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?

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

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.

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"

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

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.

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