BUSM FMIG

Wilderness Workshop

2012-01-04T04:52:00.000-08:00

Lions and tigers and bears, oh my!

Family Medicine Interest Group
invites you to attend a
Wilderness Workshop

January 3, 2012
5:00pm
Room L-203
A delicious Thai dinner will be provided!

Dr. Raj Woolever and Dr. Deborah Taylor will be discussing Wilderness Medicine and demonstrating Field Triage. This workshop will include hands-on activities like learning proper evacuation and carrying techniques, bandaging, splinting, and scene assessment and de-crumpling. This will be a great opportunity to learn about the practical skills of Family Physicians and gain valuable medical skills!

Dr. Raj Woolever and Dr. Deborah Taylor are the Program Directors of the Central Maine Medical Center Family Medicine Residency. There will be opportunities to discuss doing away clerkships in Central Main at CMMC.

Happy New Year!

FMIG Leaders,

Daniel Hwang, Annie Jack, Laura Wong, Owen Kendall, Anais Parker, & Gayatri Boddupalli

FMIG Summer Planning Event for 1st Year Students

2012-01-04T04:46:00.000-08:00

FMIG hosted a well attended (70 + students!) informal lunch for 1st years to hear from 2nd year students about their experiences last summer. 1st year students broke into groups and 2nd year students rotated to present and answer questions on the following topics:

- Family Medicine Externship Program

- Family Medicine Scholar Program

- Research (at BMC and elsewhere)

- Global Health

- The Other Side of the Bed

Thank you to everyone that participated!

2011-10-23T14:34:00.000-07:00

A Follow-Up Visit with a Country Doctor

Speaker: Dr. David Loxterkamp

Family Physician and Author

6-7:30pm, L109

Students and physicians are invited to kickoff Primary Care Week with our special keynote speaker!

Dr. David Loxtercamp is a rural family physician from Belfast, Maine. He is the author of the book, "A Measure of My Days: The Journal of a Country Doctor," which chronicles his life as a family medicine doctor and his interactions with his patients. Dr. Loxtercamp will speak about the significance of being a primary care physician in a rural area, the importance of listening to and telling patient stories, and the role of writing in his career as a physician.

NPR did an interview with Dr. Loxtercamp earlier this year. You can find the interview and transcript here.

FMIG to Co-Host BUSM Primary Care Week

2011-10-16T11:29:00.000-07:00

AMSA | FMIG | IMIG | PEDS | CHP
Boston University School of Medicine

are proud to invite you to

PRIMARY CARE WEEK

Monday, October 17th 12:00pm-1:00pm, R103
Med-Peds - A Lunchtime Discussion

Speaker: Dr. Jennifer McEntee

National Meds-Peds Residents' Association Immediate Past President

Tuesday, October 18th 11:30am-12:20pm, L109
“Advocating for Patients—Medical Legal Partnerships”
Speaker: Dr. Megan Sandel

Assistant Professor of Pediatrics

Tuesday, October 18th 6:00pm-7:30pm, L109
“A Follow Up Visit with a Country Doctor”
Speaker: Dr. David Loxterkamp

Family Practicioner/Author

Wednesday, October 19th 11:30am-12:30pm, L209
“Primary Care in Your Community”
Speaker from the MA League of Community Health Centers

Wednesday, October 19th 6:00pm-7:00pm, L110
Pathways in Primary Care Panel Doctors from Family, Ob/Gyn, Pediatrics, and Internal Medicine

Thursday, October 20th 12:30pm-1:30pm, L201/203
“Health Reform & Primary Care”
Speaker: Dr. Alan Sager
Professor of Health Policy and Management at BUSPH

"What is Family Medicine"

2011-09-03T12:21:00.000-07:00

Thank you to our panel of physicians for attending the event and for your continued support of FMIG!

Panel included:

Dr. Nanette Harvey, Director of Predoctoral Education

Dr. Joanne Wilkinson, Associate Director of Predoctoral Education

Dr. Brian Penti, Attending, Family Medicine

Dr. Jennifer Pfau, Attending, Family Medicine

"What is Family Medicine?"

2011-09-03T12:19:00.000-07:00

Greetings First and Second Years!

Have you heard of Family Medicine, but don't really know much about it? Are you curious how you can practice Peds, OB/Gyn and Medicine all under ONE speciality? Then, come check out the Family Medicine Interest Group's (FMIG) "What is Family Medicine" lunch talk.

We have a panel of wonderful BMC Family Medicine doctors ready to share with you the details of their speciality, as well as a few stories and experiences from their careers. Bring your questions and your appetites! Delicious NON-PIZZA LUNCH will be served.

When: Wednesday August 31, 11:30

Where: R-115

Cheers!

Your FMIG Co-chairs

Family Medicine Residency Match Lunch

2011-09-03T11:59:00.000-07:00

FMIG hosted a well attended event last spring to celebrate the 4th year students who matched in Family Medicine and to help 1st and 2nd year students gain insight into the opportunities available in Family Medicine and the process behind applying for residency.

Topics included:

How did you pick which residency programs to apply to?

Were you restricted by geography or specific program needs?

How many applications did you send out?

Pros and cons of Family Medicine compared to Internal Medicine.

What criteria do you look for in a residency program? How do you get involved in obstetics through a family medicine residency program?

Are you worried about not being able to pay back your loans because of the salary for Family Medicine doctors?

Why family medicine and not Med-Peds?

What are the family med-friendly areas of the country and what are the family med-unfriendly areas?

Experiences (research, volunteer, etc) that strengthened their application

Our panel included:

Ashley Wilson BUSM '11

Trina Huffman BUSM '11

Dr. Joanne Wilkinson FMIG faculty advisor

Thank you to our panel and to everyone that came out!

2011-2012 FMIG Leadership Team

2011-09-03T11:51:00.000-07:00

Introducing a great group of second year medical students to lead FMIG and bring lots of exciting events to BUSM this year!

Leadership Team (left to right):

Anais Parker, Annie Jack, Owen Kendall, Gayatri Boddupalli, Laura Wong, and Daniel Hwang

Faculty Advisor:

Dr. Joanne Wilkinson

Opening Primary Care Week With a Bang -

2010-11-03T15:42:00.000-07:00

- FMIG's first event was held on Monday!

"Can I Afford to Do Primary Care: A Workshop on the Economics of a Career in this Specialty"
with Dr. John Wiecha, Assistant Dean of Student Affairs

Students were able to see just how well a new family med doc could live after graduation. Cost of living (food, even alcohol), housing prices (in Boston or Denver), compensation (residency and beyond), loan repayments (10 or 25-year plans), spousal income, retirement savings and children were all included in the calculations.

Perhaps more importantly, a few options for debt repayment/forgiveness were outlined including the National Health Service Corps and the newer Non-Profit Loan Forgiveness (NPLF) plan.

Thank you to all the first and second-year BUSM students who came out to this important info session - watch for more sessions hosted by Dr. Wiecha in the future.

National Primary Care Week at BUSM

2010-10-29T11:14:00.000-07:00

All at BUSM are invited to attend National Primary Care Week events November 1st - November 5th.

FREE FOOD WILL BE PROVIDED AT ALL EVENTS

RSVP (http://tiny.cc/4378w)

The events include:

Monday November 1st: 11:30-12:30 *L109

"The Economics of Primary Care" A lunch talk with Dr. Wiecha and Dr. Kelly

* PLEASE RSVP to this event as space is limited (http://tiny.cc/4378w)

Tuesday November 2nd 5:00-7:00 pm

Primary Care Mixer - bring your questions for a casual, candid conversations and networking with primary care physicians. The physicians attending are from a variety of different primary care specialties and various years in practice.

* This Event is at JJFoley's 117 East Berkeley Street Boston, MA 02118

* A group will be leaving at 4:45 from the medical school lobby

Wednesday November 3rd 11:30-12:30 *L206/209

Pediatrics Residency lunch Talk and Panel

Thursday November 4th 6:00-7:30 *Heibert

"Primary Care Pathways" Come listen and ask questions to a panel of Family Medicine, Internal Medicine, Pediatric, and OB/GYN primary care physicians. The panel will discuss what drew them to primary care in general and to their field in particular, and about what their current practice is like (patient population, types of work, lifestyle, advantages/disadvantages).

Friday November 5th 11:30-12:30 *L109

"How Health Reform will Affect Primary Care" Hear from Dr. Alan Sager as he discusses the recent health reform law and how it will change the face of primary care health care.

Please RSVP to the above events at http://tiny.cc/4378w

Please also complete the following survey to assist our groups in funding these events: http://www.surveymonkey.com/s/3F69QQR

We look forward to seeing you next week!

AMSA, FMIG, IMIG, and PEDS

Room Change

2010-09-08T13:40:00.000-07:00

Our "What is Family Medicine" event on Tuesday, September 14th (11 am) will be held in R-103, not R-115 as originally posted.
See you there!

-BUSM FMIG

"What is Family Medicine?"

2010-08-16T12:11:00.000-07:00

Good question. Come out to FMIG's next event September 14th to find out!

We'll have our speakers and panelists address this and other important issues such as:
-"what is this FMIG you speak of?"
-"how do CCHERS, FaMeS, and Family Med Scholars differ?"
-"can I get some free pizza for lunch?" (yes!)

When: Tuesday September 14th, 11 am - 12 pm
Where: R-115
What: presentation/panel discusssion/Q+A/lunch

Family Medicine Residency Panel + Dinner

2010-06-16T13:38:00.000-07:00

Our first event was a great success - thank you to all the hungry first-years who came to get in on our exceptional thai food, and of course, to ask all the important questions of our family medicine panelists.

Our panelists graciously explained how family medicine differs from other specialties (such as internal medicine), what kinds of experiences prepared them for a career in the field, relevant financial considerations and why they ultimately chose family medicine. Thank you to:

Dr. Tom Hines, Residency Director at BMC Family Medicine Residency
Dr. Caitlin Day, PGY3 at BMC Family Medicine Residency
Dr. Anthony Lim, BUSM '10 and resident at
Santa Rosa Family Medicine Residency
Dr. Angelica Salazar, BUSM '10 and resident at
UCSF-Natividad/Monterey Bay

2010-2011 FMIG Gets Rolling

2010-04-27T19:02:00.001-07:00

Stay tuned for the inaugral event organized by our incoming 2010-2011 FMIG leaders!

Mark your calendars for May 11, 5-6 pm.

Cheers,

2010-2011 FMIG
Ammarah Iqbal
Emily Kidd
Laura Moreno
Lauren Scott
Megan Waterman

Global Health in Family Medicine

2010-01-18T09:35:00.000-08:00

I have attached below a post on the Student Leaders listserve regarding Global Health Opportunities in Family Medicine. Feel free to contact either of the national student reps: Andy (alutzkanin@hmc.psu.edu) or Kevin (kmb64@drexel.edu) for more information

A variety of AAFP Commissions met this past week in Kansas City, including your appointed resident and student leaders. The Subcommittee on International Family Medicine was one of these, and I wanted to provide you a few updates about what we talked about. Some things were new business, and some were finding ways to respond to student and resident resolutions from National Conference. Take a look at the notes below, and feel free to contact any one of us if you want more information!

• Global Health Networking: The Subcommittee discussed the resolution from NCFMR/S on creating a Global Health Networking Link. There is currently a discussion board and listserv for this purpose, but it is not utilized. As a start, we decided to create a Facebook page modeled after the National Conference example, but using the Family Medicine Global Health Workshop as the focus of the page. This would allow the opportunity for postings about people's experiences in international activities. The AAFP will also provide content on the page with references to available resources for Global Health, including links to a database (more info below). It will also allow the AAFP to publicize the Global Health Conference and link attendees together for productive conversation and networking.

• We discussed and updated the Global health Curriculum Guidelines. The students and residents will also be updating the presenting for National Conference on preparing for an international experience. If you have tips to share, please let us know.

• Student International Scholarships: A fund is going to be established within the AAFP Foundation to support students in international experiences. While there is not enough money to guarantee scholarships at this time, the fund will be a way to start the process for when funds become available. People can donate to this fund, with the idea that it will eventually have enough money to fund students for experiences. So if you know any rich benefactors, point them here!

• Global Health Link off homepage: It was discussed that finding global health resources takes multiple clicks off the homepage. Many discussed how global health is a big draw for students to go into Family Medicine, and suggested we make it more prominent. It also fits with the goal of trying to emphasize Family Medicine’s essential role in global health, especially given the Obama administration’s Global Health Initiative.

• Global Health Contact Database: Working from the resolution from National Conference, we agreed with setting up a database of members who have participated in global health programs and will work with staff to set it up. Staff had already been working on this through the Global Health Workshop.

• AAFP Statement on Global Health: The Obama administration’s recently announced Global Health Initiative, as well as a new Institute of Medicine report on Global Health look at improving health care systems in developing nations. Some other organizations have issued statements reviewing these documents and made recommendations. The subcommittee decided that we should also review this and create a statement that shows how FM is positioned to meet the goals outlined in these reports. So stay tuned for the statement!

• Student with Physicians with Heart: A resolution from NCFMRS requested a dedicated student position within Physicians with Heart, a group that travels on medical trips abroad. As of 2009, the AAFP is no longer a partner with Physicians with Heart, so it cannot make this happen. However, there is a rumor that Physicians with Heart is trying to make this happen anyway.

• Haiti earthquake relief: The AAFP Foundation is organizing disaster relief, both in resources and working with its partners the International Medical Corps and Heart to Heart International for volunteering.

• FM Global Health Workshop: For those interested in global health, the Family Medicine Global Health Workshop will be held in Coral Gables, FL on September 9-11, 2010. As of now, keynote speakers will include Donna Shalala, PhD, President of the University of Miami and Fitzhugh Mullan, MD, Dean of GWU Medical School. http://www.aafp.org/online/en/home/aboutus/specialty/international/pgms.html

• Newsletter: Check out the International newsletter if you want more updates. http://www.aafp.org/online/en/home/aboutus/specialty/international/internationalupdate.html

More questions? Get in touch with your subcommittee student/resident representatives
Andy Lutzkanin, MS3, Penn State College of Medicine, Hershey, PA
Kevin Bernstein, MS3, Drexel University College of Medicine, Philadelphia, PA
Lindsay Botsford, PGY-3, Baylor/Kelsey-Seybold FMRP, Houston, TX

AAFP Congress of Delegates Experience

2009-10-12T14:28:00.000-07:00

The AAFP Congress of Delegates is the academy's policy-making body. It is being held in Boston this year (as I write) and I thought I would share some of my experiences attending one day of the Congress.

The Congress consists of 2 delegates from each state, 2 resident delegates and 2 med student delegates. All AAFP members are allowed to attend (may I add at this point that medical student membership to the AAFP is free). During the Congress, the Executive and Board positions are elected. Also, various policies, which are introduced by the state delegates, are discussed and voted upon.

I attended three of the reference committee hearings: Committee on Education, Committee on Advocacy and Committee on Health of the Public. At a reference commitee hearing, resolutions created by states are introduced and any AAFP can provide testimony for or against the resolution. The reference committee then makes a recommendation for or against the resolution and this is then voted on in the large Congress.

Committee on Education highlights:

- a resolution was introduced to eliminate Step 2 CS based on the fact that it does not in fact evaluate clinical skills, is a financial burden on students and is of no use in differentiating between students for residency programs. Of note, not a single residency director or educator stood up and defended the usefulness of Step 2 CS! One of the delegates said: "A pre-med student with no clinical experience could read FirstAid for Step 2 CS and pass it."

- proposals to advocate for increase in funding for primary care residency programs

- a resolution supporting expanding student and residency leadership positions within the AAFP

Committee on Advocacy highlights:

- a huge debate about single payer health care system. It seemed like many of the members who testified supported the single payer system but did not think it is the right time to implement it

Committee on Health of the Public:

- advocating for banning cell phone usage while driving

- advocating for increased social determinants of health education in medical schools

- advocating for mandatory influenza vaccinations of health care workers

... to mention a few. Click here for more details about the congress.

Some Recent News from AAFP

2009-10-08T05:38:00.000-07:00

AAFP Leaders Attend Presidential Speech on Health Care Reform, Private Meeting With President Reinforces Importance of Primary Care

AAFP Statement: Family Physicians Call on Senate to Confirm Regina Benjamin, MD, as Surgeon General

Upcoming Events!

2009-10-08T05:19:00.001-07:00

The semester is well underway now, as you can probably guess by the recent dearth of blog posts. FMIG is still alive and kicking though! Don't pronounce us just yet.

We have super exciting events lined up for the next few weeks, especially as we partner with other student organizations to host National Primary Care Week together. This year's theme is:

Primary Care is Everybody Care:
The Future of Medicine is Now
October 19-23, 2009

To kick off NPCW, we will have a talk in Hiebert at 6pm on Friday, October 16, with none other than Dr. Ted Epperly, President of the American Academy of Family Physicians!

Dr. Epperly will begin the evening as the keynote speaker. He will be addressing the key role of family medicine and primary care in serving the future of health care in America, with a focus on minority health issues. He will also be discussing current health care reform efforts.

His keynote will be followed by dinner, small group discussions on advocacy, and networking opportunities. We hope everyone will be able to make this talk-- it is certainly not often that BUSM gets a visit from the president of a national professional academy, and even rarer to have that guest be so well-versed in and intimately connected to the current healthcare reform debate with a powerful voice for primary care and for family medicine.

Sports Medicine Workshop: On Field Emergencies

2009-08-24T19:55:00.000-07:00

Hope you had a good weekend! You are invited to our first Sports Medicine Workshop of the year -- limited to the first 20 RSVPs. Look out for the sign up email in your inbox soon.

Who: Everyone!
What: What is Sports Medicine? Introduction to On Field Emergencies! Dr. Alysia Green will be discussing the field of Sports Medicine. She will also be teaching us how to handle on field emergencies and how to spine board an athlete/patient!
When: Thursday (8/27) 5:30pm (will end no later than 7:30pm)
Where: L-301
Why: Learn about sports medicine, practice spine boarding on each other, meet first and second years, and eat snacks!

We will be having plenty more workshops in the future! Check out the Events Calendar at the top of our blog.

Contact Info from the Lunch Panel

2009-08-20T11:12:00.001-07:00

Thanks so much for coming to FMIG's "What is Family Medicine Panel?" this past Tuesday! We had a great turnout and were really happy to see a mix of both years. To those of you who weren't able to make it but wanted to, please keep your eyes open for upcoming FMIG events.

Also, we received some great questions about Family Medicine from your feedback evaluations. We will write a whole separate post to answer as many as we can, so keep visiting the blog!

Here are the email addresses of our panelists from Tuesday who all agreed that they would be happy to respond to questions you might have:

Dr. Markuns (International Health interests)- Jeffrey.Markuns@bmc.org
Dr. Green (Sports Medicine interests)- Alysia.Green@bmc.org
Dr. O'Brien (Ob-Gyn/Rural health interests)- michlynn@bu.edu or Michelle.OBrien@bmc.org
Anthony Lim (BUSM IV) - alim@bu.edu
Christopher Simons (BUSM IV)- simonsch@bu.edu

Finally, for those of you who approached Dr. Markuns after the panel and were interested in possible international health opportunities, he has kindly provided the following contact:

LeBoHA program
Libby Cunningham is the Program Coordinator (ecunning@bu.edu)
Dr.Markuns also mentioned that students should feel free to contact him directly with further questions.

Sports Medicine Workshop series!

2009-08-19T12:47:00.000-07:00

Many of you met Dr. Alysia Green at our panel this past Monday. As you heard, Dr. Green is one of four BUMC family medicine faculty fellowship-trained in sports medicine. This year, she will continue the very successful series of FMIG Sports Medicine Workshops that started last year. Thanks, Dr. Green!

This year's workshops will all take place on Thursday evenings, 5:30-7:30pm. Because the workshops teach hands-on skills, each workshop will be limited the first 20 students to sign up. Emails will be sent out in advance of each workshop with specific RSVP links. For those who like to plan ahead, check out the FMIG Events calendar at the top right corner of this page to see all upcoming Sports Medicine Workshop dates and topics.

*** The first workshop is next THURSDAY 8/27. Dr. Green will introduce Sports Medicine, in the context of Family Medicine, and will teach spine boarding! ***

Donna (MS2, kurowski[at]bu.edu) works closely with Dr. Green to plan these workshops throughout the year. Email her if you have any questions!

Reminder about AAFP

2009-08-17T19:09:00.000-07:00

Remember, as students we get FREE membership to the American Academy of Family Physicians, which includes a FREE subscription to the American Family Physician Journal, a great resource even before our clerkships. Sign up for membership online!

What is Family Medicine? Lunch Panel TOMORROW!

2009-08-17T19:05:00.000-07:00

Come to our first event of the year!

Who: Everyone
What: What is Family Medicine? Hear from family physicians and a 4th year student applying to family med residencies.
When: Tuesday (8/18) 11:30am-12:30pm
Where: L-110
Why: Learn about the full scope of practice in family medicine, meet first and second years, and eat free PIZZA! (Hint: always better to come early when there's free food...)

Check back here next week for a recap and some photos of the event...

Back to School

2009-08-17T17:53:00.000-07:00

To all the first year students: Welcome to BUSM! Thanks for stopping by our table at the student organizations fair last week. We enjoyed talking to all of you and sharing about family medicine and FMIG. And to the second year students: Don't forget to take the DRx quiz tonight. And welcome back!

Some of the FMIG leaders: Donna, Neetu, Lucas, and Jessica
(Not pictured: Carly, Caitlin, Erkeda)

While the first years are acquainting themselves with BUSM and each other, the second years hit the ground running with the first block of the Disease and Therapy course. But even with lectures galore, we at FMIG are working hard to plan a great year of events and opportunities for you.

Last Thursday, a group of second year students including many of the FMIG leaders volunteered at a health fair hosted by the Codman Square Health Center, a popular CCHERS site. We took blood pressures, spoke with teenagers from the community who helped to run part of the fair, and generally helped out where we could.

Volunteering at the Codman Square Health Center

Carly also discovered that many of the teens there were part of an awesome local organization called BOLD Teens committed to improving the quality of life in their Dorchester neighborhood. It was pretty cool to hear about what that group has accomplished over the years, and to see the investment and involvement they have in their community. I have to admit that I have not explored Boston enough yet, nor spent enough time in some of Boston's neighborhoods. Many of the family medicine faculty at BMC have their clinics at community health centers, and so much of their practice is getting to know the residents of that community. I hope we all have more chances this year to venture beyond the BUSM bubble!

Messages about NC09 from a newbie

2009-08-03T05:16:00.000-07:00

So it was my first National Conference. and i LOVED it!
As someone who was interested in FM, and now even more so, I think it was a great way to meet folks with similar questions, ideas for career paths, as well as folks with different ideas that I didn't think could/would work but clearly can in FM!
The residency fair was amazing, and a bit overwhelming, but since it's FM, everyone was super nice, friendly and supportive of what I was interested in even if it was not what their school offered. As an MS3 going to the residency fair, it was helpful in sorting out which programs I wanted to try to contact for possible sub-i's, and which programs I could spend more time researching. The fair also gave a good idea of what the people are like at that residency program. The diversity, the mentality, the focus, the spirit-if you will-of the programs.
Plus one gets to tote home a boatload of goodies: brochures, pens, gadgets, bandaids, stressballs etc and most importantly, contact info!

The workshops are also quite good: useful and applicable even if you are not necessarily interested in FM. I attended the Wilderness Medicine (sponsored by our friends up in Central Maine--they're awesome!!!), Dermatology, Maternal/Childbirth/OB, Applying to Residency workshops. All were helpful in dispelling some myths, providing more ideas, and all in all being useful info to have.

Last thing: Midwest airlines has a hub through Milwaukee. BUT, they serve 2 fresh baked, piping hot chocolate chip cookies on every flight! And the Aladdin hotel (Holiday Inn) rocks the champaigne and the retro-cool and definitely wins in terms of hotels.

Tips for next year (MS4): stay the whole time, bring business cards, CV, personal statement, nicer outfit, and your best smile.

Congress of Students and Continuity of Care

2009-08-02T10:22:00.000-07:00

At the beginning of July, I was recruited to serve as a member on a Reference Committee and began my journey in the Student Congress world of the National Conference. Concurrent to the workshops and exhibits, 50 delegates (from each state) and other interested students convened in the AAFP student government/congress Thursday thru Saturday. The congress serves two purposes: to write resolutions and to elect student leaders. I will speak here about the resolution writing process.

In the first session, a brief overview of the resolution writing process was discussed followed by discussion groups based on topic. I attended the education/career planning discussion group because one of the issues I am passionate about is continuity of care education opportunities in medical school. Looking at my school's clinical curriculum, I lament the fact that there are no continuity experiences available to students. We spend between 4-6 weeks at each site and at most see patients twice. I think that continuity experiences would allow medical students to realize the value of primary care and I spent much of my first few weeks in clerkship dreaming about a weekly continuity clinic and decided I would submit a resolution on this issues.

My resolution is as follows:

"Medical Education Continuity of Care Curriculum Recommendations

Whereas continuity of care is an esteemed value of the practice of family medicine, and

Whereas early exposure to continuity of care experiences during medical school may increase interest and awareness of family medicine as a potential career choice, and

Whereas continuity of care is beneficial to patients and enhances health outcomes, be it

Resolved, that the American Academy of Family Physicians recommend to the Council of Academic Family Medicine to explore creating curriculum recommendations to incorporate a longitudinal continuity of care experience throughout medical school such as a 4-year weekly continuity clinic."

After submitting the resolution, it went to a reference committee. Reference committees listen to testimony about the resolutions from authors and other interested parties, study proposed resolutions and provide recommendations to the congress for adoption of resolutions. They function to reduce the time needed in congress. As such, congress reviews the recommendations of reference committees and only opens individual resolutions when requested.

In addition to submitting a resolution, I also served as a reference committee member for the first time. In this position, I listened to testimony about resolutions, reviewed the resolutions with the rest of the committee and made recommendations for the congress. It was very encouraging to see that medical students were very engaged and passionate about issues surrounding family medicine. Proposed resolutions ranged from developing sleep disorder curricula to health care reform position proposals to changes in web design in the AAFP website.

This was my first time participating in the parliamentary procedure to pass resolutions and elect student officers. I thought that it was a very enlightening experience! Also, my resolution was passed both by the reference committee and in congress, and will make its way to the Council of Academic Family Medicine (composed of FM dept chairs) where hopefully they will develop curricular recommendations and guidelines for longitudinal continuity experiences!

Massages from the AAFP

2009-08-01T22:58:00.000-07:00

Jessica Chi (BUSM II, FMIG Leader) gets ready for her next blog at NC.

After several hours of residency booths, workshops, keynotes, and more, it's time to pay attention to our aching bodies. That's when we head to Booth #303 aka the "Comfort Station." To the four local massage therapists: my trapezius and rhomboids thank you. It's good for the healers to be healed every now and again!

Let your voice be heard! - Advocacy in Family Medicine

2009-08-01T18:00:00.000-07:00

The afternoon session I attended today was a health advocacy open forum where students and residents discussed any advocacy they had been involved with and provided suggestions for getting started for those of us (myself included) yet to have any experience in this area.

One student said she had never really been excited about advocacy until she stepped back and looked at the big picture of how many people she could reach with her actions. She also reminded us not to be intimidated by people at your elected representative's office and to recognize the value of speaking with the staff there even if you can't speak to your senator or congressperson.

One of the residents explained his theory of advocacy through research; performing research with the intention to change policy or viewpoints on a particular subject with your outcomes. He also reminded us that advocacy was all about "making noise" wherever you can, whether it is presenting your research results to the local news station, writing a letter to the editor of your local newspaper or serving on a committee of the AAFP, AMSA etc.

Another student reminded us that we all already advocate for our patients everyday, and that taking the next step to advocate for groups of patients is not too big a step for a student. Taking a leadership role in your local chapter of the AAFP might be a good first step or coming to the national conference and participating in the business sessions.

Another resident provided some helpful advice for getting started, including: find an organization whose "voice" you agree with and start showing up to meetings, don't be afraid to take on tasks and make your voice heard when asked, and be on the look out for people who come into your life and inspire you to change your vision or goals.

My thought it that, as physicians, we are going to be looked upon as leaders whether we like it or not, so it behooves us to be prepared with the knowledge (and hopefully practice) of how to advocate for change when it is necessary.

A little bit about me:
I am a 4th year at BUSM applying in family medicine this year. I was one of the co-leaders of the FMIG during my second year and have been a FaMeS member since 1st year. I am currently the student director sitting on the Massachusetts Academy of Family Physicians' Board of Directors.

If anyone out there is looking for more information about how to get involved either at the state or national level with the AAFP, please email me at simonsch@bu.edu

Ready to Start School Again...

2009-08-01T16:08:00.000-07:00

Blogging live from... seat 11A. Did you know that Airtran offers wifi ON THE PLANE?! Luckily, I grabbed a few free trial vouchers on my way into Kansas City so that I could blog on my flight back home to Boston.

The conference has officially ended by now, though I had to miss most of the last day due to an earlier flight. I have to admit that I did not have many expectations when I first arrived in Kansas City just a couple days ago, largely because I was still enjoying my Last Summer Vacation too much to think about medical school stuff. Now, I am so glad I went to AAFP's National Conference right before starting second year. The gears in my head are creaking back to life, and I couldn't help but send out a few emails to my fellow FMIG leaders to share the excitement!

(Excitement about FMIG, not about the upcoming exams every three weeks during second year.)

I learned so much more about what it means to be a family physician this week. And I would write more, but it's landing time at Logan!

UJC (Ultimate Journal Club)

2009-08-01T13:47:00.000-07:00

This afternoon's "Ultimate Journal Club" was run by journal heavyweight Dr. Kurt Stange, current editor of the Annals of Family Medicine. In addition to broad discussions on running effective journal clubs and publishing research articles, we discussed his recent article, "The generalist approach" (2009), which describes the qualities of a generalist physician that are suited to meet the needs of our fragmented health system (Stange, 2009).

In the article, Dr. Stange narrates a patient story in which issues of transition of care, physician-patient relationship, and continuity of care significantly impact the life (and health) of a person in his care. He notes that the generalist is uniquely able to address these issues, and is distinguished by the following characteristics (among others):

Humility
Openness to diversity
Broad knowledge base (i.e. self, family, systems, interconnectedness)
Can see the forest through the trees
Constant scanning and prioritizing
Integrating & connecting

These characteristics act as a wrapper around the evidence-based medical practices that are part of the daily work of all physicians. Yet, while they are often undervalued, these principles of the generalist are the keys to solving issues in health care today.

The Ultimate Journal Club was yet another forum in which was highlighted the unique ability of Family Medicine Physicians to address the needs of the current crisis in health care. These same characteristics were repeated in the morning keynote by Dr. Robert Graham who clearly outlined how Family Medicine principles can help improve the cost, access, and quality of health care.

So...it seems like Family Medicine is integral to the future of medicine. Med. students, pay attention. The wind is shifting (almost daily on Capitol Hill) and we've got to be prepared for where we end up.

References

"Lub dub" and so much more - Heart Sounds Workshop

2009-07-31T19:28:00.000-07:00

This afternoon I went to a heart sounds workshop put on by The Toledo Hospital. We used an awesome program called CardioSim that broadcasts heart sounds over a wireless network to these headsets (see pictures.) We started with the basics - which side of the stethoscope to use for which sounds, where to listen, how each heart sound is made, etc. Moving on to murmurs we got to see CardioSim in full action, listening to each murmur with and without lung sounds, at varying intensity levels, and with and without prompted visual cues of the sounds on the screen. We ended with a closed eyes "final exam" and a raffle for a Littman stethoscope.

It was the perfect review for medical students, starting at a slow pace and building to practice with critical skills that we will use everyday. These talks are one of many reasons I love coming to these conferences!!

Andrea Rier, BUSM IV
Future Family Physician

Exposition Hall = Games, Prizes, and...oh yeah...Residency Programs

2009-07-31T13:41:00.000-07:00

Center for the History of Family Medicine (Booth#1010)

Like many conferences, the AAFP NC has an exposition hall that's filled with a constant hum of "shmoozing" conversations, the flash of cheap give-away gadgets, and, every once-in-awhile, a jewel. Booth 1010 is one such jewel. The Center for the History of Family Medicine's booth does not seem to get much action, but something from their table catches my eye. I walk closer and discover the shiny objects in the picture below.

Past & Present Tools of the Trade

After some time gazing at these historical instruments and chatting with the CHFM's representative, I discovered that there is a rich history of how Family Medicine got to be where it is today - poised to become a unique source of quality primary health care - and there are people actively working to document and preserve that shared story of our profession.

If you want to better understand the future of Family Medicine by better knowing its past, explore the Center for the History of Family Medicine's website. Answer questions like...

When the first Family Medicine Residency program was introduced to Massachusetts?
Why is Dr. John Willis considered to be the "Grandfather of Family Practice"?
How old is the specialty of "Family Medicine?

...and once we know where we've been, what's been tried before, what's succeeded and what hasn't, then we will be best suited to face the uncertainty of the future practice of medicine in the United States of America.

Oh...and if you can guess what the instruments were used for, you get a prize! On to the next booth!!

Best FMIG practices

2009-07-31T07:33:00.000-07:00

BUSM FMIG won a categorical Program of Excellence award in Promoting the Value of Primary Care this year! We received our certificate this morning at the FMIG breakfast, and now Marcel and Jen are about to give a brief presentation on what our best practices were. Other FMIG Program of Excellence Award winners will share their best practices too.

I'm going to try to blog live, macworld style.

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Edit: if you are actually following this live, refresh the page often.
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9:37am Oregon Health and Science University is presenting their Baby Beeper program. It sounds pretty cool. Basically, first and second year students get an opportunity to see prenatal and maternity care through the lens of family medicine. Students go to at least one pre-natal visit to meet the mother, and family medicine residents call/beep students when the mother goes into labor. Residents also try to schedule post-natal visits with the students. Needs: a dedicated student coordinator, must establish buy-in from residents and L&D nurses.

9:43am Clarification, beepers are out of style and could be more impersonal. Residents and students exchanged cell phone numbers. Another program OHSU started this year was the "No One Dies Alone" program: students sit with terminally ill patients in the hospital to be there for them.

9:45am Pennsylvania State University won the Program of Excellence Award in Exposure to Family Medicine & Family Physicians. They organized a series of residency dinners wherein FM residents from different programs in the area treated students to dinner in the city to discuss any one of a list of topics that students were interested in.

9:48am Residents in Hershey PA willingly treated students for this dinner series... do you think the Boston residents are up for that?

9:52am University of Nebraska is describing highlights from their procedure night workshops. 3-4 FM residents teach 30-40 students how to do a particular procedure: casting, suturing, lumbar puncture, airways and intubation, ABG's and IV's, elbow injections and lung sounds. Sounds very similar to BUSM FMIG's sports medicine workshop series. Donna Kurowski (MS2) is heading that up this year, so keep an eye out for her emails.

9:56am Sebastian is introducing BUSM FMIG! Marcel and Jen are up...

9:58am We tackled the challenge of making primary care sexy by strengthening the FM community and by highlighting the diversity of family medicine practice. The latter was especially emphasized during last year's National Primary Care Week. I hope we can have another active NPCW this year, want to help plan events?

10:00am NPCW is a great event to co-sponsor with many potential partners on campus. Working together also brings in many students including students who may not necessarily be interested in FM.

10:01am I see Sebastian taking photos from the front, so you'll see pictures here soon.

10:02am New things for our FMIG last year: newsletter "All in the Family", blog, social events. Marcel just gave me a shoutout in the back as one of the contributing bloggers. Little does he know that I am live blogging their talk.

10:03am Ok never mind, he does know. Nice, there's a wordle of blog posts up on the powerpoint. 60 blog posts! 800+ visitors to the blog!

10:07am Meharry Medical College won the Program of Excellence Award in Community Service, Special Consideration Award for First-time Applicant. Some improvements that they implemented this year: paid dues for members to encourage commitment, really cool FMIG shirts ($5 each! Must get on that), text reminders about meetings and events.

10:10am Meharry's Project R.E.C.E.S.S. was featured in the Tennessee Academy of Family Physician's Journal (didn't catch the acronym). The project focused on smoking prevention at a local elementary school because the Tar Wars program couldn't get started in time. The featured booths: Gasping for Air activity, Jar of Tar illustration, Hazards & Effects of Smoking which was a black lung model and display board. The prizes were all active toys, such as kites, promoting active lifestyles-- what a great idea!

10:16am Who's up for starting a Tar Wars program in Boston?

10:18am And it's all over. Onto the Exposition Hall!

Main Stage Lecture: Stephanie Vance, Advocacy Guru

2009-07-31T06:37:00.000-07:00

How can we be most effective as citizens going to DC to advocate for health care reform?

We have to bring our personal stories to leaders of the country. We have the day-to-day experiences that we can bring to the table. We already advocate every day for our patients - we should take that to the next level: the state and then the federal government.

Her main points:

Many people in the audience seem to think that our government is broken. Only 4% of bills introduced are passed. Of those that pass ~ 33% are about renaming post offices and federal buildings. The founding fathers of this nation had set up a system with many checks and balances that does not work efficiently. The system was designed to work this way.

Money talks in Washington DC! But constituency also matters. Legislators want to know how you are involved with their constituents. The 14-year-old who picks up the phone still knows how to figure out your relation to constituents but doesn't know how much money you have donated. If we want to be active in the health care debate, you need to know how you are related to each individual legislator. Otherwise, honestly, they won't pay much attention to you.

Reading the bill is not the important part. Understanding the impact of the bill will make a big difference.

The August district work period is an essential time for contacting your legislators. They will be back in their local offices to do work during this period and it will be a great time to contact them.

Key message: Be Very Clear About What You Want!

First time at NC!

2009-07-31T06:14:00.000-07:00

It's my first time at the AAFP National Conference and my first time in Kansas City; actually it's my first time in Missouri. Nice place, good barbeque.

Do you remember when we had that discussion: Why is primary care not sexy? I think it was during the Crisis in Primary Care talk last fall. After Dr. Epperly's keynote speech yesterday, I think we can all agree that if primary care was not sexy before, it sure is now. What a great beginning to what is turning out to be a great conference! I definitely think everyone should have the chance to hear Dr. Epperly speak on the current healthcare reform...

Well, guess what?

Dr. Epperly is coming to BUSM in October! More details are coming, but suffice it to say that the FMIG Region 4 Coordinator, our very own Sebastian Tong, cornered Dr. Epperly at NC last year and somehow convinced him into putting BUSM onto his calendar during his trip to the AAFP Scientific Assenbly in Boston!

Yesterday, the first day of the conference, I attended a number of great workshops, my favorite being "Maternal Care and Childbirth." Dr. Scott Stringfield from the Via Christi Family Medicine Residency in Wichita, KS, examined most of the misperceptions surrounding family medicine physicians who practice obstetrics.

I became much more interested in family medicine after learning that family docs CAN deliver babies, and that family docs CAN perform c-sections. Two weeks after my last exam of first-year, I shadowed on the Labor & Delivery floor at BMC for a day. It was so cool, you should definitely do it too. If you didn't know already, at BMC the attending duties on L&D are equally shared by an OB/Gyn physician, a family medicine physician, and a midwife!

However, there are many physicians who will argue that family physicians cannot safely provide obstetrical care for a myriad of reasons such as inadequate training. Dr. Stringfield encouraged all of us to examine the data and to look at existing family medicine residency programs that include extensive OB training.

Family Physician OB Stats from the presentation:

In 1987 41% of family physicians did OB in practice

As of December 2008 (latest figures available) …

22.9% family physicians doing OB (range 8.0 – 45.4 %)
Highest region – West North Central @ 45.4% (IA, KS, MN, mo, NE, ND, SD)
7.3% family physicians do c-sections (range 0.8 – 11.1 %)
4% of FM privileges denied (usually related to OB)
Highest area of restriction – New England region 4.9%
Studies show that family physicians deliver 23% of America’s babies!

After going through many advantages of including OB in your practice, Dr. Stringfield also addressed audience concerns such as rising malpractice costs and difficult schedules. Come talk to me at school or email me if you want to hear more details!

Wilderness Medicine and Outdoor Health

2009-07-30T21:38:00.000-07:00

In the afternoon session of the conference I attended a clinical skills workshop put on by our good friends from the Central Maine Medical Center Family Medicine Residency Program (http://www.cmmcfmrp.org/.)

After a brief discussion reviewing the primary and secondary trauma examination surveys (the first for the unconscious, disoriented, unstable patient or one with multiple injuries and the second for a more detailed exam of the pertinent injuries on a stable patient), we broke up into four groups to work on some hands-on skills.

In the first group, we discussed open versus closed trauma and their general management, as well as when to treat an injury and keep hiking versus when to pack out. In the second group, we practiced using various items you may have at a campsite to immobilize and brace a leg, for example using a camping pad and clothes to splint a leg from above the knee to below the ankle.

In the third group, we practiced "unfolding people", safely moving them from positions you find them down after an injury in, back to a neutral position that would make it easier to carry them away from the site. Too bad we didn't have a camera with us at this session; you could have seen your own Jen Hsia professionally unfold me.

Fittingly, in the last group we practiced various ways to carry injured people. We were challenged to come up with ways to carry people alone (piggyback, fireman's carry, allowing them to lean on you) and with a partner (shoulders and ankles, allowing them to brace between you.) One of the best answers was to form a chair out of your and your partner's arms forming a square base. We also experimented to figure out the best way to use a tarp and two long sticks (if you have them) to carry someone out. We decided the best way was to place the sticks on the 1/3 lines of the tarp, folding the tarp over them, using the person's body weight to hold the free ends down.

Overall, it was a great workshop, mixing in some teaching with hands-on practice of some very helpful techniques. It was also nice to see the CMMC people again. They come down about once per year to teach workshops like this at BUSM for the FMIG and some students (myself included) elect to spend their 6 week core Family Medicine rotation up at CMMC in Lewiston, ME.

What Medical Students Can Do for Health Care Reform

2009-07-30T16:19:00.000-07:00

Dr. Ted Epperly gave three concrete suggestions about what medical students can do to participate in health care reform right now.

1) Join Connect for Reform. It is an e-advocacy campaign that keeps members up to date about current health care reform efforts and provides easy mechanisms to act.

2) Join Fam Med Pac, the federal political action committee. Donations are welcome there - even a small donation is great!

3) Contact your congress representative or/and senator during August recess about health care reform.

Taking care of business...

2009-07-30T16:06:00.001-07:00

While the National Conference for Family Medicine Residents and Students features a multitude of workshops and lectures, there are important "business" meetings that occur in the background. These meetings of the Resident and Student Congresses produce recommendations and actions that range from...

"Recommending that the AAFP express condolences to the families and communities of physicians and their advocates murdered while providing patient care."

to

"Recommending the AAFP strongly promote bicycle helmet usage..."

to

"Recommending that the AAFP strongly encourage the individual constituent chapters to develop preceptorships in underserved areas for all medical students."

This afternoon, I sat in on a 2-hour orientation session where members were nominated for different representative positions, current officers gave updates from the many different boards and committees, and AAFP reps gave an overview of the resolution development process. In all it was remarkable to see the underpinnings of the operation of a large professional organization. How does one reach consensus statements? Where do new ideas come from? This session laid the groundwork for these procedures and I hope to see how they play out tomorrow and Saturday.

After the orientation, student and resident members broke out into smaller topic-based discussion groups on issues surrounding Minority Health, Underserved Populations, Rural Health, Medical Education/Curriculum, Legislature/Public Policy, and more. I sat in on the Legislature/Public Policy discussion - understandably one of the more popular groups this year - and heard about current health reform efforts from those who are intimately involved in the process. It was fascinating to hear the mechanisms and politics involved in the process of shaping different health care bills. At the same time, it was incredibly empowering to know that senior-level officers from the AAFP (present at the discussion) were very interested in us producing resolutions that expressed our opinion on things like the current ideas of a public insurance option.

That's all for now! More from the halls of the Kansas City Convention Center later!

Keynote Speaker: Ted Epperly, MD, FAAFP

2009-07-30T10:11:00.000-07:00

The student and resident conference directors introduce Dr. Ted Epperly

Dr. Ted Epperly, the AAFP President and Program Director of Family Medicine Residency in Idaho, spoke eloquently about health care reform at this specific time. He called our current health care system the “perfect storm:” 20 million uninsured, businesses that can’t afford to provide employees health care any more. He believes that the current economic crisis and President Obama will come together to create change in our health care system! For example, the first law that President Obama signed into law on becoming President was S-CHIP providing health care to uninsured children.

Ted Epperly, MD, FAAFP, AAFP President addressing students and residents

He explained things that are being presented in Washington DC currently. President Obama has been engaging different groups stating that:

The status quo is not acceptable
Each group must give at least a bit in their position.
We must have reform this year!

He said that President Obama believes strongly in family medicine and primary care. He recounted a recent town hall meeting on health care reform where he was the only person called on by name by President Obama, not as an individual but as a representative of family physicians and primary care doctors. Dr. Epperly reiterated to the President that reform cannot happen unless we have a primary care backbone to that reform. He argued that “Fixing primary care is fixing the health care system.”

The current system is failing the American public. Medical schools are producing 90% specialists and 10% primary care doctors. We need 50-50 to serve the American people. Medical schools don’t get it: they are producing doctors to function in specialty hospitals and academic centers. The public needs primary care doctors who will serve in the community and serve the people.

The World Health Organization stated this year that each good health care system must be founded on a good primary care system! This was pushed by the American contingency led by the HHS Secretary.

The AAFP is playing a key role in these health care reforms. If the AAFP is not at the table then they are on the menu! The health care reform is changing not by the day but by the hour! We have a great advocate for Family Medicine in President Obama!

This is an exciting time to be a part of family medicine and primary care given all the health care reform - throughout the conference, we will be finding out about more opportunities to get involved with this health care reform in this exciting time in health care reform history!

Student asks question of Ted Epperly, MD, FAAFP

*Read our earlier post on Dr. Epperly's contribution to the White House Health Care Summit back in March 2009.

Welcome to Kansas City - AAFP National Conference for Medical Students and Residents

2009-07-30T10:08:00.000-07:00

Good morning from Kansas City! Today is the first day of the 3 day National Conference for Medical Students and Residents. Over the next three days, we will be posting regular updates on the Blog about different sessions and workshops at the conference. Keep checking in regularly for updates and to hear about what’s going on!

The High Cost (and Poor Quality) of Health Care: Blame it on the C-c-c-c-c-capital-ism?

2009-06-20T12:26:00.000-07:00

The Dilemma

Source: US Census Bureau, WHO. Compiled by CNN.

We know the commonly cited statistics: the United States of America spends more money on health care than any other country, yet the health outcomes of this expenditure are far from the best (between 20th and 50th, depending on the indicator). As future health care providers, it is incumbent upon us to address this discrepancy, since it leaves countless patients unnecessarily sick (and in financial debt). A brief glance at the current debate reveals a number of root causes as identified by a variety of groups: administrative overhead, malpractice insurance and defensive medicine, better (more costly) technology, more availability and promotion of prescription drugs, a growing population of elderly patients coupled with more intense end-of-life care...

“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

This is the hook to surgeon-writer Atul Gawande's recent article in The New Yorker about the causes of health care costs in the USA. For this article, he traveled to McAllen, Texas, whose expenditure on health care is second only to Miami. On the ground, he spoke with physicians, hospital administrators, local business persons, and working-class residents. His research and conversations indicate that the principle reason for increased health care expenditure is that physicians in McAllen are systematically overusing medicine.

Physicians as Gatekeepers

If we look at the distribution of health care expenditure (below), physicians control the majority of decisions about expenditures...and rightly so. After all, shouldn't trained healers be the ones working directly with patients to determine the appropriate services to provide?

U.S.A. National Health Care Expenditures, 2006Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group.

Compiled by the Kaiser Family Foundation.

Despite this key role, however, gatekeeper physicians have received relatively little attention/scrutany until recently. Drug companies, insurers, hospitals, and medical device manufacturers traditionally dominate the national conversation. Gawande reminds us of the central role that physicians play in the health care system - for better or for worse.

Health-care costs ultimately arise from the accumulation of individual decisions doctors make about which services and treatments to write an order for. The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.
- Atul Gawande, "The Cost Conundrum"

"Blind Spots": Personal Bias in Medicine

At the Second Annual (Student-run) Cultural Competence Workshop at BUSM, Prof. Linda Barnes spoke about cultural "blinds spots" that physicians may bring into the patient room. She mentioned biases with regard to cultures of race, class, gender, education, nationality, BMI, etc. But why does this matter? Most people would contend that very few physicians are outright "racist" or "sexist." The impact of subconscious "blind spots", however, is subtle and often occurs when medical decision-trees are less clearly defined. One example from Gawande's article describes a study done on physicians from high- and low-expenditure cities who were given sample patient cases with a ranging degree of established treatment protocols. They found that...

...in cases in which the science was unclear, some physicians pursued the maximum possible amount of testing and procedures; some pursued the minimum. And which kind of doctor they were depended on where they came from.
- Atul Gawande, "The Cost Conundrum"

So what is it about place (high- or low-expenditure city) that is related to use of medical services? A comparison between McAllen and El Paso, Texas - a city with similar demographics and significantly lower health care expenditure - indicates that this difference is unrelated to physician training, patient needs, availability of technology, or physician incentive structures. So what is the X factor?

Economic Culture

About fifteen years ago, it seems, something began to change in McAllen. A few leaders of local institutions took profit growth to be a legitimate ethic in the practice of medicine. Not all the doctors accepted this. But they failed to discourage those who did. So here, along the banks of the Rio Grande, in the Square Dance Capital of the World, a medical community came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers.
- Atul Gawande, "The Cost Conundrum"

Rather than a culture of race or gender influencing medical decision-making, Gawande posits that a culture of profiteering took hold in McAllen and, furthermore, threatens to dominate the national health care scene. The reason that this culture permeated McAllen is a combination of individual actions and systemic context. In a health care system that compensates quantity over quality and that promotes individualism/fragmentation over teamwork, individual revenue-leaning physicians were easily able to shift their behavior from using only necessary labs & procedures to using the maximum possible.

How to Transform a Revenue-focused Culture to a Healing-focused Culture

While McAllen may be an outlier, it represents an extreme that has the potential to spread throughout the current health care system, further-sending health care expenditures through the roof. Fortunately, in better defining the nature of the issue in terms of medical culture, Gawande implicitly points us in the direction of a solution: cultural re-shifting towards collaborative, quality-driven medical care. In designing a cultural shift, one must do at least three things:

Establish principles of the "new" culture
Create mechanisms for turning these principles into action
Disseminate the principles and mechanisms to the target market (ex. physicians)

Here are some ideas for how this might be done...

1. Establish principles of collaboration, quality-focused and patient-centered health care.

It seems that in our current state of high-cost, low-quality health care, we have spend much of our energy on cost-containment - this being the mantra of current health reform efforts. This seems consistent with the philosophy of W. Edwards Deming, a management consultant who "made a significant contribution to Japan's later reputation for innovative high-quality products and its economic power" (Wikipedia), who noted that when organizations focus on cost, then over time costs rise and quality falls. On the flip-side, however, when organizations focus on quality, then quality improves and costs fall. Although simplistic, this philosophy is echoed by Prof. Michael Porter, an expert on competitive strategy who recently focused his attention on competitive environments in health care. Porter (2008) states that in order to be successful, health reform must be guided by three principles:

A common goal of value for patients (i.e. patient-centered)
Medical practices organized around conditions and care cycles (i.e. collaborative)
Measurement of results (i.e. quality-focused)

In parallel with Porter, several medical societies, including the AAFP, have developed principles for a Patient-Centered Medical Home (PCMH). In addition to the above values, the PCMH includes appropriate payment structures, enhanced access, physician-directed medical practice, and personal physicians.

2. Develop mechanisms for implementing the principles of good care.

Delivering health care based upon the principles of collaboration, a focus on quality, and patient-centered care is a challenge given the fragmentation and quantity-focus of current policies. The PCMH is an attempt to implement the guiding principles within the current system. This following video from the AAFP describes how, by combining traditional primary care and family medicine with modern technology, the PCMH has already been integrated into existing clinics and has produced better health outcomes, improved physician job satisfaction, and reduced costs. Satisfied early-adopters include IBM, which had the following endorsement: "IBM believes that the Patient-Centered Medical Home addresses the core issues of what's lacking in health care."

The Patient-Centered Medical Home

The value of the patient-centered medical home in the words of patients, physicians, employers and policy leaders. From the AAFP.

3. Actively promote adoption of principles and mechanisms

How does one engineer a culture shift? One answer lies with the experts of massive behavior influence: Coca-Cola, Philip-Morris, Nike, etc. In promoting a culture shift, these organizations use active approaches at multiple levels to meet their goals of maximizing revenue: lobbying for public policies, focused marketing campaigns, word-of-mouth, and more. In the realm of public policy-making, however, these ideas have lagged far behind the private sector. Only in 2008 was the term "culture change" with regard to public policy coined by Knopf et al. in their paper, "Achieving Culture Change: a policy framework." Knopf et al. integrate ideas from behavioral economics - a field that combines human and social sciences (esp. with decision-making theory) with economic models - with traditional policy-making theory (ex. incentives, regulations and legislation) to describe multi-level approaches to enacting more effective public policy. In effect, they are adopting the strategies of the private sector.

However, while Knopf et al. describe both society-wide (ex. economics, media, & law) and individual (ex. peers, family, community & workplace) influences on culture change, Gawande seems to point out that in our current discussion of health care reform, individual-level influences (i.e. "anchor-tenants") are being left out. In his popular book, "The Tipping Point: How Little Things Can Make A Big Difference," Malcolm Gladwell explores the nature of how individual-level actors can create epidemics of products, ideas and behaviors (ex. AYBABTU). In relation to the innovation diffusion curve (below), Gladwell describes three major agents that can drive an epidemic:

The Maven - collectors of knowledge. They are the "early adopters" in the Innovation Diffusion Curve below and constantly have their ears on the ground.
The Connector - knows a lot of people. They take innovations and disseminate them to the right people.
The Salesman - powerful persuaders. They help bring an innovation from early adoption to larger diffusion.

Innovation Diffusion Curve

Image courtesy of OpenLearn.

How can one reach the Mavens, Connectors and Salesmen of the proposed epidemic of quality-driven medical care? Much like pharmaceuticals target key enzymes (i.e. "hubs," the Kevin Bacon's of the cellular world), the promoters of the culture shift must specifically target Gladwell's agents of change. The well-organized and broadly-based medical societies (ex. AAFP, AMA, APS, etc.) offer one potential route for specific targeting. They have identified leadership and local chapters that can quickly disseminate and gather information. These chapters have the ability to administer brief surveys to their members that could identify the potential change agents in their community of physicians (ex "How many physicians do you have weak ties with in your community?", "How many medical journals do you keep updated on?", etc.). Once these individuals are identified, local or regional chapters can host workshops designed to empower these agents of change to develop an intentional culture of collaborative, quality-focused and patient centered medical care. This is the most effective way of using few resources to have the greatest impact on individual level elements of culture. The time for health reform is now, and, as Gawande warns, even if we improve finance structures, if we don't address physician culture, we could still see trends of higher expenditure and lower quality.

The decision is whether we are going to reward the leaders who are trying to build a new generation of [collaborative and quality-focused solutions]. If we don’t, McAllen won’t be an outlier. It will be our future.
-Atul Gawande, "The Cost Conundrum"

What do you think?

Are physicians really responsible for high-expenditure in health care?
Can the PCMH address issues of quality-improvement and cost-reduction?
If so, is a cultural change possible?
Do we have a right to "engineer" culture change at an individual-level or is it up to traditional policy?
Do physicians (as a social group) have a responsibility to improving society-wide health?

Use the comments link to share your thoughts.

References

Bein B. "PCMH Gets Off to Slow Start in Nation's Medical Schools." AAFP News Now. 2009.
Gawande A. "The Cost Conundrum." The New Yorker. http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
Gladwell M. The Tipping Point: How Little Things Can Make a Big Difference. Little Brown. 2000.
Knott D, Muers S, Aldridge. Achieving Culture Change: a policy framework. 2008.
Landau E. "Life expectancy could be topic in health care debate." CNN. http://www.cnn.com/2009/HEALTH/06/11/life.expectancy.health.care/index.html#cnnSTCText
Porter M, Teisberg EO. "How Physicians Can Change the Future of Health Care." JAMA. March 14, 2007.
Stange KC. The Problem of Fragmentation and the Need for Integrative Solutions. The Annals of Family Medicine (2009) vol. 7 (2) pp. 100-103
Wikipedia contributors. W. Edwards Deming. Wikipedia, The Free Encyclopedia. June 18, 2009, 01:36 UTC. Available at: http://en.wikipedia.org/w/index.php?title=W._Edwards_Deming&oldid=297073705. Accessed June 18, 2009.

Upcoming National Conference

2009-06-11T19:31:00.000-07:00

It's not too late to sign up for the AAFP National Conference for Medical Students and Residents! Family Medicine is the only specialty to have a conference uniquely focused for medical students. The conference includes:

lectures from key speakers on health policy (this year's theme)
workshops and break-out sessions on a vast range of topics. Click here for a pdf with workshop details.
hands-on physical and procedural workshops
residency fair with over 300 FM residencies nation wide (tons of free stuff)
student congress sessions
chance to network with other students interested in FM and primary care!

Click here for more details and for registration.

Register before July 1st to save $50 on registration. Talk to Dr. Joanne Wilkinson for funding: the Dept of FM/SCOMSA/Mass State Chapter of Family Physicians provides funding for BU students attending!

BU FMIG awarded Program of Excellence Award!

2009-06-09T16:26:00.001-07:00

This just in...
Our FMIG won the national AAFP Program of Excellence Categorical Award for Promoting the Value of Primary Care. 10 overall and 4 categorical awards are offered each year. The award aims to promote family medicine and share ideas nationally with other FMIGs. This is the first time BU's FMIG has been awarded the PoE award!

Click here to check out other award winners or read our application/accomplishments this year.

Lunch with 4th years

2009-05-04T10:00:00.000-07:00

Today, almost 40 first and second years had lunch with 4 fourth years who matched in primary care residency programs to discuss clerkship and residency questions before they graduate in just a few weeks. If you were unable to attend, here's a summary of our discussion with Caitlin, Derek, John, and Robin, all of whom were candid in sharing their memories, experiences, and advice.

How did you decide to go into primary care; when did you make that decision?
With experiences before coming to BUSM like being in the Peace Corps and volunteering in urban shelters, most of the students knew from the beginning that they wanted to be in primary care. The family medicine clerkship at BU was also a great experience. One of the 4th years initially wanted to do surgery, until he finished the surgery clerkship and realized that it was not for him-- all that getting-up-early and standing-all-day business. He's now going into pediatrics with an interest in neonatology.

International away rotations: how many, and which clerkships can count?
In 4th year, you can do up to 3 away electives. Loophole: there are "inside away" electives, which are programs that are not here at BU, but that are credited and count as though you did it here. So, you could potentially do up to 4 months away, plus an additional 2 months of vacation/interview time... you could be away from Boston for 6 months! You can do away rotations for any of the clerkships if you find the right programs. One of the 4th years did the ER clerkship in Chile and the Family Medicine clerkship in Lesotho!

Did ICM affect your decision for residency?
Short answer: no. Longer discussion: the students shared that in such a big hospital setting, you will run into residents and attendings in the various clerkships who may look down on primary care. That can be discouraging, but it also brought the students who were interested in primary care closer together with shared experiences.

What do you wish you had known before starting third year; general advice?
In all your clerkships, keep an open mind. You may be surprised by what you enjoy, what you are good at, and what you do not like. In your clerkships, push push push for what you want to do and learn. As the youngest member in a large team setting, it is easier to stay in the background, but if you are proactive in your education, you will have many more opportunities to do and to learn. Arrive 5 minutes early and quickly review the patients who were admitted overnight to be more prepared when you round on the patients! When things are difficult, remember that each clerkship is temporary and short, and you WILL get through it. Don't take mean comments personally if it happens. Know that you are getting excellent clinical training at BU.

Which third year clerkships are better to do at BMC instead of the other sites?
Medicine, surgery, and pediatrics were highly recommended to do at BMC. And the fourth years all advised that the order of your clerkships in 3rd year does not really matter-- except that doing medicine before surgery will be really helpful. One tip was that new residents start in June/July, so you may have less chances to do procedures compared to the end of the year in April/May. Another tip: your sub-internship grades are important, and there are many sub-i choices.

Favorite part of your clinical years in med school?
Sub-I. By that point, you do feel like you know what you are doing, and it's fun. Doing a rotation at an Indian Health Service, a completely different experience. Going abroad for electives.

Lastly, remember to eat something before going into the OR lest you pass out!

New FMIG leaders

2009-05-04T09:42:00.000-07:00

As the school year draws to a close, we want to thank the FMIG leaders from this past year for all their hard work Jen Hsia, Leah Schweid, Sebastian Tong, Jessica Gray, and Marcel Tam organized almost 30 FMIG events this year! There were panels, sports medicine workshops, book talks, the National Primary Care week, and much more. We wish them all the best, especially on their upcoming USMLE Step 1 exam!

The new FMIG leaders for the upcoming year are:

Caitlin Christie
Carly Grovhoug
Donna Kurowski
Erkeda DeRouen
Jessica Chi
Lucas Thornblade
Neetu Srivastava

We know that we have big shoes to fill, so we're really excited for next year! Contact any one of us if there are any events, talks, ideas you'd like to see FMIG host; we'd love to hear from you!

The Match and Primary Care

2009-03-27T07:53:00.000-07:00

Chitose Suzuki/Associated Press

BUSM students find out where they are accepted for residency on Match Day 2009.
This photo was featured in the New York Times.

Each year, on March 19, thousands of medical school seniors receive their long-awaited match results indicating which residency they will attend. So how did Family Medicine fare this year?

At BUSM, Family Medicine matches held relatively steady, while nation-wide numbers were down. 9 students matched in family medicine this year (down from 10 last year). Match sites included:

Boston University
Swedish First Hill, Seattle
Swedish Cherry Hill, Seattle
Middlesex, CT
UCSD, CA
Contra Costa, CA
Brown University, CA

According to the Boston Globe, primary care match rates are holding fairly steady across the state.:

BU: 26 percent of 150 students (17 percent last year)
Harvard: 10 percent of 165 students (12 percent last year)
Tufts: 18 percent percent of 104 students (17 percent last year)
UMass: 39 percent of 100 students (35 percent last year)

However, nation-wide reports that only 1,083 graduating US medical seniors chose family medicine this year, 89 fewer than last year. However, 2,329 of 2,555 family medicine residency positions were taken for a fill rate of more than 91%, which is slightly greater than last year. The difference between family medicine residency positions taken and matching US seniors is filled by foreign international graduates, who fill more than half of all available family medicine residency positions.

Why do more medical students not choose family medicine? A recent report from the Graham Center showed that more medical students would choose careers in primary care if schools were to (1) increase student recruitment from rural and medically-underserved areas and (2) provide long-term experiences in primary care.

Do you agree? What do you think should be done to increase the number of students entering family medicine?

References

From the Front-Line to the Front-Row: President Obama and Family Medicine

2009-03-22T07:53:00.001-07:00

AAFP President Ted Epperly, MD speaks to President Obama at the
White House Health Care Summit on March 5th, 2009. Watch the YouTube video.

As the White House Office of Health Reform, headed by Nancy-Ann DeParle, takes on the urgent task of designing a health care system that works for everyone in the United States, Family Physicians are playing a key role in this debate. At the White House Health Care Summit on March 5th, 2009, President Obama's administration invited about 120 key stakeholders to the White House to build bipartisan support for the work being done. The AAFP, represented by AAFP President Ted Epperly, MD (Boise, Idaho) was one of seven medical associations present.

Of the seven organizations - which included the American Medical Association (AMA), the the third-largest lobbying group (based on expenditures) - President Obama called on the AAFP to represent the perspective of primary care physicians. A surprised Epperly stated that family physicians are ready to "roll up their sleeves" to support the changes needed to improve health in the United States. He also noted the critical need to address physician workforce shortages.

This opportunity resulted in the creation of the AAFP "Connect for Reform" campaign to bring together physicians working on the front-line of health care reform and to take their issues to the front-row of the debate on health care reform. With the President's ear already open to the voices from the front-line, this is a unique opportunity to make the changes that you think will fundamentally improve our health care system.

Connect for Reform Now!

References

Mental Health In Primary Care

2009-03-19T18:00:00.000-07:00

On March 19, Dr. Larry Culpepper, Chair of the Family Medicine Department, and Dr. Doug Hughes, Clerkship Director for Psychiatry, led a very informative lunch-time discussion on the role of the primary care physician in mental health care, as well as the importance of collaboration between psychiatrists and PCPs. Dr. Culpepper spoke about research demonstrating the importance of treating depression in improving health outcomes for patients with diabetes and heart disease. In addition, Dr. Hughes highlighted the necessity of teamwork between psychiatrists and PCPs to minimize harmful drug interactions as well as to monitor the adverse systemic side effects of some psychiatric drugs and conversely the adverse psychiatric outcomes related to systemic treatments. Overall, Dr. Culpepper and Dr. Hughes highlighted the need for clinicians to be aware of mental illness and its impact on patient functioning, as well as the need for insurance companies to ensure parity for both mental health and systemic diseases.

Dermatology Workshop

2009-03-19T15:37:00.000-07:00

The Residency Program from Central Maine Family Medical Center came to present their residency program, and teach us a few common dermatological procedures seen in family medicine practices.

We used pig's feet to practice making elliptical excisions of "moles" and then were taught how to suture them up. The second exercise of the workshop was taking punch biopsies from the pig's feet, and suturing the cut shut. The Maine team also taught us how to use the liquid nitrogen as a treatment for warts and superficial lesions, as well as a scraper for shaving off surface growths (again, practiced on pig's feet). The basics of skin cancer were also reviewed.

WHO calls for focus on Primary Care

2009-02-10T16:53:00.000-08:00

With the current political climate and the publication of the World Health Organization’s “Primary Health Care: Now More Than Ever,” Family Physicians everywhere are being thrust into the spotlight with health professionals, politicians, and patients all wanting to hear our thoughts how we can help fix our… somewhat dysfunctional health care system.

In 2000 WHO reported that “the U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance.” It also mentions that “the United Kingdom, which spends just six percent of GDP on health services, ranks 18th.” Unfortunately, eight years later, not much has changed.

But it’s not just the U.S. All over the world countries are investing a great amount of their financial and other resources on health care, but not achieving the desired health outcomes. The solution very well may be reforming broken systems and turning to Primary Care based systems.

The WHO’s report calls for Primary Health Care reform that encompasses the following four basic tenets:

Universal Coverage
Patient-Centered Services
Healthy Public Policies
Leadership

See the full report here.

Primary Care Residency Panel - Family Medicine and Combined Medicine-Pediatrics Programs

2009-01-21T11:27:00.001-08:00

Interested in pediatrics and internal medicine but can't decide between the two?
Don't understand the difference between Family Medicine and Med-Peds?
Want to meet some family medicine or med-peds faculty?

Join us for panel of faculty members from the BMC Family Medicine Program, Brigham Women's/Children's
Hospital Med-Peds Program, and MGH Med-Peds Program.

When: Thursday, January 29 at 6:00 pm
Where: Hiebert Lounge

Medicine-Pediatrics Residency Programs are combined 4 year training programs with 2 yrs of pediatrics training and 2 yrs of internal medicine training. Residents graduate double-boarded in both pediatrics and internal medicine and can practice in either or both fields.

Family Medicine Residency Programs are generally 3 year training programs. Residents will graduate boarded in family medicine and will be able to practice a wide scope of medicine that includes OB, pediatrics and adult medicine.

The panelists include:

Dr. Niraj Sharma, Director of the Brigham-Women's/Children's Medicine-Pediatrics Program
Dr. David Ting, Director of the MGH Medicine-Pediatrics Program
Dr. Joanne Wilkinson, Associate Predoctoral Director of the BMC Family Medicine Program
Dr. Susan Hata, Med-peds at MGH Back Bay
Dr. Colleen Monaghan, Associate Director of the Brigham-Women's/Children's Medicine-Pediatrics Program
Dr. Eileen Pierce, Family Medicine at East Boston Neighborhood Health Center

Come learn about both specialties! There will be plenty of time for questions and interaction with faculty. Dinner will be served!

This event is co-sponsored by FMIG and PEDS Group.

New Year Resolutions at the AAFP

2009-01-18T08:38:00.000-08:00

The AAFP plans to advocate for transforming the USA health care system in 2009 around the patient-centered medical home model.

Proposed transformation includes:

payment reform
workforce reform (creating a system that has enough PCPs to support universal health care)
changing cultural values: respect, recognition and relief of family physicians and primary care doctors

Progress to date on the PCMH include recognition at both state and federal levels including insurance companies, consumer organizations and legislators. The adoption of the Joint Principles of the Patient-Centered Medical Home by the AMA on Nov. 10 is a huge step forward for the PCMH. The Patient-Centered Primary Care Collaboration also has a huge role in promoting the PCMH.

One of AAFP's focuses for the coming year is in promoting the fact that we cannot achieve universal health care as a nation unless we increase the number of PCPs. Massachusetts, for example, has nearly achieved universal health care on paper only to realize that it does not have enough PCPs to cover the entire population. It is like giving free bus passes to everyone when there is only 1 bus in the city.

AAFP plans to promote a transformed health care system based on primary care, a system which every other industrialized country has discovered. This requires attracting more residents into primary care and reforming the way that existing family doctors practice.

Check out the 2009 Environmental Scan on the AAFP Website that examines some of the health care policy and politics that may affect primary care and family medicine in this year. The website provides short video clips of different aspects of health care reform and policy.

Sports Medicine Workshops: Spring Semester

2009-01-18T08:34:00.000-08:00

Dr. Alysia Green will continue leading monthly sports medicine workshops this semester. Each workshop will focus on a specific area of the body. Dr. Green will briefly review the anatomy of that region and then present an interactive examination workshop on that area of the body.

Workshops for the semester include:

Taping: January 15
Knee Exam: February 11
Concussion: March 18
Wrist/Hand and Foot/Ankle Exam: April 9

Watch for emails from fmig@bu.edu to sign up.

Big Tobacco and Family Medicine

2008-12-09T11:50:00.000-08:00

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?

2008-12-09T10:45:00.000-08:00

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...

NEJM Perspectives on Crisis in Primary Care

2008-12-05T17:28:00.000-08:00

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.

Upcoming Anti-Tobacco Advocacy Series

2008-11-24T18:53:00.000-08:00

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

2008-11-24T18:20:00.000-08:00

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

2008-11-23T11:04:00.000-08:00

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

2008-11-20T12:36:00.000-08:00

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

2008-11-17T07:58:00.000-08:00

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

2008-11-14T10:02:00.000-08:00

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

2008-11-11T07:50:00.000-08:00

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

2008-11-09T12:59:00.001-08:00

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

2008-11-09T12:46:00.001-08:00

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

Mixing it up...Primary Care style

2008-10-15T14:20:00.000-07:00

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!

What is your Dosha?

2008-10-13T18:39:00.000-07:00

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.

Making primary care "sexy": chocolate fondue

2008-10-12T11:38:00.000-07:00

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.

Ayurvedic Medicine Workshop Registration

2008-10-09T19:46:00.000-07:00

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

2008-10-09T13:11:00.000-07:00

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

2008-10-09T12:23:00.000-07:00

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.

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

2008-10-08T19:59:00.000-07:00

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.

The Patient-Centered Medical Home

2008-10-07T20:24:00.000-07:00

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):

Defects
Overproduction
Conveyance
Waiting
Inventory
Motion
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

TransforMED

Crisis in Primary Care: Making Primary Care Sexy?

2008-10-06T21:31:00.000-07:00

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?

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

2008-10-01T17:16:00.000-07:00

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.

Register for the Primary Care Mixer

2008-09-30T05:38:00.000-07:00

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.

National Primary Care Week @ BUSM

2008-09-28T19:13:00.000-07:00

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.

Patient-Centered Medical Home

2008-09-27T01:12:00.000-07:00

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:

Each patient is entitled to a personal physician
The physician is the leader of a team of individual practitioners
Whole person orientation
Care is coordinated and/or integrated using the latest and most appropriate technology
Quality & safety
Enhanced access to physicians
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

Mass Crisis: Is This The Future of Health Care?

2008-09-22T07:51:00.001-07:00

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

Ayurvedic Medicine Research

2008-09-19T11:31:00.000-07:00

Check out this link to Ayurvedic Medicine Research that Dr. Saper has done:
http://www.bu.edu/today/science-tech/2008/09/18/ayurvedic-medicines-merit-closer-look

The original JAMA article is available at:
http://jama.ama-assn.org/cgi/content/full/300/8/915

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

2008-09-17T15:39:00.000-07:00

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.

Sports Medicine Series

2008-09-08T18:50:00.000-07:00

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.

FM Scholars program

2008-09-04T08:18:00.001-07:00

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

Medical Tourism and Family Medicine

2008-08-22T15:51:00.000-07:00

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?

FMIG Kickoff Event!

2008-08-20T19:06:00.001-07:00

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.

Pictures from "What is Family Medicine?" Panel

2008-08-19T20:22:00.000-07:00

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:

Dr. Brian Penti: Family Medicine with a focus on International Health
Dr. Alysia Green: Family Medicine with a focus on Sports Medicine
Dr. Michelle O'Brien: Family Medicine with a focus on Obstetrics. Currently completing a MPH in Maternal/Child Health.
Dr. Madhavi Shah: Family Medicine practicing in a community health center
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.

"What is Family Medicine?" Panel

2008-08-15T14:47:00.001-07:00

The Family Medicine Interest Group (FMIG) is presenting a "WHAT IS FAMILY MEDICINE?" speaker panel next week, Tuesday, August 19th, in room L-110 (first classroom on your right to the left of the security desk), from 1130am-1230pm.

Come listen and learn and ask questions about family medicine, and what doctors are doing with family medicine: sports med, international work, research, community vs. private practice. NO COMMITMENT needed to attend (we won't make you go into family medicine because you came to the talk)--come see if family medicine is something you would be interested in, or to come learn something new!

Food and drink will be provided so come by for our first lunch talk of the year!

Reflections

2008-08-03T17:15:00.000-07:00

Now that my sleep deprived self is back in Boston I wanted to share some final reflections:

Through this conference, the importance of family medicine became very apparent. From the opening talk on family medicine's contributions and roles to the different workshops that explain family medicine's approaches to the plethora of family medicine residency programs at the exhibit, the different structures that make up family medicine became apparent. And family medicine no longer seems like the "dead end" road that it has been touted as by so many. There are academic tracks, rural tracks, urban tracks, international opportunities, double board with preventive medicine tracks, residencies with dual MPHs or MBAs.

I entered into this conference not really with a directed purpose. I wasn't a fourth year medical student desperately trying to impress residency directors at the exhibits, I wasn't a delegate fighting for an elected position on AAFP (I wasn't, unlike Marcel, trying to blog every second of my time at the conference). But I came away with a better sense of the scope of family medicine and the impact it has on individuals and families' lives. Mentally, I revisited my med school applications and looked at my motivations for becoming a doctor throughout the conference - and I realized that family medicine and my motivations fit like an fitted enzyme-substrate complex.

NC'08...We're all in this together

2008-08-02T08:54:00.001-07:00

As the last couple of sessions draw to a close, the crowds are getting scarcer and scarcer. MS-4s have walked the exhibit hall floor in their sleep, chanting "Hi, I'm a 4th year student at____, and I'm interested in ______. Tell me about your program." Residents know the lines and have perfected their responses and the way they will integrate the variety of brochures, freebies, and posters into their sales pitch. The military recruiters are still in full dress. Conference organizers are taking down the now-outdated session posters. The last of the Monopoly-like food tickets are being used at the food stands. Yes, the the 2008 AAFP National Conference for Residents and Students is almost over.

People attended sessions ranged from "Reading a 12-Lead ECG" to "Financial Planning for Residents and Students." In doing so, as with most conferences, a sort of group culture was developed. With the conference theme being "Global Health," one of the major group perspectives was that the field of Family Medicine has the unique position to be a potential coordinator & bridge-maker for groups from different backgrounds that need to work together in the field...whether that is internationally or domestically, in rural or urban environments, or with people of all ages, genders, and ethnic backgrounds.

Given this movement of students/residents/faculty/practitioners, Boston University School of Medicine has a great potential to become a bastion for Family Medicine, and thus, the future of medical practice. We have strong international collaborations, a history of working with community clinics in Boston, an excellent School of Public Health only steps away, and integration into a hospital with progressive programs in health care that have national renown. Perhaps Boston University faculty, residents and students can be a major force at the 2009 AAFP National Conference.

Yes, the sessions were interesting, the variety of residency programs was impressive, and the featured speakers were inspiring. However, the most important and immediate result from this conference was the personal bonding that occurred between people interested in providing primary health care for other people. MS-4s discovered people and programs that they only dreamed existed. MS-2s connected with students, residents, and faculty members from their own schools and in sharing trials and experiences, emerged more unified and optimistic. This showed that there's a great potential for changing the world, and changing ourselves, if we choose to work together.

MBA for "MD-ummies"

2008-08-01T16:31:00.000-07:00

The University of Missouri-Kansas City Family Practice Residency program offers a MBA that's integrated into their 3-year program. The residency director and one resident, both who have completed the MBA program, gave their version of the...
Top 10 Things a Medical Resident and Student Should Learn from an MBA.

#1 Change Management
#2 Marketing
#3 Leadership
#4 Economics
#5 HIPAA/EHR/Technology
#6 Outsourcing & Offshoring
#7 Quality
#8 Balance Sheet
#9 Advocacy
#10 When you don't know why something is the way it is...Money is the answer.

The skills that they talked about directly related to the practice of Family Medicine. They made a strong argument for understanding these concepts, if not for getting an MBA. It was stressed that the residents who got an MBA didn't do so to go into finance or insurance or some other higher-paying job, but to be more effective in their current positions as administrators, patient advocates, and physicians.

Given some of the ties between BUSM and the BU School of Management, it might be interesting for FMIG to host a workshop/lecture on the "Business of Family Medicine."

Workshop: Dental Emergencies and Procedures

2008-08-01T12:36:00.000-07:00

Two months ago I would have wondered why a workshop on dental care was relevant to a medical conference. But having researched on the effects of dental problems for the past 7 weeks, I was delighted that such a workshop was included!

Why is dental care important to a family doctor?

dental problems is the most common childhood disease (40% prevalence)!
rural communities and minority groups often do not have access to dentists
dental pain can interfere with intellectual, social, emotional development and daily functions
even in places where there are dentists, family doctors often serve to screen for dental problems in check-ups
the teeth are a part of the body and affect the rest of the body holistically; it cannot be looked at in isolation from the rest of the body by dentists only

The speaker was from rural Maine where almost no one has access to dental care and he does dental screening, extractions, anesthesia and other basic dental procedures. He spoke about diagnosing different dental problems and discussed that antibiotics are over prescribed by most medical doctors for dental problems when they are not effective.

To learn more about oral health to treat your future patients: www.fmdrl.org or stfm.org/oralhealth.

Global Health Panel

2008-08-01T07:45:00.000-07:00

This panel is talking about Global Health in general and the Family
Physician's role in health care internationally. They mention WONCA (http://www.globalfamilydoctor.com), an international organization or organizations of which the AAFP is a member.

Q&A:

A comment was made by a student from Alabama about the importance of recognizing underserved populations domestically that have very similar problems to those internationally.

(applause)

Q: What value does an "outside" health care professional offer to a population internationally?
A: The goal is not to bring US system abroad, but to listen to the community and provide necessary resources for the local population. This includes education and material support. The first step is listening.

Q: What is the Family Medicine community doing to be more known in the field of Global Health?
A: WONCA is part of the WHO and are trying to implement policy to promote FM. There is also a lack of individual promotion of work being done by Family docs internationally.

Some publication that were mentioned:
- "Health System Change: the contribution of Family Medicine" (WHO & WONCA)
- "Directory of Residencies with International Rotations" (AAFP)

Closing Remarks:
We have a responsibily to promote FM without paternalism & arrogance. We have a lot to learn about health care as a human right, about equity in a society, and about population medicine. So, at the end of the day, let's make sure that wherever we go, that place is better off for us having been there.

-----
Comments:
The Global Health movement is combining international health with health of underserved populations domestically, realizing that they have similar challenges. I can imagine that the next step in this logic is really redifining "health care" as a human right. That a human is a human is a human, no matter the geography. That the health of a population, as determined by system-wide structures, matters to the health of an individual. I see Family Medicine as uniquely poised to lead the way in this movement and that's why I am choosing this path!

Family of Family Medicine

2008-07-31T20:46:00.000-07:00

This is part of the BUSM family of Family Medicine. We are medical students and residents. We are dedicated to serving our people. And we love eating steaks, ribs, chicken, beans, and corn together in Kansas City while at the AAFP National Conference.

It's great to be able to share insights and experiences across medical class lines. There's so much to be gained from sharing and reflecting! As it turns out, many of the other FMIGs at other schools have structured programs for this kind of contact: mentors, combined academic activities, and combined social activities.

There's so much potential for our own group at BUSM. Both Sebastian and I have noticed this from the few interactions we've had here, starting with the FMIG Leadership Development seminar on Wednesday, that we have a great opportunity for our FMIG to develop and grow. We want to bring a positive culture of Family Medicine to BU School of Medicine. With what started at this conference, let's create a family of Family Medicine at BUSM!

List of free things to date

2008-07-31T16:18:00.000-07:00

-2 USB flashdrives (1 GB and 512 MB)
-1 nonfiction book
-1 water bottle
-1 shot glass
-4 golf tees
-1 plastic buffalo toy
-1 back massager
-1 t-shirt
-1 scrub top
-1 lanyard
-2 lights
-too many pens and highlighters
-1 pocket book on interpreting ECGs
-1 frisbee
-guide to common outpatient problems

Small Session: Dealing with Drug-Seeking Behavior

2008-07-31T15:11:00.000-07:00

After showing a brief ER clip featuring a patient who threatens the ER docs with a gun to get an analgesic drug injection, there's a presentation on drug addiction. They mention 2 articles, Addiction Part 1 and Addiction Part 2, published in American Family Physician that are highly recommended.

They are doing a simulated encounter...
It's a packed room yet volunteers are hesitant. A 2nd year med student has volunteered, but was then replaced by a "more experienced" resident.

The point of the exercise, which featured two patients with different backgrounds an appearance (i.e. Biker and lawyer), was to highlight how backgound cannot necessarily predict likelihood of drug seeking behavior.

It's helpful to see this behavior in a simulated setting so that the experience is dynamic and real, yet can be paused and analyzed by our trainers. I would love to see this kinf of session done in a small group setting at school. Perhaps HBM could feature more simulations so that students can practice both sides of the encounter and get inside the psychology of both roles.

Health Care for All: the AAFP Plan

2008-07-31T13:13:00.000-07:00

This was the title of my morning's workshop. AAFP has developed a plan that focuses on the medical home. The medical home model is based on health care being centered at a primary care office whether the actual health care takes place in the primary care office. I.e. the patient always has a person to talk to abouthealth care and keep track of their records.

It does seem to be lacking in details in terms of reimbursement but it is a good idealistic model to begin with. The President of AAFP presented and was very enthusiastic about it!

Small Session: Models of Global Health Education

2008-07-31T12:02:00.000-07:00

This is a presentation of the "Shoulder to Shoulder" model where they
developed a partnership between community and medical academia for
global health work. They have a long-term relationship with a
population in Honduras. This allows for increased impact and more
effective use of resources.

One of the big questions that the organization is trying to answer is,
"What is the best way of training future physicians to work on Global
Health?"

Tip: "If you need something from a job, get it before you start."
that's how he got funding to do global health education from an
academic position.

2005-2006 survey of global health opportunities in Family Med
Residency Training

Important to learn about systems-based perspectives in health.

Factors that don't determine involvement:
- administrative support
- school location: urban, suburban, rural
- length of non-GH rotations (ex. Surgery)

Main point: there are many opportunities for Global Health training
within Family Medicine Residencies.

"Never doubt that a small group of dedicated individuals can change
the world, indeed it is the only thing that ever has"
-Margaret Mead

Q&A:
Q: Is there formal coordination with MPH Programs?
A: No. Usually students take an extra 2 years to complete.

----------
It's great that a Family Physician can train to be prepared for
systems-based and individual health improvement both domestically and
internationally.

Residency Exhibits

2008-07-31T10:27:00.000-07:00

Yes, that's a motorcycle at the booth. I'm not sure what it has to do
with family medicine, unless there's also a helmet there as well.

It's cool to see so many programs turning out in one place: New
Mexico, UC San Diego, Morehouse, Albany...and yes, BUSM!

It really makes you feel that it's all possible. You can shape your
own path.

"Small things with great love"

2008-07-31T10:05:00.001-07:00

That is a famous quote from Mother Teresa and the key to a successful life in medicine.

That is what Dr. Morsch spoke about today in this morning's lecture. We each have choices to make in our lives and reasons why we make them. We must accept that we cannot do everything but that each day we can make a small difference!

The key question to ask each of ourselves:
Why did we want to become physicians and how are we going to live that out in our lives and relationships?

Enough said. Back to the conference!

"Why is family medicine the most important?"

2008-07-31T10:02:00.000-07:00

Arriving at the Kansas City Airport, I saw only cornfields. But my expectations were quickly fulfilled when I checked in at the hotel and was offered free champagne (or sparkling cider).

Each talk I have attended so far has made me question my motivations, ask the deeper questions and look at the bigger picture. The first talk last night examined the importance of primary care, in particular family medicine. Family doctors, Dr. Roberts, argued contribute the most the people’s health. And he showed that through epidemiological studies: increasing family doctors in a population lowers morbidity and mortality while increasing specialists increases both! I learned that we need to focus on the serving each individual person holistically. To see what each person really wants from you as their provider. Heroic medicine is what is popularly publicized in the media: we hear about the woman saved by an innovative heart surgery or the military helicopter rescues of people in flooding situations. We don’t hear about 50,000 children immunized against rubella or the long-term support physicians that go into flooding situations and help people re-establish the management of their chronic illnesses and provide emotional support. We need to focus on these long-term management treatments. That is what our patients need and we need to learn to serve the people we work with.

BUSM FMIG

Wilderness Workshop

FMIG Summer Planning Event for 1st Year Students

FMIG to Co-Host BUSM Primary Care Week

"What is Family Medicine"

"What is Family Medicine?"

Family Medicine Residency Match Lunch

2011-2012 FMIG Leadership Team

Opening Primary Care Week With a Bang -

National Primary Care Week at BUSM

*Room Change*

"What is Family Medicine?"

Family Medicine Residency Panel + Dinner

2010-2011 FMIG Gets Rolling

Global Health in Family Medicine

AAFP Congress of Delegates Experience

Some Recent News from AAFP

Upcoming Events!

Sports Medicine Workshop: On Field Emergencies

Contact Info from the Lunch Panel

Sports Medicine Workshop series!

Reminder about AAFP

What is Family Medicine? Lunch Panel TOMORROW!

Back to School

Messages about NC09 from a newbie

Congress of Students and Continuity of Care

Massages from the AAFP

Let your voice be heard! - Advocacy in Family Medicine

Ready to Start School Again...

UJC (Ultimate Journal Club)

"Lub dub" and so much more - Heart Sounds Workshop

Exposition Hall = Games, Prizes, and...oh yeah...Residency Programs

Best FMIG practices

Main Stage Lecture: Stephanie Vance, Advocacy Guru

First time at NC!

Wilderness Medicine and Outdoor Health

What Medical Students Can Do for Health Care Reform

Taking care of business...

Keynote Speaker: Ted Epperly, MD, FAAFP

Welcome to Kansas City - AAFP National Conference for Medical Students and Residents

The High Cost (and Poor Quality) of Health Care: Blame it on the C-c-c-c-c-capital-ism?

Upcoming National Conference

BU FMIG awarded Program of Excellence Award!

Lunch with 4th years

New FMIG leaders

The Match and Primary Care

From the Front-Line to the Front-Row: President Obama and Family Medicine

Mental Health In Primary Care

Dermatology Workshop

WHO calls for focus on Primary Care

Primary Care Residency Panel - Family Medicine and Combined Medicine-Pediatrics Programs

New Year Resolutions at the AAFP

Sports Medicine Workshops: Spring Semester

Big Tobacco and Family Medicine

Is BUMC marketing for Philip Morris?

NEJM Perspectives on Crisis in Primary Care

Upcoming Anti-Tobacco Advocacy Series

UK Health Care Talk - Dr. Charlton

Addiction talk with Dr. Scott Davis

Increasing reimbursement for primary care physicians

A Doctor's Descent into darkness and addiction

Starving in the United States

Innovation in Obstetric Care

Reflections: STFM Baltimore Regional Conference

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

Mixing it up...Primary Care style

What is your Dosha?

Making primary care "sexy": chocolate fondue

Ayurvedic Medicine Workshop Registration

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

Interactive Aging Workshop

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

The Patient-Centered Medical Home

Crisis in Primary Care: Making Primary Care Sexy?

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

Register for the Primary Care Mixer

National Primary Care Week @ BUSM

Patient-Centered Medical Home

Mass Crisis: Is This The Future of Health Care?

Ayurvedic Medicine Research

Room Change