Kathleen Rowland, MD, MS
Change is here, and more is coming. In medicine, we often perceive change, especially external change from hospital systems or payers, to be a threat. We feel a loss of control, which can lead to anger, resentment, and burnout.1 A survey of 3,000 US physicians done by a staffing company found that 58% of physicians who left medicine in 2013 reported doing so because they didn’t want to practice in an era of health care reform. This is more than stated they left because of economic factors such as malpractice insurance or reimbursement concerns (50%).2 The changes we face can feel overwhelming, and we have to take measures to make the changes less daunting.
Being resilient does not mean that we become pushovers. The goal of teaching resilience to change is to increase the sense that we are able to react to, triage, and adapt to changes while maintaining the core of who we are: physician teachers and healers. We can fight unwinnable battles or choose good ones. We can hold out on changing until the demand to do so is punitive, or we can adopt the change at a comfortable pace. We often do not choose the changes we face, but can choose the way we respond. As we restore that independence, we can reduce our risk of burnout and increase our satisfaction with practice.
Winston R Liaw, MD, MPH
Research is to see what everybody else has seen and to think what nobody else has thought.
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.
Kalaki M.Clarke, MD
The health care road has been less than smooth on the family physician’s journey towards optimizing America’s health. Nevertheless, I’m optimistically looking down that road and believe that 10 years from now, many of the present potholes will be filled in and many flashing red traffic lights will be repaired.
One of the main potholes in the health care road that I foresee being repaired is the family physician deficit. Currently, one-third of physicians provide primary care while more than half of all clinical visits are in primary care offices. Clearly, this particular dip in the road begs reconstruction. How do we fix this? Repair begins when family physicians fully take full pride in our responsibilities as the cornerstone of American health. Our demonstrated passion as comprehensive care providers for patients from the womb to the tomb will draw the next generation of physicians to family medicine as their vehicle of societal contribution. Medical students will inevitably be compelled to join us for the ride and contrary to popular impression they’ll discover that we see more in our clinics than the self-limited rhinovirus. They will then be less lured by the fancy and shiny specialty-driven vehicles currently advertised as the sole solution to professional fulfillment.
As our workforce increases, down the road the disproportionate 2:1 specialist to primary care provider ratio will reciprocate. We are actually headed in the right direction evidenced by NRMP (National Residency Match Program) stats showing that 95% of family medicine training positions were filled in 2016 compared to 85% in 2006.
What about some of those flashing red traffic lights presently stalling our journey’s advancement? One of the largest of these is the one that fails to value the practice of primary care. An associated roadblock includes the imbalanced manner in which family physicians are financially compensated. On my recent sports medicine rotation I was taken aback when my attending shared with me that the encounter time we spent as consultants would have been reimbursed triple the amount had we served as primary care providers managing multiple chronic conditions.
Although that was a disturbing realization, I was filled with renewed appreciation for family medicine when I learned from the AAFP Immediate Past President, Wanda Filer, MD, that the death rate decreases in communities with family physicians. Intrigued, I investigated further and found literature that cited National Institute of Health (NIH) studies published in the 1990s which proved that US states with higher ratios of PCP to population had better health outcomes including lower rates of all cause mortality from heart disease, cancer, and stroke. All of these outcomes were independent of the highly relevant social determinants of health. If that information doesn’t scream “high value” with the potential to achieve the Triple Aim (and even the Quadruple Aim), please tell me what does.