PRESIDENT’S MESSAGE The 2012 PRESIDENTIAL ADDRESS
Family Physicians: The Keys to A Better Health Care System By Brian R. Forrest, MD NCAFP President
Dr. Brian Forrest of Apex, NC, was installed as the 63rd President of the NCAFP on December 3rd, 2011, in Asheville. Below are remarks he shared with members during his inaugural address. I would like to start by thanking you, my colleagues, for giving me the honor to serve as your 63rd president. I would also like to thank several people who have helped me along this path. I have been blessed to have a supportive family, an extraordinary group of peers and colleagues, and a line of wise and caring mentors. To my mentors, Dr. Jim Jones, Dr. Bob Gwyther, Dr. Robert McConville in Sanford, Dr. Warren Newton, and more recently, Dr. Chuck Rich, and many more who I do not have time to name - you have modeled outstanding patient care, advocacy, leadership, and vision that I have learned greatly from. To my colleagues at Access Healthcare, I would like to say thanks in advance for all of the scheduling changes and covering that you will do at the practice this year and for all that you have done in the past. And finally, to my wife Shelley, who is an MPA. Greg Griggs and her would tell you that those initials stand for ‘Master of Public Administration’ since they both hold that degree. However, as I have told her, to me it stands for ‘Most Precious Asset’. And she is. She is the embodiment of compassion and has taught me a lot about that value. She also is the detail person and possesses multi-tasking skills that I will never achieve. What a blessing God sent into my life at the DMV that day in 1990. So, where do we go from here? As president of your Academy, I want to take you to a better place, a place where family physicians lead the medical home, providing continuous coordinated care for their patients that is focused on prevention of disease rather than last ditch efforts to stave off its consequences. I want to take family physicians to a place where their skills are the most highly valued, where medical students do not have to make a choice between taking care of their loans or taking care of their communities. I envision a healthcare system where family physicians are the MVP quarterbacks of their Superbowl healthcare teams, with the vision to see the entire healthcare field. Some of you may be thinking that the place I want to take you sounds like a fairytale. But the place I want to take you is your future - a future where the brightest medical students are eager to become family physicians and use their skills to keep patients healthy. There are some obstacles on the path to our destination. The practice overhead/reimbursement ratio has been steadily growing. This is driving small practices to become employed by hospitals, to look for alternative revenue streams, and, unfortunately in some cases, to close altogether. Practice managers would say the solution to an overhead/reimbursement problem is higher volume. Physicians have responded to the “make more widgets” ethos by cutting average patient contact time down to 10-minutes per visit. This impairs the ability of physicians to take the time with their patients they need to establish therapeutic relationships, which drives the culture and patient belief that doctors are an independent commodity service like gas stations. You go to the closest one you
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Winter 2012 • The NC Family Physician
can find that you have a discount creditcard for. You have no allegiance or relationship with any one gas station, you just go to the one that is open the longest and is the most convenient -- assuming that all gas is roughly the same and that convenience is all that matters -- sounds awfully close to picking a doctor solely based on their insurance network doesn’t it? Well, with physicians relationships DO matter. Knowing your patient, their family, their values, their tribulations. It affects the care we deliver as family physicians and we are not interchangeable like gas stations. To change the culture and to show our value requires better outcomes. We must show through the use of registries, quality improvement initiatives, and data collection that quality primary care makes a difference. Showing insurers, legislators and the public what a quality family physician can do for the health of a community will force them to realize that the Starfield data is accurate and, that to truly reform the health care system, it will take family physicians! Anything worth doing is worth doing yourself, so we all need to participate in reforming healthcare and making primary care the foundation on which the House of Medicine is built. Advocacy is important but legislation alone is not enough to cure what ails our current healthcare system. It will take dedicated, skilled and innovative people. It will take family physicians. To improve the health of our country, our citizens, and our communities. We must be a beacon, illuminating a path to better health care. Bringing down costs of care, while at the same time improving the quality of care will take family physicians. Bringing transparency, health care value, and integrity to the health care system will not take a bunch of bureaucrats, bean counters, or analysts. It will take family physicians. Changing our co-pay culture from a system that focuses on sickness instead of wellness, on parts rather than the whole human being, on creating demand for care rather than providing it - will take family physicians. There are communities where the only payer is the government, where poverty creates limited opportunity, where patients truly have difficulty affording any care. And for family physicians working in those rural or underserved areas, we have to stand up as advocates for our patients, support legislation that makes providing care for people in those settings tenable, and support the Community Care Network that makes being a family physician viable there. Impoverished patients will not have PAC money to support candidates that understand the value we bring to communities. There is only one voice that is strong enough and needs to be loud enough to be heard by our elected officials - it is the voice of family physicians. It will take family physicians. www.ncafp.com/ncfp