care Act

  • Establishment of payments for training provided to Teaching Health Centers, rather than hospitals
  • Reauthorization of Title VII Primary Care Training and Enhancement with an emphasis on the patient-centered medical home
  • Primary Care Extension programs to assist primary care practices regarding innovations and best practices
  • Medicare Graduate Medical Education (GME) provisions supporting community-based training within the confines of historic GME
  • Establishment of the Patient-Centered Outcomes Research Outcomes Institute (PCORI), to improve patient care and outcomes through comparative clinical effectiveness research
  • US Preventive Services Task Force (USPSTF) gained a new requirement that private insurance plans cover recommended preventive services without any patient cost-sharing

A Campaign We Must Not Lose

Assuming others will make the case for us is not an option. Working in partnership, STFM and the other CAFM organizations, along with our members, will need to actively engage on our key issues. If each of us does not get involved, we may not have the political might to support our position(s.) We do not have the luxury of large population size to assume that others will make the case for us. Members of Congress need many voices educating them about what we know–that the overall health of a population is directly linked to the strength of its primary health care system and workforce.  They need to hear why each of these provisions is important to the primary care infrastructure of the United States.

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Two Decades of Memories and a Crystal Ball

50anni_headerpresentfutureCelebrating STFM’s 50 years. I’ve been a part of the Society for nearly half of that.

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Stacy Brungardt, CAE STFM Executive Director

There have been moments when I can’t move from my chair. Like the time our Leland Blanchard Lecturer Bill Strickland told us how he partnered with the Pittsburgh community to create an arts and technology center for disadvantaged kids. I experienced the same chair paralysis when Peter Coggan, MD, shared his personal story of perseverance and why he gives back to STFM. I was too moved to move.

I see many faces from the past and present when I look back on my 23 plus years of memories and emotions.

Joy. I can still picture where I was and the amazing feeling of the phone call from Search Committee Chair John Rogers, MD, MPH, offering me the job as STFM executive director. That was a moment.

Pride. I appreciate watching excellence unfold. Like the time Mary Hall, MD, nailed her incoming president’s address or when I’ve witnessed the brilliance of Jerry Kruse, MD, as he connects the dots between disparate ideas that no one else sees.

Inspiration. During her presidency, Jeri Hepworth, PhD, talked about STFM moving big rocks. This terminology inspired our current strategic plan and reminds us that STFM and family medicine have the power to do great things if we believe and expect that of ourselves.

Perseverance. We heard for years that it was too hard to get the family of family medicine to reach consensus on a national family medicine clerkship curriculum. These folks didn’t know Scott Fields, MD, or Heidi Chumley, MD.

Adventures. My job has taken me to Italy, Prague, Singapore, Cancun, and all over the United States. I saw the world through a different lens when given the opportunity to join John Saultz, MD, and his team on a trip to Japan. I enjoyed being Stacy-san for the week.

Friendships. I’ve had countless dinners and visited the homes and families of Perry Dickinson, MD, Betsy Garrett, MD, MSPH, Sam Cullison, MD, Melly Goodell, MD, and Larry Green, MD, among others. What a gift to have these friendships and be invited into their personal lives.

STFM’s Future: Here’s What I See

The STFM leadership has created a culture of innovation within the Society that accepts risks and invests in the future. We celebrate the lifespan of activities to make space for something new. The Society is well positioned to embrace change and adapt to the future.

Terry Steyer, MD, was the STFM president who inspired the creation of our Emerging Leaders program. Deborah Taylor, PhD, Victoria Gorski, MD, and Julie Schirmer, MSW, built a leadership infrastructure that embraces and develops our behavioral science community. Katie Margo, MD, seized an opportunity to nurture young leaders in the medical student educator world. STFM has invested in developing our next generation of leaders. I imagine a future when the majority of the voices in our leadership are today’s millennials.

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The Development and Maturation of STFM

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Roger Sherwood

Roger Sherwood, past STFM executive director

When 105 family medicine educators signed on in 1967 to become a part of the newly formed Society of Teachers of Family Medicine, little did they realize the impact they would have on educating medical students and residents in this new medical specialty. These pioneers spread the message of family medicine education and they and their successors affected the lives of countless students, residents, physicians, and patients.

In its early days, STFM administratively was essentially a file drawer in the president’s office. The Society received a major boost when the American Academy of Family Physicians offered to provide administrative services in the early 1970s. Growth and success during the 1970s led STFM to build its infrastructure and hire its own staff, though the AAFP provided support through 1980, both financially and by providing office space in the AAFP headquarters.

in 1981, when I became the STFM Executive Director, incoming president F. Marian Bishop, PhD, MSPH,  initiated an outreach program to the members by introducing the concept of special interest groups. The initiative invited STFM members to develop groups to address their special areas of interest. This outreach program marked a new stage of development — the creation of an infrastructure to involve members in new ways.

Building and growing the Society resulted in a number of initiatives that enabled the Society to develop a stronger base before moving to its next stage—outreach to other organizations and the larger world of medical education.

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