Tuesday, December 9, 2008

Big Tobacco and Family Medicine

The role of Family Medicine practitioners in the prevention and treatment of tobacco use is clearly spelled out by the AAFP:
The American Academy of Family Physicians strongly encourages all of its members and staff to personally avoid tobacco use. The AAFP urges its members to:

  • save lives by working toward elimination of all tobacco use;
  • document use of tobacco products in patient charts;
  • work cooperatively with other health professionals to provide cessation counseling and other treatments;
  • discourage tobacco use in all public and workplace settings; and,
  • list tobacco as a cause on death certificates when appropriate.
How can we put these things into effect on a local level?

Tar Wars is a program sponsored by the AAFP that is attempting to educate youth (12-17), which are particularly heavily targeted (and influenced) by tobacco advertisements. The program hopes to galvanize health care professionals to become proactive in the health education of their community, especially for tobacco-free education for students, by training presenters to give 1-hour-long presentations to local schools about the health risks of tobacco consumption (smoking and smoke-less).

Since youth (under 18 years old) are a primary target for much tobacco advertising (1,000+ become regular, daily smokers each day) and since much legislation, research and advocacy is focused on tobacco consumption in this age group, this seems to be a primary battleground for the "Tar Wars."

What are we doing in Family Medicine at BUSM?

We are interested in starting up a Tar Wars program here, but are looking for someone to spearhead the initiative. Send us an e-mail if you are interested in this...

What do you think? Is a "Tar Wars" program enough to battle BIG TOBACCO? What else can be done? Should BUMC receive money from Philip Morris to conduct research?

References

Is BUMC marketing for Philip Morris?

  • Tobacco is STILL the leading cause of preventable death in the USA (~400,000 deaths/year from smoking), more than 40 years after the Surgeon General's report on the negative health effects of smoking.
  • Smoking kills more people than alcohol, AIDS, car accidents, illegal drugs, murders, and suicides combined.
  • Since 1998, Altria (Philip Morris) has spent more on lobbing Congress than any other business.
  • Boston University Medical Center (BUMC) received $3.99 million from Philip Morris USA over the past decade to fund the study of tobacco-related illnesses ("Tobacco funded Mass. research", Boston Globe, March 2008).
On Monday (Dec. 8th), Dr. Alan Blum - the Gerald Leon Wallace Endowed Chair in Family Medicine at the University of Alabama - spoke to BU medical and public health students about the controversy surrounding university research funded by big tobacco companies. His talk, "Universities 
and 
the
 Tobacco
 Industry:
 True 
Opponents
 or
 Silent
 Partners?
", focused on the role that student advocates can play in reducing the negative health effects of smoking, especially by directly confronting the tobacco companies that produce, market, and distribute the product.

As a resident, Dr. Blum started DOC (Doctors Ought To Care), a national organization focusing on school-based and community wide health promotion, for which he received the first National Public Health Award from the American Academy of Family Physicians (AAFP).

Further coverage of the event can be found at...

Friday, December 5, 2008

NEJM Perspectives on Crisis in Primary Care

In a recent issue, the NEJM published a series of perspectives on the crisis in US primary care. Six experts in this area each share their brief perspectives on the current primary care situation and the value of primary care. Click here to read the perspectives.

The NEJM also brought 5 of the 6 contributors together for a roundtable discussion of the problems and potential solutions for training, practice, compensation and sytemic change. Click here to see the video and reader comments.

Monday, November 24, 2008

Upcoming Anti-Tobacco Advocacy Series

Tobacco-related illnesses are the leading cause of death worldwide. Use of tobacco has widespread implications on the health of the individual and those around the individual and cost the health care system billions of dollars each year.

On December 8, Dr. Alan Blum, Family Physician and Director for the Study of Tobacco and Society at the University of Alabama, will be leading...

11:00-12:00 Round-table discussion on (1) history of the AMA and its role in the tobacco epidemic and (2) how to combine a family medicine career with public health advocacy (E-720)

12:00-1:00 Lecture on "Universities and the Tobacco Industry- True Opponents or Silent Partners?" (L-112)

Lunch will be provided at both talks.

These topics are of especial interest at our school since BUSM has received over the past 10 years $3.99 million in research funding from Philip Morris and is the only medical school in Massachusetts that actively receives funding from Philip Morris.

The talks are co-sponsored by the Public Health Forum, AMSA, AMA/MMS and FMIG.

UK Health Care Talk - Dr. Charlton

Dr. Rodger Charlton led a discussion on the UK medical system with focus on the differences in their primary care system. Dr. Charlton is a general practitioner in a small town in central England and the Director of Undergraduate GP Education and Associate Clinical Professor at Warwick Medical School. He was visiting Boston to share his experiences and research in primary care, and end-of-life and palliative care.

The health care system is called the National Health Service (NHS). It is funded by income tax and is provided to all residents of England regardless of ability to pay OR employment. Dr. Charlton shared about his own practice which includes comprehensive care with nursing staff, staff coordinator, triage receptionist, etc. He also shared that he sees significantly more patients a day than the typical US doctor and continues to make home visits on a regular basis.

Primary care doctors in England are reimbursed by the NHS based on the number of patients they have, not the number of procedures and services they provide. They are paid directly by the NHS; this process significantly reduces amounts of paper shuffling. A few years ago, the NHS changed reimbursement policies so that now primary care doctors make MORE money than specialists. This has increased the number of medical students who are entering into primary care significantly.

Does the US need a similar model of reimbursement? The UK has a system where 50% of its doctors are primary care doctors, a much larger proportion than the US. Would working towards changing this proportion in the US improve health outcomes?

Sunday, November 23, 2008

Addiction talk with Dr. Scott Davis

Dr. Scott Davis, BUSM ’91 and current Director of Inpatient Medical Services at Betty Ford Center, spoke to more than eighty students, faculty and staff on Thursday, November 20th at the medical school. Dr. Davis shared his personal experiences with addiction and recovery, reviewed the biology of addiction and the physiological alterations that take place in the brain of an addict, and clarified important concepts in differentiating patients with tolerance, dependence and addiction in clinical practice. After the talk, Dr. Davis gave out signed copies of his memoir, Living Jonathan’s Life: A Doctor’s Descent into Darkness and Addiction to everyone who attended. Feedback from students about the event was very positive – everyone was moved by Dr. Davis’ story and felt they had gained insight into addiction.


The Betty Ford Center has wonderful opportunities for medical students to gain understanding and insight into addictive disease and the recovery process. Zoe Tseng and Jessica Gray, (BUSM II) attended the week long Summer Institute for Medical Students (SIMS) between their first and second year and would be happy to talk to anyone who may be interested in the experience (students in all four years can attend). In the SIMS program students have the opportunity to spend five days experiencing what it is like to be a patient or a family member at the Betty Ford Center. Students spend time in inpatient treatment, residential day treatment, or the family program. Participants in all programs attend lectures addressing the medical needs of addicted patients and the theory and philosophy of treatment at the Betty Ford Center. They also attend a Treatment Planning Update (TPU) meeting to observe the multidisciplinary care process at the Center.
More information about the SIMS program as well as other opportunities at BFC is available at:
http://www.bettyfordcenter.org/training/summerinst/
http://www.bettyfordcenter.org/training/professionals/

Dr Davis can be reached at:
Scott M. Davis, M.D., M.A., FASAM
Email: sdavis@bettyfordcenter.org

Thursday, November 20, 2008

Increasing reimbursement for primary care physicians

This week, Senator Baucus, Senate Finance Chair, called for greater primary care and prevention efforts especially with regard to increased reimbursement for primary care physicians. Baucus issued a 98-page blueprint that will hopefully lead health care reform in the new Congress.

Excerpts from AAFP article:

"My plan would put more primary care doctors in practice," said Baucus. "Watching over a patient's full medical history and keeping them healthier all of their lives … that is a quality measure and a cost-control measure."

AAFP President Ted Epperly, M.D., of Boise, Idaho, said the Baucus proposal recognizes that a strong and robust primary care system must be an essential part of any successful health care reform effort. "Family physicians and the patient-centered medical home are the basic building blocks of this health care foundation," Epperly said.

Baucus said increased payments for primary care physicians may require a shift in resources, resulting in reduced payments to subspecialists. "There might have to be a bit of a readjustment," he said. "Some of these (sub)specialists might have to take a bit of a nick, but the (sub)specialists know the system is not working well. They know primary care doctors need more help individually. They also know, more fundamentally, that by giving more emphasis to primary care doctors, it is going to help the whole system."

"Payments for primary care physician visits are undervalued, particularly compared to procedures and services furnished by (sub)specialists," the document says. "In fact, the overvaluation of procedures in the Medicare physician fee schedule has both created financial incentives to provide unnecessary services and served as a disincentive for physicians to become primary care physicians."

To see the full senate proposal, click here.

Monday, November 17, 2008

A Doctor's Descent into darkness and addiction

Join us on Thursday, November 20th from 12:30-1:30 in L-112 (lunch provided):

A talk from Dr. Scott Davis, BUSM '91 and Director of Inpatient Medical Services at Betty
Ford Center.

Dr. Davis will be speaking about his personal and professional experiences with addiction, as well as the mechanisms of addiction and the road to recovery. He will be giving out a limited number of signed copies of his non-fiction autobiography, Living Jonathan's Life: A Doctor's Descent into Darkness & Addiction.

Due to the limited number of books, please RSVP by going to the link below to let us know that you are coming. The first people to respond will receive a copy of the book at the talk on November 20th. There will be additional books available for purchase at the medical campus bookstore.

Everyone is welcome to attend the lecture.

RSVP here
if you want a book!

Recent news about physicians and addiction:

Boston Globe Article 9 November 2008
"Something, anything to stop the pain"

Friday, November 14, 2008

Starving in the United States

Over 35.5 million people in the United States have limited or uncertain access to enough nutritious food for all household members to lead active and healthy life. 12.6 million of these people are children. Inadequate nutrition in children lead to significant implications for physical growth and cognitive development. The thrifty minimally nutritious food plan, which is defined by the USDA, costs at least $752 per month for a 4 person family in Boston. The maximum that any family can receive in food stamps for a given month is $542, which is 39% less than the cost of the plan. That said, most families do not even receive the maximum amount in food stamps.

These are issues that primary care physicians must be aware about to adequately address their patients' health care needs. Providing basic nutrition for patients by informing about access to food banks and advocating for change in federal welfare policies are just as important as (if not more important than) ordering tests and prescribing drugs. Why is it that the federal government can find $700 billion to bail out the financial markets but not one extra dollar to provide nutrition to our society's families and children in poverty? The latter are the ones who are affected by unemployment and have their basic health and living needs put into question in this time of economic depression.

Check out this slide show on the NY Times on recent increases in food insecurity.

Sources:
Thayer J, Murphy C, Cook J, Ettinger de Cuba S, DaCosta R, Chilton M. The Real Cost of a Healthy Diet: Coming Up Short- High food costs outstrip food stamp benefits. Report by C-SNAP. Boston Medical Center. September 2008

Tuesday, November 11, 2008

Innovation in Obstetric Care

FMIG and ACOG hosted a panel discussion on November 10 about the role that family practitioners, OB-Gyn physicians, and certified nurse midwives play in the reproductive health care of women. Dr. Michelle O'Brien from family medicine, Dr. Michelle Sia from OB-GYN, and Susanne Kisten, a midwife, discussed the different approaches each of their respective fields brings to women's health and the impact the interaction of these approaches has. They focused on the model at the Boston Medical Center Labor and Delivery ward, which is one of the most innovative and collaborative models nationwide. Family doctors, OB-GYN doctors and midwives work together in making decisions and learn from each others expertise instead of dividing their patients.

Sunday, November 9, 2008

Reflections: STFM Baltimore Regional Conference

In the few days before attending the Society of Teachers in Family Medicine (STFM) Northeast Regional Conference, I seriously thought about not going because I had an exam the day after the conference. All this changed when I received an email from the Chair of the conference. Here is an excerpt:

"Our intention has never been to just hold another meeting. Most of us have attended more than our fair share of meetings. Our intention is to energize a movement. The movement involves advancing a Family Medicine/primary care agenda that will reform our health care systems."

The theme of the conference was "The New Deal in Healthcare: A Medical Home for All." I recognized that advancing this movement is where my passions lie and that I needed to follow them. The opening plenary session on Friday set the tone when Dr. Richard Roberts and Shannon Brownlee debated about the health care system in the US. Important facts that I learned include:
  • 1/5 to 1/3 of our health dollars on care does nothing to improve health care
  • only 8-10% of our health care dollars are spent on primary care (Note: primary care has been proven time and time again to reduce mortality and morbidity much more than specialty care)
  • General Motors spends more money on health insurance for employees than for steel and Starbucks spends more money on health insurance for employees than on coffee beans. That makes GM and Starbucks health insurance providers with car manufacturing and coffee selling as side businesses

The rest of the conference focused on concrete models in which health care reform could be implemented. Another focus in the conference was networking. Students were actively encouraged to meet faculty and residents. Special interest breakfast, lunch and dinner tables were set up; students were encouraged to talk with residency directors at a residency fair; and small group seminars and workshops encouraged discussions.

BU had its moment of fame when Dr. Joanne Wilkinson, Dr. Eileen Pierce and Dr. Miriam Hoffman presented a seminar on the BU FaMeS program followed by discussion about other schools' models and challenges that schools face in promoting Family Medicine.

The conference demystified and personalized the problems in the health care system. Each of us were called to do act and given means to do so. As medical students, we were given the opportunity to network, to learn more about family medicine and even to learn about how to successfully match in family medicine. Whether through workshops, talks, plenary sessions or simple personal interactions, the air at the Baltimore Convention Center was tinged with excitement: an excitement about the possibility of reform and the desire to share that with the nation.

Lancet article names primary care as the solution to the US Health Care System

There is national consensus that the US health care system is in a crisis and desperately needs reform. What is unclear is what reform is needed.

In this week's Lancet, Pugno et al. present primary care as the option that is both effective on health outcomes and cost efficient. The United States is the only developed nation that does not have universal access to comprehensive, continuous and preventive services in a primary-care-based system. The medical home model, used in other nations, has the ability to streamline health services and eliminate disparities in health care. Primary Care through the medical home model has been shown by multiple studies to have a positive effect on health outcomes and reduce mortality/morbidity. It is also much more cost effective than specialty-based care, which also contributes to higher mortality/morbidity in society.

Pugno et al. suggest that the key to health reform is promoting careers in primary care to meet the health care needs of the people. Concrete suggestions include:
1) Increase the attractiveness of careers in primary care: changing the payment method for primary care services and increase control over lifestyle
2) Prioritization of medical students' interests in primary-care careers that practice generalist approach to health care
3) Providing support for training programmes for primary-care physicians.

Providing universal health care is not a solution without primary care doctors to provide the services. Providing funding for programs like the National Health Service Corps and community health centers are a positive step but doctors are needed to fill the spaces in these programs. Ultimately, what we need to do is change the perception of primary care and increase the attractiveness of primary care to medical students.

Pugno, PA, Kellerman R, McGaha, AL, Kahn NB Jr. The solution to the US health-care crisis. Lancet. Published online November 3, 2008

Wednesday, October 15, 2008

Mixing it up...Primary Care style

Yes, the chocolate fountain made another appearance...as did students, residents, faculty and alumni from Family Medicine, Geriatrics, General Internal Medicine, and Pediatrics!! Ken Nguyen (BUSM I) and Jonathan Hickson (BUSM I) are enjoying the chocolate fountain here while indulging in healthy fruits.


Thank you to Arthur Celestin (BUSM II) and Matt Tobey (BUSM II) for displaying their musical talent on the ivory (plastic?) keys as Mai Ngyuen, a family medicine resident, shares with Naima Khamsi (BUSM II).

Dr. Angela Jackson (Director of the Primary Care Residency Training, Internal Medicine): "We should do this again!" Marcel smiles and says, "Maybe next semester."

BUSM I students, Doreen Gidali and Ebony Lawson, listen attentively as a faculty member shares about primary care (of course!).


Dr. Ben Siegel talks about Pediatrics (or the delicious crab dip!) with BUSM II student David Epstein.


Thank y'all for a fantastic event! We'll be sure to let you know about the next one!

Monday, October 13, 2008

What is your Dosha?


This past weekend, the BUSM Family Medicine Interest Group, BMC Dept. of Family Medicine, HMS Holistic Medicine Interest Group co-sponsored a workshop designed specifically for medical students to learn more about Ayurvedic Medicine, a traditional medical system of India.


Students from BU, Harvard, and UMass came together for two days of didactic and interactive sessions designed to give a brief introduction to Ayurveda. These sessions featured Dr. H. S. Palep, the only faculty of Mumbai University recognized in both Western Medicine and Ayurveda. Drs. Palep (wife to H.S.), Anusha Sehgal (Ayurveda) and Rob Saper (Western, Family Medicine) also facilitated this unique exchange between medical systems.


During the workshop's didactic sessions, Dr. Palep spoke of the overlap of Ayurveda and Western Medicine. For example, he compared Ayurveda's understanding of information/knowledge inherent to our humanness to the understanding in Western medicine of DNA as the molecular substrate of genetic information.

The didactic sessions were complemented by a session on Ayurvedic therapeutic cooking, a guided meditation and a demonstration of the variety of herbal therapeutics used in Ayurveda.


On Sunday afternoon, the workshop was closed with delicious food catered by Kashmir Indian Restaurant.

Keep an eye out for a more personal account from one of the workshop participants, also a BUSM I student.

Sunday, October 12, 2008

Making primary care "sexy": chocolate fondue

In a movement to make primary care more "sexy," we had tables in the lobby at lunch on Wednesday with information about primary care combined with a chocolate fondue sale. Fresh strawberries and other dried fruits were sold as a fundraiser for future FMIG activities. The table served as an opportunity to sign up students for membership in the American Academy of Family Physicians. Membership is free for students! Here is an interested student signing up for membership! We had 15 students sign up.

Membership in AAFP includes:
  • free subscription to a twice-monthly peer-reviewed journal, American Family Physician
  • weekly email updates about primary care
  • scholarships to Family Medicine conferences
  • discounts on various Family Medicine resources and products
Students can also sign-up online here.
Disclaimer: The online registration form says that you will be billed $15. However, the state chapter will actually pay for students' registration. So you will not be billed!

We gave out free Family Medicine water bottles, AAFP pens, and a factsheet about primary care.

Levon here is sharing with an interested medical student the health benefits of dark chocolate, which was provided on another handout. This is an example of how primary care focuses on prevention.

Thursday, October 9, 2008

Ayurvedic Medicine Workshop Registration


Ayurveda, Sanskrit for "the science of life," is a form of traditional medicine practiced in India. This workshop is an introduction to Ayurvedic Medicine featuring guest scholar and practitioner, Dr. Hanumanthrao Palep (Founder, Dr. Palep’s Medical Research Foundation). Dr. Palep is the only recognized teacher at Mumbai University in both Modern Medicine and Ayurveda. Workshop activities include:
  • Overview of Ayurvedic Medicine
  • How to determine your Prakriti
  • Training in Tongue/Pulse diagnosis
  • Traditional herbal preparations
  • Panchakarma Treatment
  • Yoga or meditation exercise
  • Cooking Lab: Nutrition for your Prakriti
  • Final Dinner Celebration
October 11th 9:00am to 4:00pm
October 12th 9:00am to 4:00pm
Hiebert Lounge at Boston University School of Medicine

Space is limited to 30 medical students.

$15 registration fee payable to FMIG representatives upon completion of this online registration form and receipt of attendance confirmation.

Workshop sponsored by...
BMC Department of Family Medicine
Family Medicine Interest Groups (BUSM & HMS)
Association of Integrative Medicine (BUSM)

Health care crisis compared to current economic crisis - primary care touted as a solution

Tommy Thompson, former HHS Secretary, and Kenneth Thorpe, M.D., executive director of the Emory Institute for Advanced Policy Solutions in Atlanta, speaking at a media telebriefing conducted by the Partnership to Fight Chronic Disease (PFCD), argue that imminent action must be taken to prevent an impending crisis in health care similar to the one currently plaguing financial markets.



As we have been hearing for years now, the US health care system is in imminent danger of collapse. It is conceivable with the current growing costs of health care that no one will be able health care in 10-15 years.

Some current facts:
  • increasing burden of chronic diseases: 95% of Medicare expenses is spent on chronic diseases
  • this proportion is likely to grow: currently 21 million Americans are diabetic but 41 million more are pre-diabetic (this would increase expenses on diabetes from $145 billion to $400 billion annually if all these people became diabetic)
  • 16% of the GNP is spent on health care, amount to $2.4 trillion per year; proportionally more than any other nation on the planet!
  • 47 million people in the US do not have health insurance
  • example: General Motors spends $5.5 billion/yr on providing health insurance to its employees more than it spends on steel for auto parts
Thompson and Thorpe argue that the economic crisis makes it even more urgent that we must redefine the ways we approach health care. They propose the creation of integrated primary care teams, focus on prevention rather than treatment in health care, and use of technology to better integrate patient tracking. The integration of patient care based in a primary care home will reduce redundancy and reduce the need for specialist care.

To read more details see:
http://www.aafp.org/online/en/home/publications/news/news-now/government-medicine/20081008pfcd-tele.html

Interactive Aging Workshop

How well will you function when you are 85?

Join Dr. Won Lee and the BU Chapter of the American Geriatrics Society as they host an Interactive Aging Workshop to explore and experience the aging process. The workshop will be a hands on experience based on Xtreme Aging programs found at other medical schools.

Location:
L-414
When: Tuesday, October 14 @ 5:30 pm
Dinner will be provided!

Please RSVP to buags@bu.edu if you are interested.

Wednesday, October 8, 2008

In the Halls..."What makes Primary Care 'sexy' to you?"

We asked some BUSM medical students, "What makes Primary Care 'sexy' to you?" Here are their responses.

Anthony Lim (BUSM III) says:
I love that primary care takes a holistic approach to each patient rather than focusing on a single body part or system. Yesterday was my first day in primary care clinic at the Jamaica Plain VA. The first patient, Mr. D, came in with fatigue due to poor sleep patterns, concerns about the pain pills he's taking and the effect they may have on his liver, a non-healing lesion of three months on his right shin, blood and air in his urine, and a flare of his psoriasis. Only in primary care do you see patients who present with such a breadth of issues! The resident even managed to spend a few minutes encouraging Mr. D to quit smoking, which speaks to primary care's emphasis on prevention of disease rather than just treatment. Finally, Mr. D made a point of saying how only the resident really understood all his medical issues, and that he didn't want to see anyone else. His remark is a testament to the continuity of care that underlies primary care and the trust that develops between doctor and patient as a result. These are just a few of the reasons why I am so drawn to primary care!
Carly Grovhoug (BUSM I) says:
For something to be "sexy," it must arouse a certain level of intrigue and desire. "Sexy" can be transient, or it can be lasting. In dating, for example, we encounter attractive people who meet our fancy. After getting to know them, however, we come to realize that personalities do not mesh, timing is not right; the appeal fades away.

An attraction can only endure when the object of desire fits in to the framework of an individual's genuine interests.

The essence of primary care -- treating patients over time as individuals in a social and familial context -- excites me.

I want my career to challenge and fascinate me on a daily basis. I also want it to coincide with my interests and strengths. I love learning about people, their histories and their lifestyles. In order to address most of the major health concerns of our society and of our world, we must identify behavioral patterns contributing to morbidity so as to treat and advise patients appropriately. This is no easy task, especially given the economic, social and cultural diversity represented in every physician's office today. Establishing relationships with patients and educating and advocating for them so as to avoid further health complications is a crucial, yet often overlooked step.

On the surface, primary care may not stick out as the most glamorous branch of medicine. It does, however, stand alone in a number of factors -- intimacy of patient-doctor relations, emphasis on prevention and longevity of care. To me, that is more than sexy...that is something I would take home to mom.

Tuesday, October 7, 2008

The Patient-Centered Medical Home

Did you know that...
  • 44,000-98,000 Americans die from medical errors annually?
  • only 55% of patients receive the recommended care?
  • there is a 17-year lag between the discovery of more effective treatments and implementation into routine patient care?
(Institute of Medicine, Chasm in Quality)
As part of National Primary Care Week, Dr. Charles Williams (BMC Dept. of Family Medicine) spoke - at a lunchtime discussion with Thai food - about how the proposed Patient-Centered Medical Home (PCMH) attempts to make the quality improvements that are lacking in the US health care system. The discussion went through the features of the PCMH model and how they attempt to make improvements. Dr. Williams mentioned Dr. Gordon Moore's "Ideal Medical Practice" and how he borrowed from Toyota's famous "Lean Manufacturing" process to create a medical practice that would reduce the seven types of waste (Muda):
  1. Defects
  2. Overproduction
  3. Conveyance
  4. Waiting
  5. Inventory
  6. Motion
  7. Overprocessing
For example, Dr. Williams said, to reduce the waste of "Motion", Dr. Gordon placed his office as close to the parking lot as possible so that patients would waste as little energy as possible getting from their cars to the bed.

Questions from students included:
  • Is the Patient-Centered Medical Home a physical building?
"It could be," said Dr. Williams. He further explained that the PCMH is more of a model for looking at a medical practice and measuring it's many different properties to make improvements.
  • Would this receive opposition from medical insurance companies?
Dr. Williams mentioned a project in Boston that is trying to show that by implementing the model they can make improvements in both quality and cost. This, in theory, should make it more attractive for insurance companies.
  • Isn't this already being implemented by Community Health Centers?
Yes, in fact there are some local CHCs that are using this, or something similar, to do reviews of their current practices.
References

Monday, October 6, 2008

Crisis in Primary Care: Making Primary Care Sexy?

At this evening's "Crisis in Primary Care" event, we heard from Dr. James Petros (Director, BUSM General Surgery Residency Program) and Dr. John Abramson (Family Doctor & author of "Overdo$ed America") on the challenges facing the health care field as the result of a lack of focus on Primary Care.

Dr. Petros gave an overview of the physician workforce shortages from the perspective of a residency director. He mentioned that although there have been overall increases in residency placements, the number of new Primary Care practitioners graduated every year has actually decreased as more people specialize. He can see the results of this trend in the clinic as more advanced cases are seen than before...cases that should have been screened had the person had access to a primary care provider. "People just don't die on the bed anymore." said Dr. Petros, but surgical patients today are dying because of a paucity of post-operational follow-up.

He mentioned that while data indicate that the lack of recruitment to Primary Care practice is due to perceived differences in lifestyle, compensation, and general support, anecdotally, it may also be due to perspectives within medical institutions of a lack of "sexiness" of primary care practice. Students asked whether this isolationism was being resolved by increased communication and cooperation in the physician community. They also wanted to know what kind of initiatives were being pursued to make Primary Care a more attractive option for students/residents.

Dr. Abramson extended the points made by Dr. Petros. He outlined an argument that today's "evidence-based" medical environment is too-heavily influenced by the pharmaceutical industry. He emphasized that, as stated by the American Law Institute, "the fundamental purpose of a corporation is to maximize profits and return those profits to its shareholders." He showed us a shift in the early 1980's where pharmaceutical companies became the major funders of clinical trials. Because of the now pervasive influence of the pharmaceutical industry, academic medical institutions place much more emphasis on the biomedical solutions (i.e. pharmaceuticals) even though evidence shows that in many cases these are just as much or less efficacious than non-biomedical treatments (i.e. diet and exercise).

In responding to Dr. Petros' remarks on the perceived "unsexiness" of Primary Care, Dr. Abramson said that it is the non-biomedical aspects of the patient-physician relationship that are the "sexy" part of Primary Care. The trust, compassion, and respect that can be shared between a PCP and her patient are the very soul of medicine, and shifting our "folk medicine" to embrace these approaches to health care (in addition to the REAL evidence-based practices) is what makes Primary Care so "sexy."

We want to hear from you!! Add your comments about...
  • What makes Primary Care "sexy" to you?
Related Links:

Wednesday, October 1, 2008

Primary Care Brown Bag Lunch: What is the Patient-Centered Medical Home?

Dr. Charles Williams (BMC Family Medicine) will facilitate a lunchtime discussion on the Patient Centered Medical Home as a potential solution to the crisis in primary care.

Tuesday, Oct. 7th @ Noon in McNary R-109
Space is limited to 10 students.
Lunch will be provided, bring your own brown bag.

Tuesday, September 30, 2008

Register for the Primary Care Mixer


Register Here!

When: Friday, Oct. 10th, 2008 from 5:30-8:00pm
Where:
Boston Medical Center, East Newton Pavilion,
2nd floor, Conference Room C & D
Click Here for Maps



Are you...
  • a Medical Student interested in Primary Care?
  • a Resident in a Primary Care specialty?
  • a Faculty member in a Primary Care dept ?
  • an Alumnus practicing Primary Care?

You are invited to join us for the final celebration of a series of events for National Primary Care Week (Oct. 5-11th). This is an event for medical students, residents, faculty and alumni to network for and promote recruitment and retention in Primary Care medical practice. Casual attire recommended. Hors d'oeuvres, including a chocolate fountain, will be served (budgets are tight). Live music provided by generous and talented medical students.

Sunday, September 28, 2008

National Primary Care Week @ BUSM

Mon Oct 6 @ 5:30: "Crisis in Primary Care"
Speaker: Dr. John Abramson, family doctor & author of "Overdo$ed America"
Location: Hiebert
The two speakers will examine the critical shortage of primary care physicians and implications on health policy and patient health. Dr. John Abramson is an award-winning family physician, on the clinical faculty at Harvard Medical School. His publications include "Overdosed America." He will discuss the growing waste and comercialism in American medicine and identify health policy solutions.

Tue Oct 7 @ 12:00 Solutions- Patient-Centered Medical Home

Speaker: Dr. Charles Williams, Family Medicine
Location: R-109
The Patient-Centered Medical Home (PC-MH) is an approach to providing comprehensive primary care established by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association.

These groups, representing about 333,000 physicians, created a set of 7 principles for the PC-MH:

1. Each patient is entitled to a personal physician
2. The physician is the leader of a team of individual practitioners
3. Whole person orientation
4. Care is coordinated and/or integrated using the latest and most appropriate technology
5. Quality & safety
6. Enhanced access to physicians
7. Payment schemes that reflect the value of the PC-MH for patients' health.

Register here


Wed Oct 8 @ lunch: Primary Care Tables, Lobby
We will be selling fruits with chocolate fondue. Information sheets will be provided about primary care highlighting statistics, critical issues and ways to get involved. There will also be a membership sign-up for the American Academy of Family Physicians (FREE) for those interested. Membership includes subscription to American Family Physician, a twice-monthly journal, scholarships to conferences, and other discounts and benefits.

Fri Oct 10 @ 12: Global Health and Primary Care

Speaker: Dr. Thea James, Emergency Medicine
Location: L-112
Dr. Thea James is an Assistant Professor of Emergency Medicine at the Boston Medical Center. She graduated with an MD degree from Georgetown University School of Medicine in 1991, and finished her residency in Emergency Medicine right here at the Boston Medical Center. She has gone to Haitian hospitals to provide care with more modern technology, and is also the Co-Director of a BMC based Haitian Health Institute.

Fri Oct 10 @ 5:30: Primary Care Mixer
Location: BMC East Newton Pavilion, 2nd floor, Conference Room C/D
Come meet and talk with primary care residents, faculty, medical students and alumni.
Register here

Tue Oct 14 @ 5:30: Geriatrics Workshop
Hosted by Boston University Chapter of the American Geriatrics Society
Speaker: Dr. Won Lee
Location: L-414
How well will you function when you are 85?

Join Dr. Lee and the BU Chapter of the American Geriatrics Society as they host an Interactive Aging Workshop to explore and experience the aging process. The workshop will be a hands on experience based on Xtreme Aging programs found at other medical schools.


Wed Oct 15 @ 6:00: Medical Activism Panel
Speakers: Dr. Michael Grodin (BUSPH), Dr. Felton Earls (Social Medicine, HMS), Dr. Joia Mukhergee (PIH, HMS), Dr. Jay Bhatt (PGY1 Cambridge Health Alliance, past AMSA president)
Location: Bakst
A multi-generational panel of physicians will reflect on the role activism plays in their medical careers and discuss the important of activism in medicine today.

Saturday, September 27, 2008

Patient-Centered Medical Home

The Patient-Centered Medical Home (PC-MH) is an approach to providing comprehensive primary care established by the...
  • American Academy of Family Physicians (AAFP)
  • American Academy of Pediatrics (AAP)
  • American College of Physicians (ACP)
  • American Osteopathic Association (AOA)
These groups, representing about 333,000 physicians, created a set of 7 principles for the PC-MH:
  1. Each patient is entitled to a personal physician
  2. The physician is the leader of a team of individual practitioners
  3. Whole person orientation
  4. Care is coordinated and/or integrated using the latest and most appropriate technology
  5. Quality & safety
  6. Enhanced access to physicians
  7. Payment schemes that reflect the value of the PC-MH for patients' health.
Indeed, since the development of this model, it has been touted as a potential solution to the challenges of providing quality health care for the entire US population. According to the Commonwealth Fund,
The Commonwealth Fund 2006 Health Care Quality Survey finds that when adults have health insurance coverage and a medical home—defined as a health care setting that provides patients with timely, well-organized care, and enhanced access to providers—racial and ethnic disparities in access and quality are reduced or even eliminated.
Find out more about this New Model for primary care at the following events at Boston University Medical School.

Upcoming Events

Tuesday, Sept. 29th, 2008 @ 12:00pm
BMC Family Medicine Grand Rounds
The Medical Home, physician reimbursement plans, and other solutions to the crisis Primary Care
Dr. Charles Williams
Dowling 1 Conference Auditorium
Free Food

Tuesday, Oct. 7th, 2008 @ 12:00pm
--National Primary Care Week--
Solutions: The Patient-Centered Medical Home
Sponsored by FMIG
Dr. Charles Williams (BMC Family Medicine) will facilitate a lunchtime discussion on the Patient Centered Medical Home as a potential solution to the crisis in primary care. Participants are encouraged to attend Dr. Williams' talk at the Family Medicine Grand Rounds.

Dr. Williams' Bio


References

Monday, September 22, 2008

Mass Crisis: Is This The Future of Health Care?

The recent Massachusetts legislation to mandate health insurance has been touted by many as a victory in health care reform. Implementation of this experiment in solving to US health problems, however, still presents many challenges.

Mandatory Health Insurance...plenty of patients but where are the doctors
?

A recent article in the Boston Globe (Sept. 22, 2008) highlights a few of the upcoming challenges that Massachusetts will face as a result of the upcoming implementation of the MA health insurance mandate. The most immediate of these is the lengthy wait times for receiving an appt. with a primary care physcician (PCP). The average wait time to see an Internist was 52 days and 46 days to see an OB/GYN.

These long wait times are the result of a shortage of PCPs, lack of focus on preventive health care, administrative burdon, and misdirected physician compensation schemes. According to MMS President Dr. Bruce S. Auerbach, who recently addressed a session of the National Congress on Health Reform in Wasington, D.C., there are severe labor shortages in:
  • Internal Medicine
  • Family Medicine
  • Vascular Surgery
  • Neurosurgery
  • Cardiology
  • Anesthesiology
  • Psychiatry
  • Gastroenterology
  • Urology

How to Increase PCP Supply?

In an attempt to increase the availability of PCPs, the federal and state government have funded a number of programs, including:

  • loan forgiveness programs
  • advanced medical home pilot projects
  • expanded primary care training
Medical school for free?!?!?!

From the Boston Globe article...
The Massachusetts law includes $1.5 million this year to help the University of Massachusetts Medical School expand its class size - from 103 students to as many as 125 - and to waive tuition and fees for students who agree to work as primary care doctors in Massachusetts for four years after they finish training.
This is indeed a crisis situation. If the state is moving towards free education for medical students interested in primay care, it is a clear sign of the dire circumstances facing the population of Massachusetts, and the rest of the United States.

So what can be done about this?

There are several proposed solutions. Together with AMSA, FMIG has planned a series of events for National Primary Care Week (Oct. 5-11) to highlight the challenges and potential solutions facing health care in the United States of America. Come and find out for yourself what we can do as future health professionals to best prepare for the difficult sitations waiting for us upon graduation.

References
Resources

Wednesday, September 17, 2008

Study showing fewer medical students intending to become primary-care physicians

Check out this new report and the corresponding JAMA article.
http://jama.ama-assn.org/cgi/content/full/300/10/1154

NBC Nightly News (9/9, story 10, 0:30, Williams) reported that a new study shows that few medical school students plan to become primary-care physicians. Most "are going into specialized fields instead."

USA Today (9/10, Rubin) reports that "medical students are shying away from careers in general internal medicine, which could exacerbate the U.S. doctor shortage expected by the time the youngest baby boomers head into their senior years," according to a study published in the Sept. 10 issue of the Journal of the American Medical Association.

In fact, "only two percent of graduating medical students say they" were considering practicing as primary-care physicians, the AP (9/10, Johnson) adds. By comparison, a similar survey conducted in 1990 showed that nine percent of medical students were interested in primary care. The data showed that "paperwork, the demands of the chronically sick, and the need to bring work home are among the factors pushing young doctors away from careers in primary care." Lead author Karen Hauer, M.D., of the University of California-San Francisco, pointed out that "it's hard work taking care of the chronically ill, the elderly, and people with complex diseases -- 'especially when...doing it with time pressures and inadequate resources.'"

For the study, researchers surveyed "1,177 medical students last year, found just 24 wanted to practice primary care, while 23 percent were interested in internal medicine, whose subspecialties include cardiology and cancer care," New York's Newsday /Bloomberg News (9/10) notes.

Salaries in primary care dissuade medical students from the field. The Columbus Dispatch (9/10, Hoholik) reports that "fewer U.S. medical students are choosing careers in family medicine because of long work hours and low pay," according to a research letter published in the Sept. 10 issue of the Journal of the American Medical Association.

Mark H. Ebell, M.D., of the University of Georgia, "examined whether there is an association between specialty selection and anticipated incomes using current data," MedPage Today (9/9, Groch) added. He used "residency information...from the National Residency Match Program," and "mean annual salary in 2007 came from the annual American Medical Group Association survey of physician salaries."

Dr. Ebell found that "family medicine had the lowest average salary ($185,740), and the lowest percentage of filled residency positions (42.1 percent)," Modern Healthcare (9/9, Robeznieks) noted. And, "internists, with the third-lowest salary of $193,162, had the third-lowest residency fill rate: 55.9 percent." In contrast, "radiologists -- whose average salary was $414,875 -- had a residency fill rate of 88.7 percent; and orthopedic surgeons -- whose average salary was $436,481 -- had a fill rate of 93.8 percent." Dr. Ebell wrote that "the correlation between salary and primary-care physician shortages -- which, in turn, may be tied to higher all-cause cardiovascular, cancer-specific, and infant mortality rates -- has persisted since his original research on this issue was published" in 1989.

Researchers say racially diverse medical schools may better prepare students. HealthDay (9/9, Preidt) reported that "attending medical schools with high levels of racial and ethnic diversity may better prepare white medical students to care for minority patients," according to a study published in the Sept. 10 issue of the Journal of the American Medical Association. Somnath Saha, M.D., of the Portland VA Medical Center, and colleagues, "analyzed data from a Web-based survey of 20,112 graduating medical students from 118 medical schools." The researchers "found that white students at medical schools with the highest quintile (one-fifth) for student body racial and ethnic diversity, measured by the proportion of underrepresented minority (URM) students, were 33 percent more likely to rate themselves as highly prepared to care for minority patients than white students at medical schools in the lowest diversity quintile -- 61.1 percent vs. 53.9 percent, respectively." Notably, "this association was strongest in schools in which there was positive interracial interaction."

The study also showed that "students from under-represented minorities were significantly more likely (at P<0.001) than either white or non-white/non-URM students to plan to work with the underserved, at 48.7 percent, versus 18.8 percent, versus 16.2 percent, respectively," MedPage Today (9/9, Smith) added. The authors of an accompanying editorial argued that these findings "might persuade medical schools to do more to encourage diversity." The St. Louis Post-Dispatch (9/10, Bernhard) also covers the story. This week's JAMA Report video features the study.

Monday, September 8, 2008

Sports Medicine Series

Dear all,

The Family Medicine Interest Group is presenting a year-long workshop series in Sports Medicine, featuring Dr. Alysia Green, a Sports Medicine doctor at BMC.

Dr. Green will be giving an Introduction to Sports Medicine talk on Wednesday, September 10th from 11:30-12:30 in room L-110. Lunch will be provided!

Each month, Dr. Green will be presenting on a different aspect of her practice as a Sports Medicine physician. Students will be able to learn about these exams and practice interactively on each other with assistance from Dr. Green. Workshops and seminars include:
-boarding
-joint exams
-taping
-concussions

If you are interested in going to any of the workshops this year, you MUST attend this Wednesday's talk! Each workshop will be open to sign-up on a first-come, first-serve basis after that.

Thursday, September 4, 2008

FM Scholars program

Dear FMIG members,

Marcel suggested I post here to be sure you all know about our Family Medicine Scholars program. You can learn about it at:

http://www.bu.edu/familymed/medstudenteducation/scholars.html

We currently have 4 active scholars, and more joining shortly. If you are interested in learning more about this program, which is unique to our department, please contact me. My email is: John.Wiecha@bmc.org


John Wiecha, MD, MPH

Director of eLearning / Director of Predoctoral Education
Department of Family Medicine, Boston U. School of Medicine
eLearning website: www.bu.edu/familymed/distance/index.htm
Second Life: http://slurl.com/secondlife/Teaching%209/21/132/23

Friday, August 22, 2008

Medical Tourism and Family Medicine

Perhaps you have heard about it from Robin Cook's latest medical thriller, "Foreign Body," or from Atul Gawande's description of the Shouldice Hernia Clinic in his book "Complications", or in news articles about Coretta Scott King's death at the Santa Monica Hospital in Rosarito, Mexico...medical tourism, the travel of patients (mostly from the USA) abroad for medical care, is on the lips and in the minds of hospital administrators, insurers, and health care professionals all over the United States of America. Two recent articles in the Economist, "Importing Competition" and "Operating Profit" (both from Aug. 14th, 2008), describe an unprecedented globalization of health care that will see 10 million people (mostly US citizens) traveling abroad for medical care, a total estimated market size of $21 billion.

So how will this new movement affect physicians and physicians-in-training domestically? The two MD's hosting the "MBA for MD's" seminar at theis year's AAFP national conference believe that, just as we have seen the outsourcing of medical transcription, record-keeping and radiological interpretation, we will see increased outsourcing of non-urgent surgeries. While these jobs will be in jeapordy in the US, they predict a surge in the need for primary health care providers to take care of these patients post-op. Perhaps the more efficient (and effective) private clinics outside of the US will, in their quest to provide the highest quality services, help to compensate primary health care practitioners at home. So, this is seemingly good news for the field of Familiy Medicine.

But what about the effects of medical tourism in the host countries? The Economist article author's predict a potential for a win/win situation. They claim that an increased demand for medical specialist services in host countries will force a reverse brain-drain, where former ex-patriot physicians will be able to return to their home countries to practice medicine. This could potentially increase funding for medical education institutions as well.

Indeed there are examples of successful Centers of Excellence abroad, including the Heart Institute of the Caribbean in Jamaica and the Arvind Eye Clinic in India. Both of these clinics use a "Robin Hood" mission to provide the highest quality specialty medical services to everybody that enters their doors (i.e. "Excellent care without exception"). Each of these clinics offer a sliding-scale payment structure, similar to many Community Health Centers in the US, to share the cost of relatively expensive services across their population; the higher-income patients pay for the lower-income patients. But do all of the international specialty service clinics share this philosophy? Is their mission to provide lower cost services to medical tourists and to the local population?

As stated in the articles, medical tourism is bringing the international competitors to the local health care market. The local hospital is in direct competition with the Bumrungrad hospital in Bangkok, which claims to be the world's largest private clinic. We are no longer able to view the fast-paced innovations in health care abroad as quaint or interesting, nor can we ignore the impacts of our domestic health problems on the exodus of our "medical refugees."

Let us know what you think about this new "flattening of the health care world."
  • Will the ex-patriot doctors now returning home still be mostly treating the wealthy who previously sought treatment in the US?
  • How will medical tourism affect our future job opportunities as physicians?
  • Will Primary Care see an increase in pay scale over the next 5-10 years?
  • Should FMIG host a talk/discussion to bring these issues to the table at BUSM?

Wednesday, August 20, 2008

FMIG Kickoff Event!

Tuesday's kickoff event for FMIG, "What is Family Medicine", had a great lineup of panelists who demonstrated the diversity of opportunities in practicing family medicine. Over 120 BUSM students came to hear what the panelists had to say, and to enjoy the free Thai food. (By the way, we are sorry for those of you who didn't get food -- we were expecting 80! We'll make sure you are well fed at our next event.) Dr. Brian Penti is currently a hospitalist in Family Medicine at BUMC. He spoke about his wealth of international experiences in Bolivia, Guatemala, Vietnam, and Cambodia and his current involvement in training programs for doctors in Vietnam. Dr. Alysia Green shared her stories of "sideline medicine" as a sports medicine family doctor and how her passion for sports had a major impact on her career choice. Dr. O'Brien shared her career path, which began in rural private practice and has led her to BUMC where she is involved in Labor and Delivery and pursuing her MPH in Maternal and Child Health. Dr. Shah discussed what life is like in a community based health center in Boston and gave advice to the students on how to key into their personal interests in a career path. Finally we got to hear from Kevin Kless, a fourth year at BUSM, who shared his own reasons for choosing family medicine. After hearing from first and second years after the panel, the event turned out to be an incredibly informative first glance at Family Medicine.

Tuesday, August 19, 2008

Pictures from "What is Family Medicine?" Panel

We just completed our first FMIG event: "What is Family Medicine?" Panel. We had five panelists come and speak.The Panelists represented a broad spectrum of family medicine. From left to right in the photo below:
  1. Dr. Brian Penti: Family Medicine with a focus on International Health
  2. Dr. Alysia Green: Family Medicine with a focus on Sports Medicine
  3. Dr. Michelle O'Brien: Family Medicine with a focus on Obstetrics. Currently completing a MPH in Maternal/Child Health.
  4. Dr. Madhavi Shah: Family Medicine practicing in a community health center
  5. Kevin Kless: 4th year medical student applying for family medicine residency
Photos of all the students who attended the lunch talk.

One of the student leaders, Marcel Tam, introducing the speakers.
Come back soon for a more complete executive summary of the panel.