Family Medicine On The Move

Last night I spoke with the president-elect of the AAFP, Ted Epperly.  This is the guy who will shortly be running the show (as much as one person runs any national organization) at a time of dramatic change in American Medicine.

Epperly probably expends more energy in a day than I do in a week, so he’s perfect for his new job.  He mentioned that he is currently traveling close to 260 days a year.  Just the thought of being on the road that much makes me develop a nervous tic.  I often wish I could travel more…but not that much more.  I’d forget my own address.

Most of what I discussed with Epperly was with regard to running for an elected position at the AAFP.  There are numerous spots that need to be filled by family medicine residents and students every year; many of the elected spots go to attendees at the National Conference, where I’ve been for the past 5 days.  Epperly suggested that if anyone wants to lend a hand at the AAFP – student or resident – there will be a place for them.  The spot I was considering – as a delegate to the AAFP – would have required quite a bit of national travel and I needed my program director to support all the time away.  Turns out I didn’t apply for the spot and there appears to have been a good group of applicants this year to choose from anyway.  So, nothing lost by me not applying.

That said, according to Epperly anyway, I’m certainly not off the hook.  Nobody involved in family medicine is, irrespective of their involvement in the AAFP.  His premise is that American Health Care is poised for enormous changes over the next few years.  Both Obama and McCain will confront a care system that, for various complicated reason, is in shambles.  Idealogues both conservative and liberal (they like the term “progressive”) clearly see that reform of our system is imminent.  Exactly how that change occurrs, and who gets the lionshare of the “spoils” is going to be determined by how well each interested party lobbies the decision makers.  Thus, every believer in family medicine needs to be a part of the communication process.  Involvement in the AAFP is one way.  Letters to lawmakers is another.  Lobbying the AMA, letters to editors and blogging are big too (think, Kevin, M.D. etc.)

Without hesitation I say that family medicine doctors should be a major part of a health care system restructuring.  I think that family medicine – broadly-trained, general physicians – are without doubt the most effective and efficient agents in delivering health care.  I think they should have more power at the health care bargaining table than business, pharma, legal, governmental, insurance, para-professional groups, and allied health organizations that promote doctor-nurses, nurse practitioners, physician assistants, etc.

I’ve lived overseas and utilized a national health care system (Israel).  Additionally, I’ve read about the nationalized systems in New Zeland, Australia, UK, Canada, France, Germany and Japan.  While they all have their problems, one thing they have in common is an emphasis on primary care, and usually that care is provided by generalist doctors who have been trained in medical school and residency.  A recent article in the New York Times about eye-widening success in reforming health care in Siberia also describes how money was allocated almost exclusively toward primary care in individual villages.

Epperly was inspiring even because he is so confident that family medicine will prevail in this tussle for health care money.  His belief appears to be grounded in the idea that ultimately, family medicine is the best medicine not only for individuals, but also for health care systems.  Really, the only thing that appears to concern him is whether or not that message will be articulated effectively.  Epperly and some surrogates will be attending the Democratic National Convention this fall, and some other AAFP heavies will be similarly attending the Republican Convention.  The guy is on the road nearly every day in an effort to get the message out.  All who believe as he does, and as I do – that family medicine is the superior method of health care delivery – need to follow Epperly’s lead.  We may not travel the country 260 days a year, but we need to tell our stories that often.  If the world knows, healthcare wins.