"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.
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.
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
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!
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
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.
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.
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!
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 HomeThe 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.
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?
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?
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.
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:
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.
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?
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/
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.
"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."
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!
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.
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.
The Family Medicine Interest Group (FMIG) at Boston University School of Medicine (BUSM) is part of a national network of FMIGs organized by the American Academy of Family Physicians (AAFP).
