Alex Sheriffs, MD was recently appointed to the governing board for both the San Joaquin Valley Air Pollution Control District and the California Air Resources Board.

Dr. Sherrifs is a native Californian, as well as his wife, Joan Rubinstein, MD.  After his undergraduate years at Yale, he met Dr. Rubinstein at UC Davis and married when there were both residents in the family medicine residency program at Valley Medical Center, Fresno.  Drs. Sherriffs and Rubinstein spent two years with the Indian Health Service in northern Michigan.  Dr. Sherriffs spends half his time with the residency program at UCSF Fresno and as Medical Director of the Alzheimer's and Memory Center of Fresno. He has a certificate of added qualification in geriatrics and sees most of the nursing home patients.  He and Dr. Rubinstein are also clinical professors at UCSF Fresno campus.

A special pleasure of Drs. Sherriffs and Rubinstein has been participating in CAFP’s Preceptorship program by sponsoring one second year medical student for one month during each summer for the past 17 years in their Fowler practice.  This experience generated more adrenalin when the practice included OB and hospital work, but continues to provide an intense opportunity to immerse in the realities of rural practice.  They also have continued a house calls curriculum for third year medical students from UCSF, originally developed through a Robert Wood Johnson grant.

A past president of the Fresno-Madera Medical Society (FMMS), Dr. Sherriffs chaired the Public Health Committee of the FMMS in 2006 proposing to champion air quality.  As Dr. Sherrifs says, “We were seeing COPD in adults who had never smoked, and more and more pediatric asthma. Scientific literature was accumulating supporting direct links between air quality and lung disease, cardiovascular outcomes and cancer.  School athletic practices were being cancelled because of poor air quality. Our daughter never needed her inhaler after moving to San Diego.  We have loved living in the Valley – we have to leave it a better place than when we arrived.” The FMMS efforts led to a Hewlett Foundation grant to support a full-time staff person dedicated to air quality, and the development of collaborative relationships with other medical societies, air quality advocacy groups, and Smart Growth advocates.

They raised their two daughters in Fowler, and took great pleasure in the community involvement that resulted:  coaching soccer, 4-H, team physician for the high school, mentoring in the Science Olympiad program, and of course attending the full range of school concerts, plays, awards events and field trips.

Why are you a member of AAFP and CAFP and why is being an Academy member important for your patient-care philosophy? Our contact with individual patients and the challenges of applying the science of medicine fuel our daily professional lives.  Being part of larger organizations supports our commitment to our patients and communities. It is key to our ability to deliver quality care.  Our Academy offers first rate CME in publications and the Annual Scientific Assemblies.  The CAFP has been a critical supporter of the Medical Injury Compensation Reform Act  (MICRA), a model for the AAFP’s national efforts for tort reform. Without our Academy’s efforts, health care reform would not have recognized the central role of primary care and the need for broader accountability to improve our nation’s health.

As an active CAFP member, which member resource is most helpful to you? The staff!  They are interested in what we are doing, and in promoting family medicine.  If they can’t answer a question, they can point us in the right direction.

How do you champion family medicine? First, I try to provide quality personal care to the patients I see, and when they know I am a family physician they become advocates for family medicine.  Second, I try to model for students considering medicine, medical students and residents.  I want them to see that family medicine is challenging, satisfying, and doable.  Our monetary rewards may be at the bottom of physician reimbursement but the non-remunerative rewards are tops.  And under health care reform, primary care will be more equitably remunerated.

What do you love about family medicine?  What a gift to be a family physician!  Every day offers new challenges and new opportunities to learn new skills.  Every case of the “common” cold takes place in unique circumstances.  Every week brings unusual presentations or unusual diseases through our office doors. We have the opportunity to appreciate the context of disease for individuals and for families. If you are in private practice you are a job creator, and have the opportunity to create an environment that people want to work in.  Most of my patient encounters begin with “How can I help you?” and indeed in our work there is always the opportunity to be a teacher, a healer, at the very least someone who has made something better.

Can you tell us about any goal(s) you hope to accomplish in your new position on the San Joaquin Valley Air District Board and California Air Resources Board? The health consequences of air pollution in our Central Valley are legion, and deeply disturbing. We have the highest rates of childhood asthma in the nation. A heart attack on a bad air day significantly increases your risk of death.  The Valley pays $1 billion in excess health care related costs for its bad air.  One study suggested air quality may shorten life expectancy by up to two years. Although the Valley has greater air quality challenges than most of the state, air quality is also a major issue for the Bay Area and the Los Angeles basin. CARB has become a global leader in its efforts to address carbon emissions and global climate change. These efforts affect major economic players- agriculture, trucking, petrochemicals, the auto industry, and how our communities develop. It is a lot to balance.  I hope to be a more effective voice for health in both Boards deliberations.

What are your experiences with advocating on behalf of family medicine or affecting policy through the CAFP? The Academy offers many high quality opportunities for advocacy training for physicians including the annual legislative advocacy day and training related to the annual Congress of Delegates.  Service on CAFP committees is an excellent portal for new members.

What is the biggest opportunity or challenge you see in the specialty in the next five years? The unsustainability of health care as we know it in the United States and the uncertainties of health care reform  are opportunity and challenge enough!  As an individual I cannot hope to keep up, nor influence the outcome, but through our Academy we can exert a positive influence.

Any advice for new family physicians transitioning into practice or health policy from residency? Great choice of specialty! Stay as broad as you can as you learn what you like and are effective at.  It is easy to get narrow and head down a given path- it is much harder to jump to a new path.

What advice would you give to a colleague about work-life balance?  Define your “life” needs.  Establish the priorities.  And embrace the notion that some of it might fit better in five or 10 years.  As for the family life balance, being devoted to family doesn’t mean spending 100 percent of your non-work time with family, but it does mean having dedicated uninterruptable regular time.  And I am confident the family therapists would say talk it over(negotiate) to set the priorities.  That said, having come late to dog ownership I would advocate being an early adopter- a dog can help you understand what is really important, and ours gave me a healthy outlet for my need to be an Alpha.

Other thoughts?  I see a lot of younger faces at the Academy meetings, which is great.  However, like every organization in the early 21^st century, we need to focus even more on getting the next generation to join and be more involved, and focus on how the organization can evolve to meet the needs of our more newly minted family physicians.

How do you spend your free time? Family, gardening, cooking,  farming, bridge, fly fishing, photography, hiking, backpacking, birding, opera, reading, walking the dog (every day).

What books have you recently read?  1491: New Revelations of the Americas Before Columbus, Atul Gawande’s Better: A Surgeon's Notes on Performance, and Dog on It by Spencer Quinn.

What is the coolest thing your kids do?  They have found things that they are passionate about in their career choices, spouses, and avocations. They are good friends to each other. And they seem to enjoy their parents’ company too.  What a gift!

If you weren’t a family physician, what profession would you most like to try? Teacher.