Listening to Dr Joe Scherger1 recently, one understands that personal responsibility is required to create a functional health care system. “Creating” seems better than “reforming”, for instance, because the functionality of the current system is in dire straits. Consider a restaurant where the patrons and the workers are dissatisfied, ratings are bad and the books show red ink for almost 60 years in a row. Any sensible owner would have started over years ago (getting out of the business not being an option). Dr Scherger describes some success rising from the ashes, however: “Idealized micro-practices” where physicians have increased career satisfaction and patients are so pleased they are actually paying out of pocket to belong! Proactive care delivered to “activated” patients who are empowered to have an impact on their own health care. The family medicine physician is employing (and perhaps is actually an agent of) what he describes as “disruptive technology,” turning the tides of woe into currents of hope for frustrated patients and doctors.
So perhaps, with apologies to Ronald Reagan, it is morning in family medicine--optimism awakens. The alarm clocks of the powers that be are playing a tune written by the nation’s primary care physicians and their patients. Perry Pugno’s “paralysis of inaction”2 could well dissolve in the face of many such success stories.
The Clinton administration failed to focus on “systemic problems in funding, organization, and delivery of care,”3 and saw good ideas and well-intentioned initiative fall short of success. The Obama administration is taking aim at health care reform, and is listening to the family of family medicine. We cannot merely complain to legislators about “Big Pharma” and physician reimbursement, although these are undoubtedly important topics. Now is the time to get actively involved in legislative advocacy. We must rise to more effective tactics. Frontline private and academic physicians should learn to feel comfortable bringing issues to legislators and our patients. Those that we serve can become our biggest advocates. We must forge ahead and DO the things that have been shown to improve quality and reduce cost.
Even office design now has evidence-based literature showing cost savings.4 We must be familiar with TransforMED’s findings and new models such as Idealized Micro-Practices, but our key talking points with legislators should be based upon our own personal or program’s experiences in trying to achieve patient-centered care. We need to identify current barriers to improving the quality of care and ask for help to eliminate them. We should discuss why the almost 45-year old hospital-based graduate medical education reimbursement system is particularly problematic for adequately financing primary care residencies and that it needs an overhaul. Legislators need to hear stories of how our local innovations are working to improve patient satisfaction and reduce cost, while also training future family doctors. These tales will resonate with lawmakers, and be more tangible than promises based on dreams of what could be done “if only we had more money.”
Advocacy in family medicine, like a planetary nebula, is beginning to coalesce into some well organized efforts from the haze of the national-level health care issues. The focus tends to remain at a national, rather than state or local level, since ideas traded across listserves now understandably concern the Obama administration. We need to meet with our state and national legislators, and carry our message to our home residency communities at medical staff meetings and county medical society gatherings to develop key physician contacts for local and state as well as federal legislators. We must implement advocacy curricula to educate all family medicine residents as an opportunity for familiarity and comfort with the necessary topics and strategies, and to encourage development of relationships with legislators. Patient-centered medical home (PCMH) strategies are buzzwords in Washington now; staffers need to be aware that we are using tools such as open-access scheduling, health care teams, and patient registries to improve and document outcomes. It is imperative that we are giving more than lip service to the PCMH if we expect more than that out of legislation.
Of all health care costs, 50% are consumed by 5 diagnoses: asthma, diabetes, hypertension, coronary disease, and depression. This sounds like the afternoon schedule of every family physician in America! How can Washington or anyone else deny that the practicing family physician is equipped to lead the change? We are already doing it. The time is now to beat a drum in our state and nation’s capitals to create the rhythm of change.
- © 2009 Annals of Family Medicine, Inc.
