Posted from Kansas City, MO on 05.04.12 by Jay W. Lee, MD

Follow Dr. Stevens on Twitter (@ggstephens) and join the conversation (#AAFPNCSC).

Posted on 3.15.12 by Jay W. Lee, MD

Remember Newton’s Second Law of Motion? To review, force = mass x acceleration. In other words, to determine the force of an object in motion, an observer must know the mass of that object multiplied by its change in speed over time.

Now, work with me. Imagine that the force is that which will shift a vector and that the vector, in this case, is the incentive system that drives rational physician behavior. At the present moment, that incentive system is designed to encourage one thing: volume of services and/or procedures. A doctor decides to do more for their patient and that doctor gets paid more for services rendered (usually no questions asked). This economic incentive is a powerful driver of cost and is largely responsible for the growth in health care costs, particularly when you apply the same incentive structure across the entire system to every provider of health care service widgets. Add to this economic scenario the increasing cost gap between procedural and cognitive services driven by the relative value unit (RVU)-based payment system, and what we have is a health care system that costs a lot without providing a lot of consumer surplus to the most important stakeholder in our health care industry: our patients.

Whew. Take a deep breath. That was a lot to digest (and probably brings back fond memories of studying physics for your MCATs).

Anyhow, let’s focus on that vector again. This volume-driven vector and its relation to cost (or payment in the health care provider’s eye) is what a health care executive (especially one whose title is a three-letter acronym that starts with a ‘C’ and ends with an ‘O’), or one of their bean counters, might use to measure a program’s value to an organization: those programs that provide the highest margin of revenue-over-cost survive whereas those that provide the lowest margin (or negative margin), should be cut. I would argue, however, that cost centers are not just cost centers; they provide health care services to real people and do, in fact, provide value beyond what is seen on a financial ledger.

The best example of this phenomenon of financial myopia and how to fight it occurred recently at Kern County Medical Center (KMC). In February, KMC CEO Paul Hensler decided not to allow the family medicine residency program to submit a rank list for the upcoming National Residency Match Program (NRMP). His rationale was that the medical center’s financial ledger showed a $5.5 million cost per annum related to operating the program. "We're looking at an increasingly difficult financial time,” Hensler said. “It's difficult to support a program that's not a necessary component to the hospital."

Boy was his accounting off.

Soon thereafter, a media and social media storm ensued. Twitter and Facebook were ablaze with furious posts regarding the proposed cuts. Word got to the Kern County Board of Supervisors and Mr. Hensler’s decision was publicly called into question. Community members and organizations banded together into a unified voice of stakeholders to decry what signaled the potential demise a family medicine program that clearly and loudly is a necessary component of Kern County (even if by Mr. Hensler’s calculations, the program is not a “necessary component of the hospital”). The storm of protest went on for three solid weeks. Then, on Monday, March 12, 2012, the Kern County Board of Supervisors “directed Kern Medical Center CEO Paul Hensler to bring in a new class of family [medicine] resident physicians, apparently determining that the program's $5.5 million annual cost was money well spent” according to the Bakersfield Californian.

What conclusions can be drawn? Fight force with force. Remember Newton’s First Law of Motion? An object in motion stays in motion until acted upon by an outside force. An object at rest stays at rest until acted upon by an outside force. Will we continue to allow volume to dominate health care delivery? What will it take for value to dominate health care delivery instead? And who will be the force for change?

In order for us to change the current vector of the health care market, we must force it to change. Let me rephrase: it’s time for us family docs to roll up our sleeves and act like we mean it even if that means we have to mess up the political dynamics in the proverbial sandbox of medicine and even if it means we have to “bloody our knuckles” (as I heard one family doc closer-to-retirement-than-me say at a recent county meeting) to get there.

So here is my revised Newton’s Second Law of Motion. Let’s call it: Family Medicine’s Second Law of Revolution: Family Medicine Revolution = Mass x Amplification

To generate sufficient Family Medicine Revolution force to change the current value trajectory in health care, we must increase our mass and/or amplify our voice. We are making progress on both accounts.

We have mass. This year, CAFP reached more than 8,000 members and AAFP surpassed 100,000 members. And if this year’s residency interview season was any indication of the quality and enthusiasm of tomorrow’s family medicine workforce, I anticipate a bright future.

We are just beginning to understand how to amplify our voice. The Kern County case is a living example of our possibilities. So if you aren’t already on Facebook or Twitter, join the growing community of family docs on social media and look for other #FMRevolution-aries. And if you are on social media already, make yourself known and help us amplify our family medicine voice. Long live the Family Medicine Revolution!

Posted on 05.18.11 by Jay W. Lee, MD, MPH

It has been said that the mere act of showing up is an act of leadership. That would be true for the vast majority of family docs who remain present for their patients and communities. However, I believe that the time is upon us for a paradigm shift. Merely showing up is not enough.

I have been trying to wrap my mind around how family medicine and civic engagement, natural fits for one another when you think about it, sometimes mix like oil and water. Then I remembered that we all went to medical school and therefore are physicians first. What I mean is that we are trained to think linearly whereas "treating" social determinants of health is not linear at all. 

As we build more effective training opportunities for family docs to exercise the "systems" part of their brains (such as the National Conference for Special Constituencies - or NCSC), I believe that the intellectual part of family medicine leadership will catch up with passion part of it and we will have achieved our tipping point: one in which family docs are as comfortable in the clinic as they are in a coalition meeting or legislative visit or press conference.

Follow Dr. Lee on Twitter (@familydocwonk).

Posted on 03.09.11 by Jay W. Lee, MD, MPH

Ah, change. Isn't it lovely? With the passage of the Patient Protection and Affordable Care Act (PPACA) last year, much change has been afoot and most of it has been rapid and frantic change. Many stakeholders, from physicians to health plans and from patients to employers, are probably not entirely comfortable with the ground beneath them moving and so quickly (though I would argue that here in California, we're accustomed to the ground shaking). I would also argue one of the main reasons why folks are so darned uncomfortable is that the vector of our health care delivery system has begun to shift away from fragmented, volume-based to integrated, value-based care. My question for you, dear colleague, is: "Will you choose to sit on the sidelines or will you compete in the game?" This, of course, is a variation on the oft-repeated trope in organized medicine circles: "Either you're at the table or you're on the menu."

As Dr. Roland Goertz, our AAFP President, stated at this past weekend's CAFP Congress of Delegates (CoD): "Our time is now." Let's analyze what that means and its impact on our specialty:

"Our"
We are all part of this sea of change whether we're a country doc, a city doc, a public health official, an academic, part of a multi-specialty group, or in solo practice. This change is about showing the value that family medicine (and other primary care specialties) brings to the US health care system and doing so in a way that is purposeful, loud, and united. We can no longer be the silent sufferers that we have allowed ourselves to become (in the name of harmony). It's ok for us to challenge and confront how our country delivers health care because that's what the health care system needs, that's what our economy needs, and most importantly, that's what our patients need. We must revolt against the status quo and we must take ownership of the revolt.

"Time"
Quietly, AAFP and other family medicine leaders (via collaboration with other like-minded groups such as the PCPCC) have worked to build the political capital necessary to put us in a position to live at the table, not die on the menu. Remember the "Future of Family Medicine" project? That was nearly 10 years ago. The landscape has changed quite a bit and the simple political fact that family medicine is helping to drive policy changes is simply remarkable. Time has been invested to put us in the position to make significant changes in health care delivery. The idea of accountable care organizations (ACOs), for example, has not been fully differentiated just yet but theoretically, the health care provided via ACOs using patient-centered medical home (PCMH) models should value primary care services better than the current fee-for-service model does now. The amount of time that each of us will need to devote to remaining at the table in our local markets will be critically important.

"Now"
Remember managed care in the 1990s? Remember how few physicians were truly engaged in the process? We do not have time to wait and see whether PPACA will live or die in our judicial system. We do not have time to sit back and hope that this will just pass us by like managed care did in the 1990s. Our time is now. Our leadership as family physicians is more crucial than ever before. We must not sit idly by and allow others to shape the health care system. We must revolt against the status quo.

"So..."
Last year, an inspired group of residents started a Family Medicine T-shirt Revolution. These t-shirts said things like: "Use all parts of your brain; be a family physician" and "Americans are dying to have a family doc." Their focus was on raising awareness, particularly among medical students, about the importance of family medicine and cautioning against being intimidated by academics, who have steered many bright students away from primary care.

Well, let's take this one step further, shall we?

Many of you are on social media like Facebook or Twitter. Let's start a Family Medicine Revolution campaign called #FMRevolution. My vision is two-fold: (1) that family physicians and other primary care providers embrace this idea that we are better than what the status quo values us at and that we need to 'revolt' against the currently fragmented health care delivery machine that exists right now (we've been great playing in the sandbox historically, but we have a political window right now to shift the health care system vector permanently away from volume-based FFS and toward value-based care); (2) that the general public sees this anti-establishment health care reform movement and embraces it (though the overarching goals of #FMRevolution and #hcr are the same, ultimately, the American public trusts their doctors more than their government).

Whenever you post an article or status update that is family medicine-oriented, simply add #FMRevolution. Let's bring medicine back to our patients and their communities. Vive la résistance!

Whether your politics lean left or lean right, there is no doubt that the U.S. political landscape shifted with the 2010 Election. My intention here is not to debate the merits of or problems with this change in political environment; I will leave that task to the political pundits. Instead, what I want to highlight is the unprecedented opportunity for family physicians to fundamentally shift the vector of the health care system back towards a patient-centered primary care-based health care system.

I just returned from the 2010 Society of Teachers of Family Medicine Conference on Practice Improvement in San Antonio, TX. What I learned astounded me: family docs from across our great nation have been making improvements in the way they deliver care to their patients, not because of the passage of the American Reinvestment and Recovery Act (ARRA) and the Patient Protection and Affordable Care Act (PPACA), but rather because they are sick of the status quo and want to provide better care for their patients. Wait, you mean local markets are making changes because they want to provide value-added care that maximizes the utility of the health care dollar? Yep.

Let me give you a few examples:

• In Oklahoma and New York, family medicine practices have been using bachelor's degree-level practice facilitators to support their quality improvement and population management efforts with significant return on investment (ROI)
• In Maine, family medicine practices have been using post-hospital group visits to reduce re-hospitalization rates
• In West Virginia, family medicine practices have been using pre-clinic huddles to improve efficiency and patient satisfaction

What was even more remarkable for me is that all of these practice improvement endeavors were born of Patient-Centered Medical Home (PCMH) transformation efforts at the local level. In some communities, these PCMH practices have even begun to become connected to each other via regional efforts to improve the delivery of health care. Are we beginning to see PCMHs becoming PCMH Neighborhoods? Are we reaching that Malcolm Gladwell tipping point?

CAFP has made PCMH transformation a strategic priority. If you want to learn more about this movement, please check out this resource: www.familydocs.org/pcmh.php

So what are your thoughts about PCMH?

Posted on 08.16.10 by Jay W. Lee, MD, MPH

Remember this NY Times piece: Study Shows ‘Invisible' Burden of Family Doctors? In case you don't, let me remind you. It was about a study published in NEJM that details the uncompensated work that family docs like you and me perform daily on behalf of our patients. Acts such as calling patients with lab results, coordinating care with subspecialists, filling out insurance authorization forms, and writing letters make a world of difference for the seamless patient experience but often go unnoticed unless something goes awry. Even with administrative time, these tasks pile up quickly spilling into time that could otherwise be devoted to equally important things like spending time with loved ones. I hate to admit but some of my best work catching up with patients is before or after hours; thankfully, my patients appreciate this care and attention to detail and I hope your patients do to.

Couldn't we do better? Definitely. In fact, my practice is in its nascent stages of transforming into a Patient Centered Medical Home. We started by taking the TransforMED MHIQ. What we have discovered is that though we do provide a lot of patient-centered services in our office, we could be doing a lot more and a lot more efficiently. We are now in the strategic planning stage for how to successfully tackle each TransforMED module so that we can become more patient-centered across the practice from how we schedule appointments to how we communicate with patients to how often we see patients in the office. We are also planning on sending a team including faculty, residents, nursing and office staff to the STFM Conference on Practice Improvement to learn how best to implement PCMH in our office.

All this activity is being driven by our dream to provide medical care that is at the right place and at the right time and that is appropriately compensated. With the movement towards ACOs, we feel that the time is now to begin the long transformation process. This LA Times article about doctors in San Antonio forming ACOs highlights at how much of a tipping point we are.

To facilitate individual practices in making this transformation, CAFP is a co-sponsor of AB1542. The first step policy wise is to define what a PCMH is. AB1542 does exactly that without adding a single penny to the state budget. This bill, if passed, would serve as a compass to guide physicians in the direction of becoming a PCMH. Find out how your practice can move beyond contemplation and towards becoming a PCMH.

Posted on 02.26.10 by Jay, W. Lee, MD, MPH 

In my last blog entry, I reflected on why we teach health policy in our family medicine residency curriculum. It's not just because being wonky is sexy. Policies developed proximally to our distal clinical world have profound and lasting effects on our ability to deliver care for our patients and on our patients' abilities to optimize their health in the context of their neighborhoods. Yes, neighborhoods matter (http://bit.ly/cUoWPe) but I digress ...

Why does it feel that clinical medicine is so far removed from health policy to a degree that anything remotely wonky is rejected outright with an emphatic, "Dammit, Jim! I'm a doctor" not a wonk? Even the idea of non-partisan voter registration (http://bit.ly/cfIYEj) makes some of us docs want to run for the hills though it's about as Ameri-can as mother and apple pie.

It starts in medical school. In September 2006, the NEJM featured a review of the 100 years since the Flexner Report (http://bit.ly/97WQ4Q) which stated "our current predicament: medical students and residents are often taught clinical medicine either by faculty who spend very limited time seeing patients and honing their clinical skills (and who regard the practice of medicine as a secondary activity in their careers) or by teachers who have little familiarity with modern biomedical science (and who see few, if any, academic rewards in leaving their busy practices to teach). In either case, many clinical teachers no longer exemplify Flexner's model of the clinician-investigator." I would add that the modern day complexities of practicing medicine in the US health care system, the enormous debt burden facing graduating medical students, and the financial incentives in our fee-for-service model of reimbursement all conspire to shift medical students away from primary care (http://nyti.ms/ddJZXJ).

That said, what are some potential policy solutions to fix the issue of a declining primary care workforce in the US? Here are three:

1. Provide financial or other incentives for US medical schools to graduate a minimum percentage of each class (dare I say 51 percent!?) in a primary care specialty. For example, renewal of accreditation could be tied directly to a medical school's actual production of primary care physicians: produce too few and lose your accreditation. We need to hold public institutions, like UC, accountable for building our state's primary care workforce.
2. Eliminate medical school debt for graduates who choose a primary care residency, finish residency, and become board certified. I always advise medical students to keep a copy of their personal statement by their bedside to remind them of why they chose to become a doctor. Some listen but many more look at their debt burden and make a microeconomic decision for fear that they may never pay off their loans.
3. Maintain or increase funding for innovative programs, like PRIME-LC (http://bit.ly/bV8188), which stimulate bright and socially-minded medical students to become physicians that not only care for their panel of patients but also care for their communities. Without becoming more civically engaged, we are in danger of becoming RVU-producing docs-in-a-box that don't add value to our society-at-large.

If we are to build Patient Centered Medical Homes for America, we family physicians need to shift our view of ourselves from being victims of policy changes to actual policy movers-and-shakers. In fact, I would love to see every primary care residency program in the country develop health policy curricula to activate and engage our future leaders in this dialogue.

I challenge each of you to get involved in the dialogue and take on mentoring of a medical student or three. They need to know that we care about these issues and that the future of family medicine will involve working on fixing these vexing policy issues.

What say you?

Posted on 01.08.10 by Jay W. Lee, MD, MPH

One of my professional roles is to facilitate a better understanding among our family medicine residents about the effects that health policies may have proximally on our ability to deliver care for patients distally.  To that end, I have developed a curriculum that touches on important arenas in health policy for clinicians ranging from social determinants of health, to history of health care reform, to stakeholder analysis of health care in the United States.  Last month, we began a health policy journal club that used two articles from Health Affairs (http://www.healthaffairs.org/) as a platform for discussing rising health care costs and how to "bend the cost curve."  One of the articles specifically looked at whether having more primary care physicians would cut health spending growth: http://bit.ly/4O1GqQ.

Their conclusion is that, though increasing the percentage of primary care physicians would bend the cost curve some, it would not be enough to do so sufficiently to address spending growth.  Should that stop us from trying to increase the percentage of primary care physicians?  Absolutely not.  What it suggests is we should be trying harder to demonstrate our value to the US health care system.  As family physicians we know our value, but does your average American know, and more importantly from a policy standpoint, does your elected representative know?

Various obstacles lie ahead of us to achieving an ideal percentage of primary care physicians in the physician workforce (at least 50 percent in my humble opinion).  Let me highlight three of the most critical:

1. How we prepare medical students for physician-hood;
2. How we pay physicians; and
3. How for-profit has undermined for-patient medicine. 

Over the next several blogposts, I will analyze these obstacles in detail and suggest potential policy solutions.  Meanwhile, if you have suggestions for future topics that you would like to see featured in this legislative blog, please comment below.

Posted on 10.08.09 by Jay W. Lee, MPH

Yes, after months of hemming and hawing about whether to Twitter (is that even a verb!?), I took the plunge last month.  I got to say ... it's not bad.  For the wonkabes (a word I made up to define those docs who have even an interest in health policy; aren't we all?), it is a way to organize your readings.

Here are a few examples of Twitter feeds I am following at the moment:

• @aafp (yes, our national academy)
• @tweetcongress (tweet your legislator)
• @thehill (latest news from Capitol Hill)
• @KevinMD (leading medical blog)
• @Health_Affairs (awesome wonky health policy journal)
• @CalHealthline (free daily digest of CA health care news)
• @KHNews (from the non-partisan Kaiser Family Foundation)
• @whitehouse (yes, that one)
• @wonkroom (through which I was receiving moment-by-moment updates on the Senate Finance Committee's health reform bill deliberations)

My Twitter feed keeps me up to date on current goings-on in the health policy world and with health care reform in nearly every news/blog outlet, it keeps me organized (and well-fed/watered).  Tweeting has become a much more efficient means of staying informed.  On top of that, I have set-up my Twitter feed to link with my Facebook account (www.facebook.com/jaywon), where I have hosted several heated health care reform debates via my wall (happy to report that nobody lost a finger whilst debating the merits/faults of the public option).

This year, I am planning to tweet from the AAFP Congress of Delegates in Boston beginning October 11 through October 14, and where I will be serving as a Special Constituency Delegate (BTW - think about joining the 2010 CAFP NCSC Delegation: http://www.aafp.org/online/en/home/cme/aafpcourses/conferences/leader/ncsc.html).

You can follow me @jaywonmdmph. See you in Tweetville!

Posted on 07.01.09 by Jay W. Lee, MD, MPH

Alas, it is July again: a time to recognize family medicine life transitions.  Two transitions are particularly noteworthy.

The first is that cadre of new family physicians who will be leaving the warm comforts of the residency womb for the relative cold chaos of the post-residency world.  Many more degrees of freedom = stress.  Did I do the right thing by signing that contract?  What is tail coverage?  Should I get work-specific disability insurance?  Do I know enough to see patients without the watchful eye of my faculty?  Will I enjoy working with my new colleagues?  Am I prepared to hire/fire?  Will I be able to practice the scope of family medicine that I want?  New family physicians, share your questions/concerns by adding your comments below.

The second is that cadre of new physicians who will be joining our ranks as family medicine trainees.  Again, many more degrees of freedom = stress.  Did I study hard enough in medical school?  Am I prepared to be on-call?  Where do I find scrubs?  How is the food in the hospital cafeteria?  Will I like my residency classmates?  Will I have sufficient free-time to have a life outside work?  Can I pay my rent?  Do I really speak Spanish well enough? New family medicine residents, share your questions/concerns by adding your comments below.

A third transition is becoming more noteworthy every day that the words "health care reform" are uttered by someone in Sacramento or Washington DC.  That transition is notable as the medical student interested in family medicine, the family medicine resident, and the family physician are all growing into their patients' best advocate and by extension their own best advocate. How?

Eager participation.  Not every family physician will be testifying for a House, Senate or Assembly committee or meeting with the Governor or POTUS - though some of us might be smart- and/or good-looking enough to appear on the NBC Nightly News with Brian Williams and PBS' NewsHour with Jim Lehrer.  However, your voice is critical to ensuring that our state/nation create a healthcare system that best serves our patients' needs by allowing us to do what we do best: provide high quality, cost-effective patient-centered primary care.

That "white-coat presence" is you.  We must begin thinking of ourselves as family physicians-leaders.  Think of advocacy as a spectrum.  Find that wavelength in the leadership spectrum where you are most comfortable.  You will find that there are many wavelengths to call home: CAFP committees (a plug for those folks interested in getting more involved on a state-level), frontline delivery of clinical services, clinic/hospital committee, teaching students/residents, blogs, radio, television, letters to the editor, op-ed pieces, town hall meetings, websites like Doctors for America (http://drsforamerica.org/), voter registration, and even reading more about the issues.  Share what you do to make family medicine stronger for California.

Posted on 4.13.09 by Jay W. Lee, MP, MPH

In my last blog, I said voting and contributing to the FP-PAC can make our voice meaningful.  However, that voice still needs to be heard - and heard often. So share your story.

By sharing your story - and by others doing so - there will be a "tipping point" toward meaningful health care reform.  National efforts at health care reform have been going on for 100 years. It isn't for a lack of bold and innovative ideas that we haven't achieved health care for all.  Rather, it is from a lack of political will.  Imagine if we could harness the collective voices of every family physician and all of their patients in our state.  Surely, we cannot be ignored.

Let me give you a few examples of how you can share your story:

(1) Write a letter to the editor;

(2) Write an op-ed;

(3) Call into a talk radio show and share your views on health care;

(4) Participate in CAFP's "A Day in the Life of the Uninsured" project;

(5) Be open to talking with the news media (try media relations at your hospital for instance, or participate in CAFP's Congress of Delegates)

In conclusion, I have shared with you several ways of how we can begin to achieve health care reform.  First, get out and vote: you, your staff, your family, and most importantly, your patients.  Second, get involved in whatever way is most convenient and comfortable for you: give money to your FP-PAC, get to know your legislators, or offer to speak as an expert witness for a legislative hearing.  Lastly, share your story: say it loud, say it proud.

ACTION #3 = Make your voice heard in different ways.

Posted on 4.03.09 by Jay Lee, MD, MPH

Alright, you are registered to vote.  Now what?  Take Action.

1. Go Vote: Enough said.

2. Become a legislative Key Contact: What a key legislative contact does is act as a point of contact with legislators in regard to health care issues. Should a legislator have a question about the frontline issues in the delivery of patient care or how a law may affect primary care physicians or the patients you serve, you would be your legislator's primary "go-to" physician constituent. CAFP maintains a list of members who serve as legislative key contacts and helps train those who want to participate. Have you already made a personal contact with a legislator? Phone call? Email? Letter? Text message? Is this something that interests you? Email CAFP and they can help coordinate efforts with you.

Alternatively, there may be one particular issue on which you are an expert or can provide a witness account. Let me share an example.  When I lived in Massachusetts, I testified for a bill that's purpose was to identify and reduce health care disparities in the state.  I teamed up with legislative key contacts from various patient advocacy organizations, and I provided expert testimony as a family physician working with underserved populations at a community health center.  At the heart of what I was doing was conveying issues facing real patients in legislators' communities and states. Not only was I speaking for family medicine, I was speaking for my patients - patients whom legislators probably don't know about or have never heard from.

3. Contribute to your FP-PAC: FP-PAC stands for the Family Physicians Political Action Committee.  FP-PAC is a bipartisan group dedicated to helping pro-family medicine candidates win election to public office and educating current legislators on the importance of family medicine. Every dollar that is contributed to FP-PAC goes directly to fund campaigns and help elect candidates to state office that share family medicine's priorities.

ACTION #2 = Learn who your state legislators are, contact them and let them know you would like to be a health information resource for them. Contribute to FP-PAC to ensure our voice is heard in Sacramento 

Posted on 3.26.09

Health care is in the air and, not surprisingly, 2009 has been a crazy busy year with no signs of slowing down anytime soon in spite of the bleak state of the economy.  Unlike 1994, the last time we earnestly put our collective minds to fixing health care, many more stakeholders were invited and remain at the table to discuss what reform would look like.  We have gone from discussing models of reform to a health care reform movement, and one thing is clear: the current system is broken and needs transformation.

At the CAFP Congress of Delegates in early March, your chapter delegations convened to discuss our specialty's role in this transformation.  We heard from AAFP President Ted Epperly, MD fresh from his participation in the White House Summit on Health Care.  Based on his dialogue with POTUS (President of the United States) and other key members of government, family physicians should have a prominent role in our transformed health care system; this news encourages my heart and we should be ready to roll up our sleeves and meet the challenges.  The reference committee heard impassioned testimony from your delegates about issues ranging from the Patient Centered Medical Home to unfair CCS privileging regulations for family physicians to considering a single-payer model to support a statewide immunization registry.  We also had the opportunity to meet with our state legislators to make our case to include statutory language defining the Medical Home (AB1542), expanding health care coverage for all CA children (SB1), requiring health plans to pay for immunizations at an equal or greater rate than the cost of acquiring and administrating them (AB1201), and establishing a state health professions workforce planning group (AB 657).

The following week, I flew to Washington DC, where I had the chance to meet with representatives in the offices of Senators Dianne Feinstein and Barbara Boxer as well as in Congressperson Dana Rohrabacher's office.  Again, the tone was hopeful albeit cautious with regards to meaningful health care reform.  One thing that was stressed repeatedly is that coverage does NOT equal access and workforce issues must be addressed (see Massachusetts).  Otherwise, Americans will have a meaningless insurance card because they won't have real access or will lack a strong primary care infrastructure in our nation.  A family physician's voice was heard.

I know these are dark times.  Yet, I believe the dark is what comes before the dawn.  We must use our voices now and in unison with our patients if we want change.  We can prevent the dark from becoming permanent.

To that end, I believe strongly that it is high time to move forward through this rare window of opportunity in our history.  We must put aside the differences in our self-interests and look for values that we share in common and craft policies that reflect our enlightened interests.  We must stop this prisoner's game of chicken and begin a dialogue so that we can reach that optimal solution of cost-effective, universal and continuous health care delivery that rewards quality over quantity, coordination over fragmentation and whole-person orientation over organ system care: right service, right place, right time.

Failure is not an option.  That is why your voice and our patients' voices must be heard.  I challenge each of you to do something within the next month and leave a comment on this blog describing your action(s): write a Letter to the Editor to your local newspaper, call-in to a radio talk show, write to - or better yet - meet with your legislators, and/or post a comment on a health care blog (other than this one).  What matters most is that you are part of the process and being heard. Silence is not an option.

Posted on 3.23.09 

To date, I have made the argument of WHY you should have a vested interest in what happens in Sacramento and WHAT the process looks like when CAFP takes positions on legislation.  In today's entry, I will address HOW we will achieve patient-centered primary care-based health care reform together.

Registering to vote is the crux of successful legislative advocacy.  Without exercising your right to vote, your voice will be silent: no matter the depth of your passion, no matter the strength of your argument. If you have yet to register, do it here. The May 19 Special election is quickly approaching and there will be many ballot measures effecting funding for programs involving family physicians on a daily basis.

Secondly, register your patients to vote.  You may want to consider providing voter registration materials in your office or becoming a designated polling site.

I work at a hospital-based residency program and we have incorporated voter registration in the work flow of our clinic, meaning voter registration forms are accessible just as easily as patient education materials.  We view it has a form of "civic" check-up and patients are encouraged in a non-partisan way to exercise their right to vote.  Becoming registered to vote enhances the likelihood that you and your patients' shared voice will be carefully considered and viewed meaningfully by your legislators, and could even lead to patient-centered primary care-based health care reform.

ACTION #1 = Register to vote and help your patients register to vote.

Posted on 12.12.08

Jay Lee, MD, MPH, author of CAFP's Legislative Blog, was recently published in blog comments on two major national newspaper articles regarding patients struggling to find primary care physicians. In his comments, Dr. Lee advocates for physicians to have a stronger voice in politics. He is Director of Health Policy at Long Beach Memorial's Family Medicine department and a member of CAFP Legislative Affairs Committee.

Below are his comments from each newspaper, followed by links to the original articles:

The Wall Street Journal (Posted on 12.11.08)
"As a result of the relative disparity in payment (read: value) for primary care interplayed with the significant amount of debt with which many medical school graduates face, we, the people, are at a difficult crossroads. The current supply of primary care physicians is plummeting with many leaving in droves and fewer new grads to fill the gaps. Why? It is a matter of simple microeconomics. Hence, many primary care physicians are becoming "partialists" (providing more limited scope of practice, often higher margin services such as aesthetics) and medical school grads are choosing higher paying specialties. That merely explains the behavior. Does the explanation make it right (for the nation's health care system)? No. We, the people, lack the incentives and proximal to that, the political will to make meaningful reform happen. Primary care physicians and all Americans have a responsibility, individually and collectively, to see that primary care remain vibrant and the core of our nation's health care delivery. Although I am sick of bailouts, dare I say that we need to bail out health care!?"

Click here to read "Medicare Patients Struggle to Find Primary Care Docs"

Washington Post (posted on 12.09.08)
"As a family physician in California, I understand the frustration expressed by this article. I would argue that refusing to accept new Medicare patients is not the solution, and in fact, will only exacerbate the problem further in the long run. For too long, the voice of physicians as patient advocates has long been absent from the political landscape. Rather, physicians have been largely reactionists or alarmists, especially when it comes to threats to microeconomic conditions (read: Medicare cuts). While I would agree that microeconomics is important, I would disagree wholeheartedly that it should be physicians' guiding principle. What happened to civic responsibility and prima facie, caring for your patient (within the medical home model)? I believe that the time is upon the medical profession (and our patients) to realize that being on the menu is no longer an option and that we need to be at the table (or create new tables) for change."

Click here to read "The Doctor is Out"