Time to swing for the fences

Tags: president, fiesinger, advocacy, family medicine

An excerpt from the 2012 incoming presidential address

By Troy Fiesinger, M.D.
TAFP President, 2012-2013

Whether we practice in Houston or Henderson, Wichita Falls or Weimar, El Paso or Del Rio, Alpine or Austin; we are all Texas family physicians. We bring different perspectives to the Academy based on where we live and where we’re from. I know what it’s like to work in a large integrated health care system, run a community health center, and teach our future family physicians, but I don’t know how to run your practice. I want to hear from each of you about how we can strengthen family medicine and take care of our patients.

Our health care system is in the midst of a painful rebirth. The insurers, the government, and the hospitals are pulling us in different directions. We stand with our patients at the middle of this storm of abbreviations and acronyms: ACA, ACO, PCMH, EHR, and the Medicaid 1115 waiver.

Now, we can ride off into the sunset like the cowboy in an old Western, resigned to obsolescence as the specialists, large hospital systems, and insurers take over health care. Or we can choose to pull up our britches and get to work. “If you don’t like change, you’re going to like irrelevance even less.” President Lyndon B. Johnson said there are two kinds of people in the world: “can-do people” and “can’t-do people.” I think family doctors are can-do people.

When Bobby Youens and Jorge Duchicela of Weimar grew frustrated at the lack of family physicians in rural Texas, they got together with Tricia Elliott of UTMB to organize a rural residency track. Instead of resigning himself to complaining about changes in health care, Lloyd Van Winkle of Castroville organized primary care docs into an IPA—and is running for the board of the American Academy of Family Physicians. When Melissa Gerdes and Mike McCrady grew concerned about how family docs would fit into large health care systems, they became physician leaders who could advocate for their patients from the inside. Instead of getting mad, Roland Goertz got even and headed off to Washington, D.C., as our AAFP president to bend the ear of every congressperson and senator he could find about the value of family physicians. While other specialties complain about “the government doing this” or “insurers doing that,” family doctors come up with a plan and get to work.

It is easy to get frustrated by the changes hitting us daily, but I urge you to channel your anger into action. We understand better than most the reality on the ground—and what our patients need. When patients ask me if I think all the frustrations are worth it, I think of a 1991 CNN interview with an old redneck from the Boots and Coots well control company. Boots and Coots is who they send in when the world is going to hell and someone needs to put the fire out. Behind him, the burning Kuwaiti oil wells spewed smoke and flames into the sky. When the reporter asked him why someone would do something so dangerous, he answered in his best Texas drawl: “Hell, there’s nothin’ I’d rather be doin’ than fightin’ oil fires.” I don’t push each day to get my patients the health care they deserve to quit now. They deserve my best. And there’s “nothin’ I’d rather be doin’.”

Let’s be honest, though. We took some lumps in the 2011 legislative session: the primary care preceptorship was eliminated, state GME funding for residencies like mine was cut to within an inch of its life, and the loan repayment program which placed family docs in needy communities was slashed so badly it’s on life support. Medicaid rates weren’t cut, but in typical legislative fashion, Medicaid will run out of money on Dec. 31. Your physician leaders and Academy staff have drafted a policy manifesto for the 2013 legislative session: the Primary Care Rescue Act. This plan shows our legislators how they can improve the health of their constituents—our patients—by investing in training new family doctors and getting those doctors to where our patients need them. To improve health care in Texas, we need to:

  • Train more primary care doctors by restoring funding to our residency programs,
  • Push our taxpayer-funded medical schools to train more residents and make sure the medical students they educate go where the taxpayers need them,
  • Encourage medical students to pursue primary care by funding the primary care preceptorship program,
  • Consolidate Texas’ two loan repayment programs and restore their funding,
  • Encourage doctors to adopt health information technology by offering loan programs and business tax credits, and
  • Reward quality improvement by requiring health plans that receive state general funds to increase the fees paid to physicians who achieve national quality certifications from the NCQA and others.

These areas will be the focus of our legislative efforts for the next session. Now we could trot off to Austin in January with this list in hand to ask for more money—just like the school teachers, the universities, and everyone else whose programs were cut last time around. Too often, doctors approach politics like a disease to be cured. We come up with a sound policy, then we wait for our leaders to respond to the rightness of our cause. But being right doesn’t get us votes.

Politicians follow a different logic. Our most important issue may not be theirs. We must get to know them, learn what motivates them, and understand what issues matter to their constituents. Next year, the legislature will make decisions that will have a major impact on health care in this state. Now is the time to lay the groundwork for 2013.

Every TAFP member can contribute. You each have a state representative and a senator. Call them. Remind them you are a constituent—and so are your patients. “My patients have trouble getting the health care they need, they live in your district, and they vote.”

I am honored and humbled to be chosen as your president. It is time to swing for the fences. As I look forward to the next 12 months, I think of the motto: “Lead, follow, or get out of the way.” I am proud to be president of an Academy which chooses to lead.

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