Rewards and challenges of family medicine

Tags: value, primary care, graduate medical education, payment, reform, president's letter, youens

From the inaugural address of TAFP’s new president

By Robert Youens, M.D.
TAFP President, 2008-2009

I’m a board-certified, residency-trained family physician starting my 30th year of practice in Weimar, Texas. My grandfather started practicing in my community 100 years ago and my father started 60 years ago. Sometimes I feel that I am simply a continuation of that one spirit. I love what I do. I love what our specialty does and I embrace its uniqueness. The longer I am at this business the more I realize how our particular brand of medicine is what’s best for all patients. Our holistic approach to the treatment of our patients continues to make us the best specialty on which to found a health care system. As the president of TAFP, I will continue our efforts to reinforce the truths that have been known to us and proven by repeated studies that family medicine delivers better outcomes at lower cost. We will continue to actively participate in any arena that will allow us to promote and support our proper place in the health care of our nation.

We need to be properly paid for what we do and TAFP will be there for any effort, including defining a medical home, that will get this done.

We need to be sure that graduate medical education is funded so that the physician pipeline can produce sufficient primary care and especially family physicians to meet the increased demands for our services.

If there is increased demand and not enough primary care physicians, one solution that will be offered is to lower the standards for the practice of medicine.

One of the principal efforts of the next year, taken on by TAFP, will be to protect patients’ interests by not allowing the practice of medicine by non-physicians. All people who practice medicine should have the same core education and experience requirements and those people should be called doctors of medicine. Physicians. It is one of those things that is so true on its face, that it would seem impossible that we would have to fight in the state legislature to stop the passage of laws whose sole purpose is to lower the experience and education standards for the practice of medicine.

Additionally we expect to have the opportunity to prevent the dilution of physician supervision of mid-level providers. This dilution is in the interest of retail clinic corporations and the few physicians who feel there is money to be made by abandoning the belief that every person deserves his or her own personal physician.

By itself the leadership of our specialty society cannot take on the efforts on behalf of our patients and us. We must be together. Our society will need your help both personally to provide testimony of your real world and financially to deal with the reality of politics in our democracy.

I have mentioned some of the opportunities we will have in the coming year to help our patients, our specialty and our profession. With your help we will meet these challenges. We will inform the people and their representatives of our view of what is right. We will reiterate our view and we will passionately represent family medicine in the state and nationally.

Having said these things, let’s review what we can do for ourselves. We will try to change those things outside of us that negatively impact our patients, but what are those things we can do now that allow us to take personal responsibility for our destiny? What can you do for your patients that is only positive?

Let’s review the four A’s. The four A’s are the essence of a credo I have followed through my practice lifetime. They are as follows: availability, affordability, affability, and ability.

Are you available? Do you talk to patients when they call or do you have layers of personnel to shield you from the interruption? Do you have a system for answering questions that is patient friendly? Or is the patient’s lack of persistence deemed a reflection of lack of importance? Do you take call at night? I mean take call, as in being available personally or through another call-covering physician to answer patient’s concerns after hours? Can patients see you the day they need you, or do you have systemic processes that steer patients to alternative provider resources? Availability is part of the definition of a family physician.

Are you affordable? I’m not confused. I know who determines what I get paid and I believe it’s wrong to not have the patient and his or her physician make this determination. That said, you can affect affordability. Do you steward your patients’ resources wisely? Do you use generics when appropriate? Are you mindful of patient cost when ordering tests or making referrals? Do you order tests and visits based on patient need and convenience or is there a conflicting factor of self-interest?

Are you affable? I mean friendly, fun to work with, pleasant, fun to be around. We work in a sometimes mortally serious business and I’m not talking about being silly. I’m talking about being upbeat and positive to make patients feel better. Can you leave your personal troubles out of the visit? I’m talking about being a good leader in your office by being someone who makes others happy to come to work. A positive and pleasant

attitude and affect can have a healing effect on patients. I know that we and the members of our team all have troubles and some more so than others, but it is hard enough helping patients with a pleasant countenance without having members of the team bringing their personal issues to the patient care arena. The patient care setting is for patients. Be appropriately fun and be the example of how this is done.

Are you able? Do you have the ability? I hope we all understand that this is our identifying feature. We are physicians, family physicians, and specially trained for what we do. It is our obligation to be current and knowledgeable. We can do the first three A’s, but if we don’t do this one we are being disingenuous.

Commanding the knowledge base of our specialty is the foundation, the backbone for who we are. It’s is our core competency. It is the thing that we are ultimately selling to the public.

  • Are you board certified?
  • Do you follow evidence-based guidelines?
  • Are you comfortable handling multiple patients with multiple medical problems that don’t fit these guidelines?
  • Do you have reminders for patient health maintenance and screening interventions?
  • Do you have patient registries that allow you to track classes of patients to allow verification of and study of your interventions?
  • Are you able to do real-time drug interaction assessments?
  • Do you have ready access to decision support?
  • Are you comfortable with your competencies so that you can discuss issues with educated patients and let them know of your willingness to learn more? Do you make appropriate referrals and council patients when referral is unnecessary?
  • Do you help them understand the complexities of our current fractured health care system with regard to insurance coverage and how that might impact their health?

Some of these latter issues may seem out of the category of a physician’s ability but you, the patient’s personal physician, are the one with the answers. It’s appropriate that you should help patients with issues that at times we all wish were peripheral to our job, but we must help our customers through the system. You are the person all patients should depend on for all matters pertaining to their health.

In conclusion, it is our responsibility to follow the four A’s, to be available, affordable, affable and able. If we, as a specialty, honored and followed these principles, many of our battles, though still to be fought, would be less onerous. Let us continue to take the high ground. Let’s continue to wear the white hat. Let’s stay focused on our patients.

Robert Youens, M.D.

Dr. Youens is a graduate of the University of Texas at Austin. He received his medical degree from the Baylor College of Medicine and completed a residency in family medicine at the Central Texas Medical Foundation at Brackenridge Hospital in Austin. In 2003, he earned a master’s in medical management from the University of Southern California’s Marshall School of Business. Board certified in family medicine, Dr. Youens has been practicing at the Youens and Duchicela Clinic in Weimar since 1979. He is also a clinical assistant professor of family medicine at the University of Texas Medical Branch.

Outside of his practice, Dr. Youens is very active in his community. He is a past president of numerous organizations, including the Weimar Independent School District Board of Trustees, the Colorado Fayette Medical Society, the Weimar Rotary Club and the Weimar Booster Club. He has been named Health Care Provider of the Year by the Weimar Rotary Club and Teacher of the Year by the UTMB Family Medicine Residency Program.

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