From the Front-Line to the Front-Row: President Obama and 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.

Connect for Reform Now!

References

• "It's a New Day for Health Reform in Washington and You Should Be Involved" AAFP, From the President, March 13, 2009
• AAFP President Tells Obama of Need To Strengthen the Nation's Primary Care Workforce, AAFP News Now, March 6th, 2009

Mental Health In Primary Care

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

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

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

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

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

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

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

• AAFP: Tobacco Use, Prevention and Cessation
  
• AAFP: Tobacco Statistics
  
• Tar Wars: A tobacco-free education program for kids from the American Academy of Family Physicians (AAFP)
  

Is BUMC marketing for Philip Morris?

• Tobacco is STILL the leading cause of preventable death in the USA (~400,000 deaths/year from smoking), more than 40 years after the Surgeon General's report on the negative health effects of smoking.
• Smoking kills more people than alcohol, AIDS, car accidents, illegal drugs, murders, and suicides combined.
• Since 1998, Altria (Philip Morris) has spent more on lobbing Congress than any other business.
  
• Boston University Medical Center (BUMC) received $3.99 million from Philip Morris USA over the past decade to fund the study of tobacco-related illnesses ("Tobacco funded Mass. research", Boston Globe, March 2008).
  

On Monday (Dec. 8th), Dr. Alan Blum - the Gerald Leon Wallace Endowed Chair in Family Medicine at the University of Alabama - spoke to BU medical and public health students about the controversy surrounding university research funded by big tobacco companies. His talk, "Universities 
and 
the
 Tobacco
 Industry:
 True 
Opponents
 or
 Silent
 Partners?
", focused on the role that student advocates can play in reducing the negative health effects of smoking, especially by directly confronting the tobacco companies that produce, market, and distribute the product.

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

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

• "BU forum turns spotlight on tobacco company-funded research -- including its own" (Boston Globe)
• "Tobacco funding slammed" (BU Daily Free Press)
• "Medical Research by the Marlboro Man" (BU Today)

NEJM Perspectives on Crisis in Primary Care

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

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

Upcoming Anti-Tobacco Advocacy Series

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

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

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

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

Lunch will be provided at both talks.

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

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

UK Health Care Talk - Dr. Charlton

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

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

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

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

Addiction talk with Dr. Scott Davis

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


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

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

Increasing reimbursement for primary care physicians

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

Excerpts from AAFP article:

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

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

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

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

To see the full senate proposal, click here.

A Doctor's Descent into darkness and addiction

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

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

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

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

Everyone is welcome to attend the lecture.

RSVP here if you want a book!

Recent news about physicians and addiction:

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