texas family physician VOL. 64 NO. 1 WINTER 2013
Medical Student Conference At UTHSCSA Focuses On Primary Care Tar Wars Celebrates Its Silver Anniversary 2012 Year In Review
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INSIDE TEXAS FAMILY PHYSICIAN VOL. 64 NO. 1 WINTER 2013
Primary care makes progress in the mission city
Medical students from around the country learn the importance of primary care from family medicine champions at a recent American Medical Student Association conference held at the University of Texas Health Science Center at San Antonio School of Medicine.
By Samantha White
Meet TAFP’s Physician of the Year: Justin Bartos III, M.D.
Currently practicing at the David Pillow Senior Clinic and the Medical Clinic of North Texas in North Richland Hills simultaneously, 2012-2013 Physician of the Year Justin Bartos III, M.D., is revered by patients, nurses, and fellow physicians alike. The former TAFP president is a passionate spokesman for the specialty of family medicine.
By Kate Alfano
Lloyd Van Winkle, M.D., wins bid for AAFP Board of Directors TAFP’s 2011-2012 Family Physician of the Year continues the tradition of great Texas leadership at the national level.
10 NEWS IN BRIEF For patients, price isn’t everything. | Evidence supports cost savings for medical home. | Deadline approaches for EHR incentive. | EHR satisfaction survey results are in. | Study reveals factors in physicians’ adoption of social media. 14 MEMBER NEWS Huang receives AAFP Public Health Award. | Alpine family doctor appointed to national advisory council. | TAFP members join AAFP commissions. | Brenham doc wins EMS award. | TAFP member named Catholic Doctor of the Year. 30 Foundation Focus Thanks to donors for supporting family medicine.
32 PUBLIC HEALTH Tar Wars turns 25.
6 PRESIDENT’S LETTER Clinical quality reports send docs into five stages of denial.
38 TAFP PERSPECTIVE As the 83rd Texas Legislature begins, Clare Hawkins, M.D., says stakeholders support family medicine residency training.
A look back at 2012
The year of the dragon was great for TAFP and its members.
NEW ICD-10 DEADLINE:
OCT 1, 2014
2014 COMPLIANCE DEADLINE FOR ICD-10 The ICD-10 transition is coming October 1, 2014. The ICD-10 transition will change every part of how you provide care, from software upgrades, to patient registration and referrals, to clinical documentation, and billing. Work with your software vendor, clearinghouse, and billing service now to ensure you are ready when the time comes. ICD-10 is closer than it seems. CMS can help. Visit the CMS website at www.cms.gov/ICD10 for resources to get your practice ready.
Official CMS Industry Resources for the ICD-10 Transition
TEXAS FAMILY PHYSICIAN VOL. 64 NO. 1 WINTER 2013 The Texas Academy of Family Physicians is the premier membership organization dedicated to uniting the family doctors of Texas through advocacy, education, and member services, and empowering them to provide a medical home for patients of all ages. Texas Family Physician is published quarterly by TAFP at 12012 Technology Blvd., Ste. 200, Austin, Texas 78727. Contact TFP at (512) 329-8666 or email@example.com. Officers president
Troy Fiesinger, M.D.
Clare Hawkins, M.D. Ajay Gupta, M.D.
vice president treasurer
Dale Ragle, M.D.
Tricia Elliott, M.D.
immediate past president
I.L. Balkcom IV, M.D.
Editorial Staff managing editor
Jonathan L. Nelson
chief executive officer and executive vice president
Tom Banning chief operating officer
Kathy McCarthy, C.A.E.
advertising sales associates
Michael and Audra Conwell Contributing Editors Kate Alfano Rebecca Hart, M.D. Clare Hawkins, M.D. cover photo
By Troy Fiesinger, M.D. TAFP President we received our monthly physician quality report cards recently. Software mines our electronic health record and generates reports to tell us if we are meeting our goals. These quality measures are defined by Medicare, our clinically integrated physicians group, and commercial payers like Blue Cross Blue Shield. While some are based on solid medical evidence, others seem arbitrary and not relevant to the day-to-day reality of seeing family medicine patients. I prefer creating and using our own data instead of relying on the often incomplete and inaccurate claims data from insurance. Despite our efforts to be good sports, often we feel bombarded by the endless number of things we should do to show we are good doctors. When the CDC announced a new recommendation to screen all adults born between 1945 and 1965 for hepatitis C, I groaned. One more thing to do. My office visits have not
While I firmly believe that we must measure our performance to improve, I have been through this often enough to find our reactions humorously consistent. The late, great psychiatrist Elisabeth Kübler-Ross, M.D., could have used us as a case study. 1. Denial — “These patients aren’t mine. The attribution algorithm is wrong.” 2. Anger — “I referred him five times to get a colonoscopy. What do I have to do, drive him there myself?” 3. Bargaining — “If they could correctly identify my patients, then I would know where to start.” 4. Depression — “This is impossible. I’ve told them a thousand times to exercise. I give up.” 5. Acceptance — “OK, fine. Schedule those diabetics to see me and our dietitian so we can talk about healthy eating.”
subscriptions To subscribe to Texas Family Physician, write to TAFP Department of Communications, 12012 Technology Blvd., Ste. 200, Austin, Texas 78727. Subscriptions are $20 per year. Articles published in Texas Family Physician represent the opinions of the authors and do not necessarily reflect the policy or views of the Texas Academy of Family Physicians. The editors reserve the right to review and to accept or reject commentary and advertising deemed inappropriate. Publication of an advertisement is not to be considered an endorsement by the Texas Academy of Family Physicians of the product or service involved. Texas Family Physician is printed by The Whitley Company, Austin, Texas. legislative advertising Articles in Texas Family Physician that mention TAFP’s position on state legislation are defined as “legislative advertising,” according to Texas Govt. Code Ann. §305.027. The person who contracts with the printer to publish the legislative advertising is Tom Banning, CEO, TAFP, 12012 Technology Blvd., Ste. 200, Austin, Texas 78727. © 2013 Texas Academy of Family Physicians postmaster Send address changes to Texas Family Physician, 12012 Technology Blvd., Ste. 200, Austin, TX 78727. 6
Denial ain’t just a river in Egypt
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Everywhere we turn, we seem to face pressure to do more while making each patient feel we spent enough time with them. With all this pressure pushing us in different directions, I am not surprised at my colleagues’ reactions to the report cards. gotten longer while my checklist for each visit has. When we are not having to meet new quality measures, we have to make sure our Medicare patients get their annual senior assessments and have all of their medical problems reviewed to make sure that our risk scores are correct. Everywhere we turn, we seem to face pressure to do more while making each patient feel we spent enough time with them. With all this pressure pushing us in different directions, I am not surprised at my colleagues’ reactions to the report cards. I, too, often feel that I am back in school. I have been tempted to tell patients: “Hey, you’re killing me on my quality report card. Can you get your A1C checked for heaven’s sake?”
Despite our frustrations, we do learn more about our practice by looking at this data. For example, our colorectal screening rate was at the national average, but only 10 percent of those tests were reported to the insurers with the correct CPT II code. That means we may not get the quality bonus we deserve. You can bet that motivated us all to click the little button for colorectal screening reporting. We all think we’re good doctors when we sit in front of a patient. You have to have intestinal fortitude to look honestly at clinical data and admit that you are not as good as you think you are. So step by step, report card by report card, we pass through Stage 5 and get back to work.
Price isn’t everything Patients want low-cost health care, but a survey reveals most of them aren’t willing to make concessions in their care to reduce costs, particularly when it involves giving up their doctor. 72 percent of “retail health care consumers”—adults younger than 65 who are uninsured, covered by an individual health insurance policy, or covered by a group policy for businesses with fewer than 100 employees—are more concerned with affordability than quality or access. However: • Only 23 percent would switch to a new primary care physician, • 29 percent would switch to a new hospital, • 41 percent would see a nurse practitioner instead of a physician for routine care to cut costs, and • 43 percent would change brand prescriptions to treat the same condition. Source: “Most Patients Won’t See an NP Instead of Doc to Save Money.” Medscape Medical News. Dec. 3, 2012.
2.5 million the number of children enrolled in Texas Medicaid as of September 2011. Source: “Texas Health Care 2011: What Has Happened and the Work that Remains.” Center for Public Policy Priorities, December 2011
Medical home reduces costs for complex patients A study of the patientcentered medical home’s impact on health care costs found that the greatest savings occur in the most medically complex patients, or those taking seven or more medications. The study compared annual costs and utilization of more than 58,000 patients receiving primary care at one of 22 medical groups over a five-year period. All PCMH patients experienced fewer emergency department visits, but the total cost of care for complex patients decreased most significantly: $446 per person in 2005 and $184 per person in 2009. The cost of outpatient care for this group decreased $241 per person in 2005 and $54 per person in 2009. Source: “Patient-centered medical home cost reductions limited to complex patients.” American Journal of Managed Care. November 2012.
Study: Medicare can cut 5 to 10 percent of total spending by focusing on chronic disease and coordinated care • More than 90 percent of Medicare spending is associated with patients with one or more chronic conditions, and roughly a quarter of Medicare beneficiaries have diabetes. • 20 percent of Medicare patients were treated for five or more chronic conditions during the year, accounting for half of total Medicare spending. • Rising obesity rates among seniors account for approximately 10 percent of the increase in spending. • 20 percent of hospitalized Medicare patients are readmitted to the hospital within 30 days. • Roughly a quarter of all adults who went to an emergency room could have been treated in a more cost-effective non-emergent setting. Source: “The Medicare Advantage Experience: Lessons for Reform to Original Medicare.” Kenneth E. Thorpe, Ph.D. December 2012.
Texas Medicaid EHR Incentive Program Eligible professional participation deadline for FY2012 is March 16, 2013 For eligible professionals, or EPs, who are participating in the Texas Medicaid Electronic Health Record Incentive Program, a deadline is approaching fast. To receive a payment for 2012 participation, eligible professionals must successfully complete their attestation in the program portal and be in the “Payment Pending” status by March 16, 2013. This means that eligible professionals who wish to participate in 2012 must meet all program requirements by March 16, 2013, and EPs that are in “Payment Pending” status by that date will be allowed to finish through to payment. Enrollment for program year 2012 will not be accepted after March 16, 2013, even for EPs who have completed their initial registration with the Centers for Medicare and Medicaid Services to participate in the incentive program.
TEXAS FAMILY PHYSICIAN
Eligible professionals who do not meet the March 16, 2013, deadline may still continue their enrollment in the program but their participation will be advanced to 2013. Here are two examples for a shut-down date of March 16, 2013: • EP 1: “Payment Pending” status by March 16, 2013 – Status remains active for program year 2012 will be carried through to payment. • EP 2: “In Progress” or “Not Started” status on March 16, 2013 – program year 2012 status is closed. The EP may begin attestation for program year 2013. To learn more about the program and how to participate, visit www.texasehrincentives.com for a user-friendly e-learning tool, and www.tmhp.com/Pages/HealthIT/HIT_Home.aspx for the latest program news and resource documents. For additional assistance on this and other aspects of the Texas Medicaid EHR Incentive Program, e-mail HealthIT@tmhp.com or call the contact center at (800) 925-9126 (option 4).
Today more than 3,500 children will try their first cigarette.
Stop kids from starting. Volunteer to be a Tar Wars presenter. www.tarwars.org
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of family physicians surveyed said they were highly satisfied with their electronic health record. Users were most satisfied with the way their EHRs facilitated intra-office messaging and tasking, found information, documented data, and facilitated electronic prescribing. They were most dissatisfied with the effect on productivity, distraction from patient care, and lack of vendor support. Nearly half of respondents were from practices of 10 or fewer physicians and almost half were from practices of more than 20 physicians.
social docs Approximately one in four physicians currently utilizes social media daily or numerous times a day to access medical information, and 14 percent contribute new material to social media sites daily.
Source: “The 2012 EHR User Satisfaction Survey: Responses from 3,088 Family Physicians.” Family Practice Management. November/ December 2012.
practice costs on the rise From 2001 to 2011, operating costs for multi-specialty practices have increased by 64 percent, amounting to $528,182 per full-time physician. The ten-year rise in price includes the 1.27 percent increase experienced by physician-owned practices from 2010 to 2011. Source: “Medical Practice Costs Creep Higher.” HealthLeaders Media. December 2012.
When asked on a weekly or multiple times a week basis, 61 percent of respondents claimed to look for information and 46 percent contribute fresh information. A mere 7 percent of surveyed physicians currently use Twitter, while 52 percent are members of physician-only communities like Ozmosis and Sermo. According to the report, primary care physicians are influenced to use social media by the ability to network with peers, positive outlooks on social media itself, user-friendliness, and helpfulness. Source: “Understanding the Factors that Influence the Adoption and Meaningful Use of Social Media by Physicians to Share Medical Information.” Journal of Medical Internet Research. September 2012.
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TEXAS FAMILY PHYSICIAN
Third-year medical student Jerry Abraham, M.P.H., and Kaparaboyna Ashok Kumar, M.D., relax between sessions of the AMSA conference on the UT School of Medicine San Antonio campus.
AMSA brings student conference to San Antonio medical school By Samantha White
the american medical student Association held the Empowering Future Physicians Conference at the University of Texas Health Science Center at San Antonio this past October, bringing numerous leaders in the primary care world together to address medical students from around the country. The three-day event included speakers from various realms of medical education, from admissions to curriculum development, and engaged students through an exhibit fair and other activities. Jerry Abraham, M.P.H., AMSA March Meeting 2013 chair and chair of the TAFP Section on Medical Students, is a third-year medical student at UTHSCSA and was heavily involved in the planning and executing of the AMSA conference. He says that this conference and similar events “build a community of committed physicians-in-training that lead to future collaborations, leadership development, and solutions to many of the challenges facing physicians and the health care system.” About 250 students attended the conference, according to Abraham. Kaparaboyna Ashok Kumar, M.D., F.R.C.S., is a professor of family and community medi12
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cine at UTHSCSA and spoke to TAFP between conference events. Educating current students on what primary care truly is will encourage them the most to choose it as a path, Kumar says. He explains that while most medical school training takes place in a hospital, more focus must be placed on local mentors to spark medical student interest in primary care and ensure a strong primary care physician workforce in the future. Kumar serves as faculty advisor for the UTHSCSA Family Medicine Interest Group and works to bring community physicians to campus to talk about the ins and outs of being a primary care physician, hoping to show “happy role models” to students who are interested in a family medicine career. Having practiced as a primary care doctor himself for many years, Kumar says of his teaching strategies: “I can tell the real life stories. My students and residents get to see that. Teaching from books and medical school knowledge is different from really teaching them what the community needs.” Similarly, Abraham says that “there’s only so much you can learn in medical school,” on the importance of the AMSA conference.
FMIGs provide a positive venue to educate students about family medicine through meetings, procedural workshops, community service projects, and guest speaker events. The San Antonio FMIG is very active on the UTHSCSA campus and has won the AAFP Program of Excellence Award a total of five times. Kumar says they put on campus programs for students at least once a month and that all medical school students are allowed to attend, regardless of their interests, in hopes undecided students will be attracted to family medicine. Another aspect of teaching students about primary care, according to Kumar, is making sure they understand that it is more than treating the common cold and cough. “Primary care is taking care of the whole person: prevention, multiple medical problems, and complex patients. It is a challenging specialty,” he says. “Prevention is very important and family medicine really gives that kind of training.” Andrew Morris-Singer, M.D., is president and principal founder of the Boston-based organization Primary Care Progress, a nonprofit that aims to revive the primary care workforce pipeline with a “field-organizing model that engages clinicians, trainees, and educators,” according to their website. Morris-Singer spoke at the AMSA event on behalf of his organization. Seeing the conference as an “opportunity to speak to the next generation of clinicians,” Morris-Singer attends and speaks at similar events to encourage medical school students who are usually otherwise discouraged from choosing a primary care path. “We have to provide support for the students that are interested in primary care careers. Student interest groups are wonderful, whether you call it a family medicine interest group, Primary Care Progress, whatever it is, it’s got to exist,” says Morris-Singer. Kumar says that the AMSA conference and others like it are crucial to reversing the country’s primary care physician shortage because they expose students to “what primary care is in a more meaningful way than what they are learning in schools.” Introducing students to actual family physicians will remind them why they began medical school in the first place—to help people, explains Kumar. The conference not only allows students to meet and network with practicing family physicians, but also confronts them with some of the issues facing primary care doctors including quicker medical school
“We have to provide support for the students that are interested in primary care careers. Student interest groups are wonderful, whether you call it a family medicine interest group, Primary Care Progress, whatever it is, it’s got to exist.”
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The program is free to your practice, and enrollment is completely voluntary. The Texas Academy of Family Physicians is partnering with Atlantic Health Partners because Atlantic can save family physicians money, advocate for fair payment and support family medicine. Atlantic Health Partners will donate 10 percent of revenue from all TAFP member sales to TAFP and provide an additional $1,000 unrestricted educational grant to the TAFP Foundation for every 125 TAFP members registered.
Andrew Morris-Singer, M.D. debt recovery through payment reform and new models of primary care like the patient-centered medical home. Morris-Singer says medical schools need to help solve the physician workforce shortage. “The medical schools have to really commit to recruiting a primary care workforce,” he says. “We’ve got to get [students] exposed to new models of primary care, we’ve got to get them mentored by people who are excited about primary care, and we’ve got to find the people that are discouraging them from primary care careers and steer them away from those folks.” There is excitement around similar events across the country, says MorrisSinger, a sort of “wave,” as he describes it. “I think it’s going to be a slow initial climb and then it’s going to take off exponentially,” he says of the shortage ending. All three see a bright future for the family medicine workforce, but realize there is still a considerable amount of work to do. The AMSA San Antonio conference and others like it across the country bring an abundance of momentum and energy to primary care and show that there are, indeed, students interested in the field. The battle of making sure interested students actually choose primary care as a specialty will continue, but events like this will contribute to building a strong physician workforce.
Contact Cindy Berenson or Jeff Winokur at (800) 741-2044 or firstname.lastname@example.org for more information and to register.
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Van Winkle elected to AAFP Board of Directors TAFP’s 2010-2011 Family Physician of the Year, Lloyd Van Winkle, M.D., has won his bid to serve on the board of directors of the American Academy of Family Physicians. The announcement was made during the 2012 AAFP Congress of Delegates on Wednesday, Oct. 17, in Philadelphia, Pa. He will serve a three-year term on the board, advocating on behalf of family physicians and patients to inspire positive change in the U.S. health care system. “I look forward to being able to serve the American Academy at the board level and be involved in the governance of medicine, and effect the legislation that influences our practices every day,” Van Winkle said in a video posted on the AAFP website. Van Winkle has been a family physician in solo practice in rural Castroville for 27 years. He also serves as a clinical associate professor in the Department of Family Medicine at the University of Texas Health Science Center in San Antonio. In addition, Van Winkle is the health officer for Castroville and its neighboring community, La Coste, and served as medical director of the Medina Valley Emergency Medical Service for more than 25 years. He is an aviation medical examiner and a quality reviewer for 14
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Texas Medical Foundation Health Quality Institute. He also provides expert testimony for Texas Medical Liability Trust, defending family physicians in medical malpractice litigation. A member of the AAFP since 1985, Van Winkle served as a delegate and alternate delegate to the AAFP Congress of Delegates for 10 years. He also has served on the AAFP Commission on Membership and Member Services, and as chair of the AAFP Committee on Communications and the Subcommittee on Awards. Van Winkle served as president of TAFP in 2000 and 2001, and served on numerous committees and commissions over the years. He also served as chair of TAFP’s Political Action Committee Board of Directors. An active member of his community, Van Winkle sponsors children’s baseball, soccer, and basketball teams, and serves as a volunteer physician at the annual marathon in San Antonio. He has provided free care for many patients at VITAS Innovative Hospice Care of Texas, where he now serves as a part-time attending physician. Van Winkle also has precepted medical students in his office for more than 20 years, mentoring the next generation of family physicians.
Huang wins AAFP Public Health Award TAFP member Philip Huang, M.D., M.P.H., was awarded the 2012 Public Health Award by the American Academy of Family Physicians at its annual meeting in Philadelphia, Pa. AAFP’s Public Health Award recognizes individuals who have made or are making extraordinary contributions to the health of the American public. Throughout his career, Huang has shown extraordinary dedication to improving the health of the public through his coordination and implementation of a number of programs that have sought to reduce tobacco use and treat chronic disease. He currently serves as medical director and health authority for the Austin/Travis County Health Department, where he oversees communicable disease control, epidemiology and surveillance, emergency preparedness, immunizations, and chronic disease prevention. After identifying tobacco use as the leading cause of death in Travis County in 2007—more than alcohol, drugs, suicide, car accidents, HIV/AIDS, homicide, and fire combined—Huang began actively pursuing funding for a comprehensive community tobacco cessation program. In 2010, the Austin/Travis County Health Department was awarded a $7.5 million grant from the Centers for Disease Control and Prevention to implement comprehensive community changes to reduce tobacco use. He oversaw a campaign that promoted free community tobacco cessation resources, discouraged youth access to smoking products, and called for tobacco-free campus policies at area worksites, colleges, and other public settings. This campaign has become a model for other communities across Texas and throughout the nation. Huang’s commitment to this cause began in medical school at UT Southwestern Medical School in Dallas, where he organized a student chapter of Doctors Ought to Care and presented AAFP’s Tar Wars youth tobacco use prevention program at area schools. He even convinced a local advertising company to donate billboard signs to display their poster contest winner’s artwork.
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Rural family physician appointed to national advisory council TAFP member Adrian Billings, Ph.D., M.D., has been appointed to the National Advisory Council on the National Health Service Corps by Health and Human Services Secretary Kathleen Sebelius. He will serve a three-year term. Billings is a family physician practicing full spectrum family medicine in rural Alpine, Sanderson, and Fort Stockton. He says he is “humbled” by the appointment. “I was fortunate and blessed to receive a National Health Service Corps Scholarship while in medical school,” Billing says. “This scholarship enabled me to return to the Texas-Mexico border and fulfill my scholarship obligation from 2007-2011. I hope now that I am able to give back to the National Health Service Corps by bringing a rural perspective to the Council.” Billings has spoken nationally for NHSC at scholar and loan repayment conferences and
speaks passionately of his experience working with underserved populations in a rural setting. He is currently chief medical officer for Cactus Health Services, medical director of student health services for Sul Ross State University, assistant clinical professor of family and community medicine at Texas Tech University Health Sciences Center School of Medicine and the University of Texas Medical Branch, and holds active privileges at Big Bend Regional Medical Center. Billings received a bachelor’s degree from Texas A&M University, and a doctorate in philosophy in experimental pathology and a doctorate in medicine from the University of Texas Medical Branch. Billings completed his family medicine residency at John Peter Smith Hospital in Fort Worth, serving his final year as chief resident. He then completed an obstetrics fellowship at JPS.
TAFP members appointed to AAFP commissions Three TAFP members have been appointed to AAFP commissions. Justin Bartos III, M.D., has been appointed to a four-year term on the Commission on Membership and Member Services; Tricia Elliott, M.D., has been appointed to a four-year term on the Commission on Education; and Charles Willnauer has been appointed to a one-year term on the Commission on Governmental Advocacy as the commission’s student representative. Bartos currently serves as medical director of the David Pillow Senior Health Clinic and as a physician for Medical Clinic of North Texas – North Richland Hills. He previously practiced for more than 25 years at North Hills Family Medicine, provid-
ing multigenerational care in the private practice setting. Elliott is the director of the University of Texas Medical Branch Family Medicine Residency Program. She also serves UTMB’s Department of Family Medicine as an associate professor and as vice chair for clinical affairs. Willnauer is a third-year medical student at Texas Tech University Health Sciences Center School of Medicine in Lubbock. He is a participant in the Family Medicine Accelerated Track, which culminates in a medical degree in three years for students interested in pursuing family medicine. Willnauer is also pursuing an MBA in Health Organization Management.
SEEKING FAMILY PHYSICIAN We are looking for a family practice doctor to take over a practice in Austin, Texas. This is the practice of a retiring physician who shares space and office expenses with another full-time family physician. The retiring doctor plans to phase out to allow for a smooth transition. The practice is in an office building located near the University of Texas, the Capitol complex, and downtown. This is a great opportunity for a physician, who is interested in having a solo practice, to build on an existing patient base. Find out more by sending an e-mail to email@example.com.
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TAFP Physician Emeritus wins EMS medical director award Henry J. Boehm Jr., M.D., of Brenham, Texas, was awarded the 2012 EMS Medical Director Award by the Texas Department of State Health Services for his longtime service to the Washington County EMS. The award is presented each year at the Texas EMS Conference and honors a physician who has served as a medical director, on-line or off-line, for an EMS organization, and continually demonstrates a commitment to excellent patient care. He was nominated by the Washington County EMS staff, who wrote that Boehm is “beloved by his peers as a warm and upbeat colleague, and a leading advocate for his patients. He is renowned as a community leader in Brenham.” He became medical director in 1979 and helped shape the organization’s foundation of commitment to excellent patient care. One of his lasting accomplishments was the development of their progressive protocols. Boehm retired as medical director in October 2011. Boehm was born and raised in Brenham. He graduated as valedictorian of Brenham High School in 1956, attended the University of Texas in Austin for his undergraduate education, and earned his medical degree from the University of Texas Medical Branch in Galveston. Boehm has also served as medical director for AMA Home Care and Gazebo Terrace Nursing Home. He has won numerous awards and has received extensive recognition for his contributions to the medical field and the community, including being named TAFP’s 2012 Physician Emeritus. In 1998, he began serving on the faculty of the Texas A&M Health Science Center College of Medicine. He serves on the Blinn College Board of Trustees. He is a past president of the Brenham Rotary Club, the Brenham Boys and Girls Club, the Downtown Development Committee, and the Summer Youth Recreation Board. He has served on the Washington County Chamber of Commerce Board of Directors and Volunteer Services Council of the Brenham State School. Boehm and his wife, Teddy, have four children and 11 grandchildren.
El Paso physician honored as Catholic Doctor of the Year
Photo courtesy of Luisa Enriquez
to personally staff the clinic, he continues to provide patient care TAFP member Andres Enriquez, M.D., has been awarded the 2012 remotely through a nurse. Catholic Doctor of the Year World of Difference Award. The Mission Enriquez was also instrumental in leading Doctors Association presents this award anthe first diocesan medical mission trip to nually in recognition of the efforts of a doctor Choluteca, Honduras, seeing more than 700 whose life and work exemplifies the teachpatients in three days. ing of the Hippocratic oath and who “has His nominator, Norma Valdez, the direcresponded to Christ’s call to heal the sick as a tor of youth and young adult ministry for the member of the catholic faith community and Diocese of El Paso, said, “Dr. Andres Enin doing so has made a world of difference.” riquez exemplifies the teaching of Christ by The organization received 1,400 nominaliving out the calling of the Roman Catholic tions from around the country and selected Church and the Hippocratic oath. His acEnriquez as this year’s honoree. tions respond not only to the needs of the Enriquez practices family medicine at poor and marginalized but also to those in Franklin Medical Center in El Paso. He most need of his gifts.” was recognized “for the faith-filled care he When asked how his faith affects his work provides to his local community,” offering his as a doctor, Enriquez said, “It brings me full time free of charge and often making house circle in my profession. I see people who are calls, and also for his work caring for the poor hurting not only physically but also spirituin Honduras and the border areas of Texas ally, people who have lost their way and and Mexico. sometimes are in need of a simple kind word. He is an active member of Siguiendo los I don’t have the answers to everything but I Pasos de Jesus (Following in the Footsteps of know where to look them up and having a Jesus), a catholic organization dedicated to Andres Enriquez, M.D. strong faith shows my patients that God does providing shelter, food, and clothing for the care and he is here to help.” indigent of Juarez, and in 2005 he opened The ceremony was held at St. Jerome Church in Los Angeles, a free clinic near Juarez to serve the poorest neighborhoods in Calif., on Oct. 21. the city. Though violence in the region has influenced his ability
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2012-2013 Texas Family Physician of the Year
JUSTIN BARTOS a spokesman for the specialty
by kate alfano
When he was TAFP president in 2001, Justin V. Bartos III, M.D., promoted a campaign he called “Take Back Medicine.” It was based on three premises, three directives for himself and his fellow family medicine colleagues: Be a role model, be politically active, and expand your capabilities to be successful in the future. Although a decade has passed, he believes this still holds true. “I think family physicians by nature try to be role models. I don’t think they’re politically active enough; I don’t know if you can be too politically active. Then expanding your capabilities to be successful in the future, I think that’s true of most businesses or occupations, but particularly for family physicians. We have to keep reinventing ourselves and our role in the health care environment.”
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JONATHAN NELSON Photo courtesy of JUSTIN BARTOS
Top left: Bartos has worked with Kim Odell, L.V.N., for almost 15 years. She says he has a gift for listening, which allows him to find solutions to patient care questions other physicians may have missed. Top right: Bartos poses with his wife, Sheryl, outside their Bedford home. Married in college, she has been with him throughout his career and says
s the 2012-2013 Texas Family Physician of the Year talks about the evolution of his own career in northeast Tarrant County and beyond, it’s clear that this has been a very successful model for him, firmly establishing his place as a pillar in his community and a leader in the profession. Ever humble yet incredibly driven, Bartos credits many role models who helped shape his family medicine career. It all began in La Grange, Texas, a small community halfway between Austin and Houston, where he grew up. His father, the late Justin Bartos Jr., was a pharmacist for 55 years and a highly respected figure in the town, and his mother, Laura, taught high school math.
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that while it has been stressful at times, she and their three daughters are “all so proud that he represents what a true family physician should be.” Bottom right: With more stable hours than in his early career, Bartos has been able to make more time for old hobbies like golf and new hobbies like cycling. Here he is after a 45-mile bike ride in Gruene, Texas.
One day his mother returned from an educational seminar having decided that her oldest son must choose his career. Bartos was in eighth grade. “So I lay awake in bed for several nights wondering what I would be when I grew up,” he recalls. “I told her I wanted to be a family physician. Her response was, ‘What? Don’t you want to be an engineer?’ I said, ‘No, I want to be a family physician.’ I explained that the people I admired were the local family physicians. I had a strong background in science and loved the role of a physician in the community, and I thought that would be a great fit.” One local physician in particular, Herb Smith, M.D., the father of one of his classmates, strongly influenced this decision. “He treated
to look at it? Paper has been the only thing that has stood the test of my asthma in the middle of the night, he removed my appendix, he time. It’s been around since the Egyptians.’ That was a typical Pillow repaired my lacerated heel and my fractured arms,” Bartos says. Smith statement. He made a lot of similar comments, but I always remember also organized the local medical explorers, an extension of the scoutthe one about if you jump on the latest technology it will probably be ing program, and led a group of a dozen high school students on a trip replaced by something else soon.” to St. Luke’s Hospital in Houston to see Denton Cooley perform open The wisdom imparted by Pillow has stuck with him and the traits heart surgery. “Things were never the same. I now had a vision of the instilled in early practice have become his greatest qualities. Again and future and the path I would follow.” again, those who speak of Bartos say he’s compassionate, thorough, Bartos entered the University of Texas at Austin as a pre-med stuand sincere in his clinical care, forward thinking in the business asdent majoring in mechanical engineering with a focus on biomedipects of medicine, and always willing to recruit, inform, or promote cal engineering. While there he married Sheryl, whom he met in high the specialty. school, and the young couple looked for a medical school that would His wife Sheryl says it is evident that he truly cares for his patients. provide high-quality education and be supportive of families. They “He takes the time to listen to them, regardless of how long it takes, settled on the University of Texas Medical Branch in Galveston, which and he goes the extra yard to make sure that they receive the best care at the time was the alma mater for half the physicians practicing in the possible whether it be by him or someone that state of Texas. he refers them to. … His patients know that While in medical school he studied under he is compassionate, caring, and thorough. two more extraordinary family physicians, He will laugh at their jokes and hold their Paul Young, M.D., chair of the family practice “I think family hands when they need it most. He is a family department at the time and “one of the foundphysician in every sense of the word.” ers of the family practice movement,” Bartos physicians have Kim Odell, L.V.N., has been his nurse for says, and Barbara Thompson, M.D., current more to offer than nearly 15 years and says he accepts patients chair of the UTMB family medicine departalmost any other who feel helpless and like there’s no one who ment, who at the time conducted his medical health care entity will listen, or complicated patients other docschool interview and served as Bartos’ faculty tors might not want. But he gives each his full advisor and preceptor during his formative out there and that attention and the time they need until he can years in Galveston. they should be work through their condition. Though he briefly considered other sperewarded sufficiently “There’s times, even as a nurse, that I’m cialties, he pursued a family medicine residenfor doing so, so thinking ‘oh please come out of that [exam] cy at John Peter Smith Hospital in Fort Worth, room!’ But you know what, that’s what that led by program director Bruce Jacobson, M.D., they’ll be happy patient needs. I trust him to stay in there and who would serve as another role model. “JPS and healthy and take care of everything even if we’re getting at the time was and still is considered the prepersuade others really behind in the schedule,” Odell says. mier family medicine program in the state of to follow our lead.” “Most of our patients have been with us for a Texas,” Bartos says. “Unlike Parkland or Baylor long time and they understand that he’s there or places like that, in those locations you were Justin Bartos III, M.D. for whatever amount of time needs to be takcompeting for patients with internal medien to take care of the situation.” cine, pediatrics, and all of the subspecialties. Patient Jan Jacobson wrote in a nominaAt JPS, you basically had family medicine, a tion letter that Bartos has been the “epitome few ob-gyns, and a few ortho residents, and of integrity when it comes to the care of my that was it. So that made your experience that whole being—body, mind, and spirit.” much more intense.” “He thoroughly examines me first, rather than relying only upon The training prepared him to join a practice that would later be sophisticated diagnostic tests or shuffling me off to a specialist. He known as North Hills Family Medicine, founded by David Pillow, talks to me, he looks me in the eye, and he makes sure that I underM.D., a former residency director, well-respected family physician, stand all aspects of whatever it is that he wants me to know before and icon in the northeast Tarrant County medical community. Pillow I leave his office. With every question I ask—and, boy howdy, I ask became Bartos’ greatest mentor, instilling in him the characteristics them—he answers with both patience and wisdom. Such exemplary of an exemplary physician. “He’s a very unique individual and has a care requires his valuable time, and not once in 25 years has he ever storyteller personality,” Bartos says of Pillow. rushed through any appointment I have had with him.” “Most of what he taught me was the importance of establishing In his early years under Pillow, Bartos began to expand his outrelationships with your patients, the importance of good relationships reach and community service. Pillow encouraged him to teach nurse and support among members of a group practice, and the importance practitioner students, which later included medical students; he enof fairness in all feelings with the monetary aspects of the practice.” couraged him to become the medical director of a local nursing home, Pillow also stressed that even when you’re seeing your partner’s paa post he held for two decades that evolved into co-ownership and tients, you must care for them like your own; don’t ever do less service led to the startup of a hospice service; and he encouraged him to get for them than you’d normally provide. involved in organized medicine. And Bartos recalls that while Pillow was always interested in the Surprisingly, Bartos’ decorated service in the Academy started on a latest technology, he was practical about it: “We talked about electronsour note. Pillow took him and another young physician to a monthly ic records and whether they would replace paper and he said, ‘What meeting of the Tarrant County Chapter of TAFP, which was held in a if everyone’s records were on an 8-track player? Would you be able
small classroom in a tower of St. Joseph’s Hospital in downtown Fort Worth. He recalls there were five total in attendance, the speaker was unintelligible, and “then we had something to eat which consisted of going through the line and eating institutional food at the cafeteria. I was not very impressed with that encounter.” A year later, Ronnie Irwin, M.D., a local physician, asked Bartos if he would consider organizing the programs for the local chapter. “I said I would consider it but I wasn’t going to have any of them in a hospital classroom with food from the cafeteria hospital food line.” He approached some of the local pharmaceutical representatives—far before sponsored meetings were commonplace—and told them the chapter needed a large meeting room and speakers of national caliber. “It was based on the concept of good food, good fellowship, and a good educational program. Soon we had meetings that were held at good restaurants, we had great speakers from around the country, we had attendance of between 40 and 50 physicians, and everyone looked forward to them. They became a big part of the social interactions of physicians to meet and discuss issues in how the practice of medicine was evolving.” As he moved up in the ranks as a Tarrant County chapter officer, he also began attending state meetings, having seen his former JPS colleague, Roland Goertz, M.D., get involved in TAFP. “As I went and watched, I realized I could be seated as Tarrant County delegate, so I started asking to be seated as a Tarrant County delegate. Then I realized I could become involved in committees, so I became involved in committees.”
“At that time I had developed a lot of experience in managed care because I was involved in starting up the first IPA at the North Hills Hospital site where I was, so I became more involved with that process, trying to raise the level of concern and expertise at TAFP regarding managed care, IPAs, HMOs, the gatekeeper model, and how that could benefit patients and physicians.” Bartos first joined the TAFP Bylaws Committee, but what had the greatest impact on his trajectory into the TAFP leadership was when Leah Raye Mabry, M.D., and Stephen Benold, M.D., tapped him to join the Task Force on Governance, which exposed him to the top TAFP leadership. He continued serving on Bylaws, and also joined the Commission on Membership and Member Services and the Executive Committee, moving up the ranks to serve as president in 2001 and expanding his service from there. During his presidency, Bartos led a successful campaign to elect James Martin, M.D., as the first AAFP president from Texas in decades. “That was an exciting time to be president and evolve,” he says. In his own community he became more politically active, attending town hall meetings held by his state representative, Bill Carter, to alleviate fears in the general public about the AIDS epidemic. Speaking on clinical topics initially, “that rapidly evolved into my concerns about the changes that were occurring with managed care,” he says. He also became a regular campaign supporter of local lawmakers state Rep. Vicki Truitt and state Sen. Jane Nelson, and supported U.S. Rep. Michael Burgess’ initial campaigns.
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All of these factors contributed to his desire to become more active in AAFP, and he joined the AAFP Commission on Practice Enhancement, later renamed the Commission on Quality and Practice. “I had the opportunity to work with many impressive individuals that make up the leadership of the AAFP and many people with a lot of expertise from across the country. This was one of the highlights of my time with AAFP.” In 2003, Bartos became an alternate delegate and then delegate to the AAFP Congress of Delegates, following Martin, Mabry, and Goertz as they ascended to higher office. He says of his time as delegate, “I always enjoy the interaction and I enjoy the discussions. It’s something I hope many other members have an opportunity to participate in because you do feel like you’re helping to set policy for the organization, especially with an active group like we have in Texas.” Considering his involvement in his community, organized medicine, as a leader in his practice, and as a dedicated husband and father to three daughters, one might wonder how he had enough hours in the day. In a nomination letter for the award, Erica Swegler, M.D., a longtime friend, practice partner, and TAFP leader, wrote that one of her mentors frequently said it is important to give back to your profession, your church, and your community—but you do not have to do them all simultaneously. “Dr. Bartos has managed to serve all three at the same time,” she wrote. In addition to his service to TAFP and AAFP, “he has served on multiple committees for the Texas Medical Association and the Tar-
“I think he has a good eye for the trends and the direction that the health care system in general is going. I’ve worked with him in a couple of different capacities and he’s always been on the cutting edge of what is new in health care and he’s willing to take those chances when new things come around.” Stacey Howard
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Bartos meets with a post-operation patient during a busy day at the Medical Clinic of North Texas in North Richland Hills.
rant County Medical Society. He served as the administrative physician for North Hills Family Medicine from 1993-2010.” “When John Peter Smith Health Network/Tarrant County Hospital District needed a family physician’s input, Dr. Bartos stepped up and served on the Board of Managers and Quality Committee from 20042006; a demanding and very time-consuming role. He has served as medical director for a nursing home and hospice, and as chief of staff for North Hills Hospital. Additionally, his service includes being physician advisor for the catholic schools in the Diocese of Fort Worth since 1995.” “While doing all of this, Dr. Bartos has been an outstanding clinician and a caring friend to his patients. While he is not infrequently behind on his schedule, his patients remain loyal to him because they know that once he is in the exam room with them, he will give them the full measure of time and attention of their needs.” Bartos says it was possible because the practice of medicine used to be much less time consuming. “We worked in an environment with 24
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fewer documentation requirements, fewer compliance issues, fewer billing and administrative hassles, and fewer referral hassles; all of the things that are now present in practice. In that environment we could see patients more efficiently.” “At that point in time it was still relatively easy to see people, implement a plan and finish your treatments, and end your day in a timely manner. It did allow you to do more things. You had more time for the hospital and nursing home, and maybe a round of golf every once in awhile, and an opportunity to participate in other things in the community. As these compliance items have built up, it’s now consuming a major portion of physicians’ time and we find ourselves pretty much confined to the office and doing less of these things that we used to do.” “That’s a change I’m hoping will swing back the other way because I think the younger physicians would enjoy practicing even more in the type of environment that existed in the mid-1980s and early 1990s.” As his career has progressed, he has kept a keen eye to the practice environment. He says the key to long-term successful practice is
ment. “Seniors require a lot of resources. They require people to not not just the clinical aspect of care; you have to be in an economically only arrange visits with their doctors and arrange their diagnostics, friendly setting as well. “That motivated me to pursue policies that but they frequently have issues trying to arrange appropriate follow I thought would help family physicians survive in whatever environup, ensuring they’re receiving the appropriate medications, and ensurment they try to practice in, and to this day that is something that moing they understand the treatments that have been recommended for tivates me to get involved in all of the political activities. I think family them. So in this population that has so many different problems, so physicians have more to offer than almost any other health care entity many different medicines, so many different services that you’re trying out there and that they should be rewarded sufficiently for doing so, so to arrange for them, having a team to tackle that is of great benefit to they’ll be happy and healthy and persuade others to follow our lead.” both the practice and the patient.” Continually attuned to the evolving practice environment and the While he was building the senior practice, Bartos had a large folfamily physician’s role in it, he found his latest practice endeavor. Just lowing of non-Medicare patients from NHFM who were eager to see under two years ago, as he saw that many of his patients at North Hills him. He again approached MCNT, this time about starting a commerFamily Medicine had aged into Medicare, he looked for a viable model cial clinic to continue to care for them. A few months after transitionto take care of a large senior population. He found the David Pillow ing to full-time practice at the Pillow clinic, he opened MCNT North Senior Clinic at North Hills Hospital, aptly named for his longtime Richland Hills. mentor, which had been left without any permanent physicians folHe now works part time at both clinics. lowing recent mergers in the community. “It’s challenging but also satisfying to see how Bartos approached the hospital administraquickly I’ve been able to reestablish the senior tor, where he’d had privileges for many years, clinic population and now grow a commercial and asked if it would be possible for him to population.” practice part time in the senior clinic. They “I’ve always had Bartos’ practice has slowed somewhat pointed him to the Medical Clinic of North from the years when he’d have to read over Texas, newly responsible for the clinic’s staffthe feeling that if his schedule to know where he had to be and ing. He resigned from NHFM and began pracmedicine became more when, but he remains active with the Acadticing full time at the senior clinic in April 2011, sophisticated and more emy and with his church. He has made more adding two more physicians in September and complicated, there time for old hobbies like golf and to start November to handle increasing demand. “It took almost a year to get the clinic will be an even greater new hobbies like cycling, and to travel overseas to new and unfamiliar places. And now back to its previous status; patient visits had need for someone like that his daughters are grown and married, he dropped to a third of what they were under a family physician to and Sheryl frequently spend time with their the previous group. But I represented a conserve as a coordinator family, going on “adventures” with their four sistent provider, a known entity in the area, grandchildren and sharing their excitement and it started to build back up.” and a liaison through in their first experiences. That time was “pretty hectic,” says Stacomplicated medical And even as physicians face the challenges cey Howard, who served as the director of the treatment protocols.” of technical and process-oriented changes, clinic at the time. “He definitely brought stabilimplementation of new care models and ity to the clinic and that was important to the Justin Bartos III, M.D. quality initiatives, and reforming the paypatients as well as the staff. That helped with ment model, Bartos is hopeful for the future. morale and that helped with perseverance.” “I’ve always had the feeling that if medicine “I think he has a good eye for the trends became more sophisticated and more compliand the direction that the health care system cated, there will be an even greater need for in general is going,” she says. “I’ve worked with someone like a family physician to serve as a coordinator and a liaison him in a couple of different capacities and he’s always been on the cutthrough complicated medical treatment protocols.” ting edge of what is new in health care and he’s willing to take those His career has exceeded his expectations. “When I started I had a chances when new things come around.” relatively narrow view of the capabilities of family physicians. I was “He’s always trying to find a better way to provide care that works from a small community where the local physician was a health care for all the parties involved because you have to provide good patient resource, but he was also a role model in community and a supporter care, but at the same time you have to have people who want to proof a lot of different initiatives. I envisioned myself being in a relavide that care, feel good about it, and are able to do their very best. tively confined community serving their health needs and particiThat’s what’s always hit me is that he’s always looking for the best way pating in other opportunities within the community. I didn’t look at to do that so everybody’s needs are met.” the family physician as having political influence, having the ability The senior clinic uses a team-based model to care for the populato interact on multiple levels with policymakers and with leaders in tion, the only way you can see large numbers of Medicare patients, larger communities that are affecting the delivery of health care on Bartos says. He works with an L.V.N. and an RN part of the time, as a national basis.” well as an in-house social worker, administrative support staff, and the In all of these ways, he has been and continues to be the embodidirector of the facility. “With that type of team, you can take on older ment of his “Take Back Medicine” campaign, advocating for the spepeople with multiple medical problems and social needs and address cialty of family medicine, stepping up to lead even in challenging those concerns.” circumstances, and continually expanding his capabilities to be sucThe average age of his patients in the senior clinic is 85 and he says cessful with his practice and to serve his patients. most have six to 10 medical problems for which they’re receiving treat
TAFP Year In Review By Samantha White tafp worked hard in 2012 to continue serving our members all across the state. The year included high attendance at Academy events, a rebranding of TAFP’s look, a record amount of scholarships given out, and a plethora of members winning accolades and achieving prestigious positions. advocacy: TAFP hosted the Leadership and Legislative Training in conjunction with July’s Annual Session and Scientific Assembly in Austin. Roughly 60 people attended and listened to presenters speak on topics such as the current state of Texas’ demography, shortages in the primary care workforce, budget challenges we’ll face in the 83rd Texas Legislature, and economic incentives to invest in primary care. The Academy welcomed distinguished speakers at the event, including: Kim Ross, consultant, Kimble Public Affairs, Inc.; Lloyd Potter, Ph.D., M.P.H., Texas state demographer; Stacey Silverman, Ph.D., senior director of academic research and grant programs for
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the Texas Higher Education Coordinating Board; Roland Goertz, M.D., M.B.A., AAFP board chair; Charles Bell, M.D., former deputy executive director of the Texas Health and Human Services Commission; and Marshall Kenderdine, Dan Hinkle, Kurt Meachum, and Jerry Philips — TAFP’s lobby team. Attendees became the core group of TAFP’s new Key Contacts program and agreed to build or rekindle relationships with their local lawmakers. They have participated in a series of advocacy action items, sharing policy recommendations with their legislators. In addition to the leadership conference, the TAFP advocacy team spent the last half of the year laying the groundwork for a set of initiatives to strengthen the Texas primary care workforce. 2012 was the year of a brand-new look for TAFP as the communications team redesigned multiple entities of the Academy, particularly with the launch of a new logo and website.
We ‘lit the torch’ and rolled out the new logo and identity for TAFP. The previous logo, depicting a family of three, was redesigned to match that of the American Academy and many of our sister state chapters to demonstrate the unity of family physicians across the nation. The unveiling of the new logo coincided with the launch of the all-new TAFP.org. The site is now more graphically stimulating, and includes a social media share bar across all pages and an extensive footer menu to help you navigate areas of the site from any page, making the new site significantly easier to browse and find resources. Additionally, the blog has been incorporated into the new site and now lives at TAFP.org/blog, with all past blog content moved onto the new site. We are also using tags more effectively, making the TAFP.org search function more robust. The Academy also turned the QuickInfo e-newsletter into TAFP News Now, which features an updated main image and new fonts and formatting.
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TAFP’s social media efforts have expanded and will continue to grow, particularly via Facebook, Twitter, and LinkedIn. If you have not liked, followed, or friended us, please do! The Academy will also continue its Member of the Month feature on the website and encourages you to nominate a colleague or yourself to be featured. Make a suggestion by sending the nominee’s name, phone number, and e-mail address to firstname.lastname@example.org. education: TAFP held four annual symposia in 2012: the C. Frank Webber Lectureship in Austin, TAFP’s 63rd Annual Session and Scientific Assembly also in Austin, and Primary Care Summit in Houston as well as Dallas. These programs combined had nearly 1,550 attendees and offered the opportunity to earn up to 84 CME credits. TAFP also offered nine SAM Group Study Workshops during 2012 to help American Board of Family Medicine diplomates meet Maintenance of Certification requirements. Seven of the workshops were held in conjunction with TAFP symposia and two stand-
alone programs were held in Fort Worth and San Antonio. The Academy plans to host 12 SAM workshops in 2013, seven coinciding with symposia and five by themselves. The National Procedures Institute also stayed busy in 2012, presenting procedural training workshops for primary care physicians on various topics. NPI offered 83 courses and welcomed over 1,000 medical professionals this year. To see the 2013 event schedule and register for upcoming programs, visit the NPI website at www.NPInstitute.com. TAFP membership is above 7,600, with over half being active members, and AAFP ended 2012 with just over 106,000 total members. Many TAFP members ascended to the leadership of various organizations: Lewis Foxhall, M.D., was re-elected to the TMA Board of Trustees; Mark Chassay, M.D., became deputy executive commissioner for the Office of Health Policy and Clinical Services, a branch of the Texas Health and Human
members and leaders:
Services Commission; third-year medical student Jerry Abraham, M.P.H., became the AMSA March Meeting 2013 chair; and three TAFP members were appointed to the board of directors of the Texas Institute for Health Care Quality and Efficiency: Patrick Carter, M.D., M.B.A.; Beverly Nuckols, M.D.; and John Joe, M.D., M.P.H. Two TAFP members received AAFP awards: Dora Martinez, M.D., was awarded the 2012 Pfizer Teacher Development Award; and Philip Huang, M.D., M.P.H., received the AAFP Public Health Award at their annual meeting in Philadelphia. TAFP’s new officers were installed at the 2012 Annual Session: President Troy Fiesinger, M.D.; President-elect Clare Hawkins, M.D.; Vice President Ajay Gupta, M.D.; Treasurer Dale Ragle, M.D.; and Parliamentarian Tricia Elliott, M.D. The Academy recognized its award recipients during Annual Session. Justin Bartos III, M.D., was named the Family Physician of the Year; Henry Boehm, M.D., was recognized as Physician Emeritus; Foxhall received the
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Presidential Award of Merit; Rep. Vicki Truitt was presented with the Patient Advocacy Award; David Buck, M.D., M.P.H, was awarded the Public Health Award; Donald Briscoe, M.D., received the Exemplary Teaching Award; the University of North Texas Health Science Center and Texas College of Osteopathic Medicine was given the Medical School Award of Achievement; Linda Siy, M.D., received the Special Constituency Leadership Award; Edwin Franks, M.D., was named the TAFP Foundation Philanthropist of the Year; and Lloyd Van Winkle, M.D., was awarded the TAFP Political Action Committee Award. At AAFP, Roland Goertz, M.D., M.B.A., completed his term as AAFP board chair, and Van Winkle was elected to the AAFP Board of Directors. Representing TAFP at the AAFP Congress of Delegates were Delegates Bartos and Erica Swegler, M.D.; and Alternate Delegates Siy and Douglas Curran, M.D. The Academy was well represented on multiple AAFP committees in 2012: Hawkins, Commission on Continuing Pro-
fessional Development; Joane Baumer, M.D., Commission on Education; Swegler and TAFP CEO/EVP Tom Banning, Commission on Governmental Advocacy; Rebecca Hart, M.D., and Kaparaboyna Ashok Kumar, M.D., Commission on Health of the Public and Science; Christina Kelly, M.D., Commission on Membership and Member Services; Melissa Gerdes, M.D., and Charles Willnauer, student representative, Commission on Quality and Practice; and Dale Moquist, M.D., AAFP Foundation Board of Trustees. tafp foundation: The TAFP Foundation continued efforts to raise and distribute funds for scholarships for medical students planning to pursue careers in family medicine, office-based family medicine research, family medicine interest group activities at medical schools across the state, and family medicine resident activities. The Foundation would like to thank all donors, especially our 71 monthly donors, for contributing to these efforts and we look forward to continue working with you to meet our goals to support the specialty.
The TAFP Board of Directors unanimously voted that the Foundation take over the Texas Statewide Family Medicine Preceptorship Program after its funding was cut by the 82nd Texas Legislature. Fundraising began this year, and the goal for 2013 is to restore stipends under the program to pre-clinical students on a competitive basis. The Foundation gave out 20 scholarships during 2012, totaling over $23,000 for medical students across Texas. Both the number of scholarships as well as the total dollar amount were records for the organization. Among the recipients was Sai Palepu, M.D., who received the James C. Martin Scholarship and spent two weeks doing policy work for TAFP in Austin. TAFP is actively preparing for programs and events taking place in 2013, while advocating for family physicians in the 83rd Texas Legislature. Thank you to all of our members for everything you do for your patients and the state of Texas.
Confidential and experienCed LegaL RepResentation
Representation before the Texas Medical Board, The Texas Medical Foundation and Medical Staff Peer Review. Medical Practice Act and Medical Board Actions (hearings, settlement conferences and licensure) • Personal Counsel in Medical Liability Cases • Probation Modification / Termination • Managed Care Exclusions • Licensure • Reinstatement • Medico-legal Issues • Expert Review • Telemedicine • Medicare/Medicaid Appeals • Medical Ethics Opinions • Physician Assistants. tony cobos*
chRis shaRp Of Counsel
shaRp & cobos, LLP, Attorneys At LAw 4705 spicewood spRings Road • suite 100• austin, texas 78759 • 512 473 2265 • fax: 512 473 8525 • www.sharpcobos.com * Board Certified in Administrative Law by the Texas Board of Legal Specialization. SharpLLPGSAd12_09.indd 1
12/21/09 2:52:24 PM
2012 TAFP Foundation donors
Thank you to these 2012 TAFP Foundation donors, whose contributions fund scholarships for Texas medical students, family medicine research grants, and travel scholarships for residents to attend continuing professional development activities.
★ Mary S. Nguyen Poole, M.D. Kurt Eric Nielsen, M.D. Donald R. Niño, M.D. Beverly Burnett Nuckols, M.D. Carolyn Jean Oliver, M.D. Luis C. Palacios, M.D. John A. Partin, M.D. Max Peralta, M.D. ★ Henry David Pope, M.D. ★ Dale Ragle, M.D. George and Fran Ramsey Stephanie D. Redding, M.D.
★ = TAFP Foundation monthly donor
★ John R. Richmond, M.D. Clarence A. Riser, M.D. ★ Shelley Poe Roaten, M.D. ★ Janet L. Hurley, M.D.
JoAnne L. Rogers, M.D.
Ruben Aleman, M.D.
★ Tamarah L. Duperval-Brownlee, M.D.
John C. Joe, M.D., M.P.H.
Fred Rohm, D.O.
★ Trisha A. Allamon, M.D.
Carolyn Eaton, M.D.
Frederick H. Kasten
Marilyn Ruiz, M.D.
★ Barbara L. Allen, M.D.
★ Bruce Alan Echols, M.D.
★ David A. Katerndahl, M.D.
★ Sarah Samreen, M.D.
Kent E. Anthony, M.D.
★ Tricia C. Elliott, M.D.
Christina Marie Kelly, M.D.
Ramiro Sanchez, M.D.
Ichabod L. Balkcom IV, M.D.
Sheridan Scott Evans, M.D.
Lukman A. Sanusi, M.D.
★ Maria Diana Ballesteros, M.D.
★ Robert Floyd Ezell, M.D.
★ Kaparaboyna Ashok Kumar, M.D., F.R.C.S.
★ Tom Banning
★ Troy Treanor Fiesinger, M.D.
★ C. Tim Lambert, M.D.
★ Lee R. Schreiber, M.D.
★ Lynda Jayne Barry, M.D.
★ Aimee Lyn Flournoy, M.D.
★ Loren S. Lasater, M.D.
Puja Anil Sehgal, M.D.
★ Justin V. Bartos III, M.D.
Laine Foran, D.O.
★ Don A. Lawrence, D.O.
★ Amer Shakil, M.D.
Arturo Enrique Batres, M.D.
Kay Lynn Lee, M.D.
★ Robert F. Shields, D.O.
David W. Bauer, M.D., Ph.D.
★ Lewis Emory Foxhall, M.D.
★ Zafreen Arfeen Siddiqui, M.D.
★ Joane Goforth Baumer, M.D.
Edwin R. Franks, M.D.
Paul and Kathy Locus, M.D.
★ Linda Marie Siy, M.D.
★ Stephen D. Benold, M.D.
★ Leah Raye Mabry, M.D.
Hubert L. Smith Jr., M.D.
Adrian Billings, Ph.D., M.D.
★ Gregory Michael Fuller, M.D.
Bonny A. M. Macfarlane, C.M., M.D.
★ Mary Carmen Spalding, M.D.
★ Alex J. Blanco, M.D.
★ Kelly A. Gabler, M.D.
Cheri L. Mann, D.O.
★ Donald E. Stillwagon, M.D.
★ Henry Julius Boehm Jr., M.D.
Oscar Garza, M.D.
★ Javier D. Margo Jr., M.D.
★ Erica Williams Swegler, M.D.
★ Lindsay K. Botsford, M.D.
★ Melissa S. Gerdes, M.D.
James C. Martin, M.D.
★ Sheri J. Talley, M.D.
★ Emily D. Briggs, M.D.
★ Lisa Biry Glenn, M.D.
Dudley D. McCalla
Maxine A. Theriot, M.D.
Regina Rodriguez Capili, M.D.
★ Roland A. Goertz, M.D.
★ Kathy McCarthy, C.A.E.
★ Ashok Tripathy, M.D.
Jack Quinten Cash, M.D.
Gold Star Show Services
★ William Mike McCrady, M.D.
★ Thao Minh Truong, M.D.
★ Chinglin Lillian Chan, M.D.
★ John Edward Green, M.D.
★ John M. McCullough, M.D.
Evan Lee Underwood, M.D.
★ C. Mark Chassay, M.D.
★ Thomas David Greer, M.D.
Edmund and Pam McIlhenny
★ Lloyd Van Winkle, M.D.
Kate and Stephen Clark, M.D.
Jill Ann Grimes, M.D.
James and Melinda McMichael
David B. Vaughan, M.D.
★ Samuel T. Coleridge, D.O.
★ Ajay Kumar Gupta, M.D.
Susan E. McNeil, M.D.
★ Seth B. Cowan, M.D.
★ Natalia Gutierrez, M.D.
★ Gary R. Mennie, M.D.
Chi H. Vu, M.D.
★ Lesca C. Hadley, M.D.
★ Sally Pyle Weaver, M.D.
Douglas W. Curran, M.D.
John J. Hall, M.D.
Mark Douglas Miller, M.D.
★ Judith K. Werner, D.O.
Mark and Rebecca Davis
★ Suhaib W. Haq, M.D.
★ Nina Miller, M.D.
★ Jim White
★ Kenneth Gayle Davis, M.D.
★ Rebecca Eileen Hart, M.D.
Presley Joe Mock Jr., M.D.
Walter D. Wilkerson, M.D.
★ Tamra K. Deuser, M.D.
Bill and Gail Hartin
★ Hugh H. Wilson, M.D.
★ Chrisette M. Dharmagunaratne, M.D.
Sharon Hausman-Cohen, M.D.
★ Dale C. Moquist, M.D.
Clare Arnot Hawkins, M.D., M.S.C.
★ Mary Helen Morrow, M.D.
Keith Allen Wixtrom, M.D.
Phillip H. Disraeli, M.D.
★ James Michael Henderson, M.D.
Estela Marina Mota-Garcia, M.D.
★ Khalida Yasmin, M.D.
William Hudspeth Jr.
William Mygdal, Ed.D.
★ Robert A. Youens, M.D.
★ Jorge Duchicela, M.D.
Leigh Hunter, M.D.
Carol Corley Nelson
★ Richard A. Young, M.D.
Kelly Alberda, M.D.
TEXAS FAMILY PHYSICIAN
Maxwell Curtis Scarlett, M.D.
110,000 Texans will be told
“You have cancer.” In 2012, it is estimated … •
39,000 Texans will lose their lives to cancer.
The annual cost associated with cancer will be $28 billion.
In 2012, it is estimated … •
14,500 Texans will be diagnosed with lung cancer.
16,000 women in Texas will be diagnosed with breast cancer.
1,200 women in Texas will be diagnosed with cervical cancer.
10,600 Texans will be diagnosed with colorectal cancer.
What can you do? The Texas Cancer Plan aims to reduce the cancer burden in Texas and improve the lives of all Texans. Find out more at
Tar Wars celebrates 25 years Join this public health effort and help decrease youth tobacco use By Rebecca Hart, M.D.
bubbles, not smoke.” It was a painting of a girl blowing bubbles with happy anniversary, tar wars! Did you know that Tar Wars, AAFP’s a little boy looking up at her. It is a great, positive message that he tobacco-free education program, celebrated 25 years in 2012? To mark created. Every year there are hundreds of these messages generated this milestone, the National Tar Wars Advisory Group wants to reby American kids who are prompted to energize the program. think about the advantages of being Remember Tar Wars? Most of you smoke free for life. may have been involved in medical In Texas, in the last year, Tar Wars school or residency, giving talks to fifthhas reached over 13,000 students at 137 grade students at local schools. You went In Texas, in the last year, schools across the state. Last year there into the classroom with about 30 kids Tar Wars has reached were at least 240 presentations given with and had a fun interactive session talkeven more plans for this year. Residencies ing about smoking, questioning them over 13,000 students throughout the state sent residents into about what they knew, educating them, at 137 schools across schools, medical school FMIG groups and inviting them to do their own creparticipated, and multiple private doctors ative thinking about how to stay smoke the state. Last year gave presentations locally. But we can do free. You then invited them to make a there were at least 240 even better with more participation! smoke-free poster and enter the national presentations given with In honor of its 25th anniversary year, I poster contest. Kids love the interactive urge you to become more involved in Tar presentation, and really enjoy the coneven more plans for Wars locally. Here are a few ways can you test. It was fun for you and was a great this year. Residencies get involved as a family physician in Texas. community service. Tar Wars’ mission is to teach kids throughout the state sent • Contact our state coordinator, about being tobacco free, give them tools residents into schools, Juleah Williams, by calling her at to make positive decisions about their medical school FMIG the TAFP office at (512) 329-8666, or health, and promote personal responsie-mailing her at email@example.com. bility for their well-being. It accomplishgroups participated, and • Work with your local chapter to es its goals with the help of family phymultiple private doctors sponsor speakers for local schools. sicians, educators, and other health care Some chapters sponsor a classroom, professionals, like residents and medical gave presentations such as providing $25 for art supplies students, who give presentations to stulocally. But we can do for the poster contest. dents at school. even better with more • Log on to the Tar Wars Facebook Tar Wars promotes advocacy for site or the Tar Wars website and tobacco-free activities in communities, participation! download the presentation. such as clean air ordinances and smok• Consider a donation to the national ing bans in workplaces. The annual Tar Tar Wars effort. Wars National Conference is part of this, as an opportunity to stress to legislaIt’s easy to get involved, so do it as a tors the importance of tobacco control. great community service activity. Tar Wars is a positive, worthwhile Student poster winners from the Tar Wars Poster Contest gather in program, sponsored by our own AAFP. Through Tar Wars, we teach Washington, D.C., to learn more about being tobacco free, meet their kids about a tobacco-free life. We teach them to gain a greater understate congressmen and women, present them with their state winning standing of the problem of tobacco abuse and addiction, to advocate poster, and talk about the project with them. for tobacco-free lives, and learn how they can make a difference in This last summer, I had the privilege of accompanying our national their community. Join me. Be a part of it! first place winner, Juan Elizondo of Houston, Texas, to meet Sen. John Cornyn at the Capitol Building in Washington. It was a great moment for him and 50 other kids from around the country. What an exciting Dr. Hart is a member of the AAFP Commission on Health of the Public and prize for a fifth-grader to earn from being involved in a poster contest Science, and serves as the national chair of the Tar Wars Advisory Group. about staying smoke free! Juan’s poster said, “Say no to tobacco – Blow 32
TEXAS FAMILY PHYSICIAN
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Overwhelmingly, stakeholders support family medicine residencies By Clare Hawkins, M.D., TAFP President-elect
with another legislative session underway, our Academy is poised to make great gains for family medicine and recoup budget losses from 2011. We’re building on a decade of work educating legislators and the public about the value of family medicine, but it’s evident that our work particularly since the last session has led to a deeper understanding of the current and coming crisis in the primary care workforce. This summer TAFP held a legislative training seminar in Austin and attendees of that conference formed the core of a new Key Contacts program. These leaders actively share resources provided by the Academy with their state representative and senator, which include not only our own policy briefs and legislative magazine features, but editorials and news stories from the major daily newspapers. People are “getting it.” In early October, I attended a stimulating meeting of stakeholders presenting to the Texas Higher Education Coordinating Board’s Graduate Health Professions Subcommittee. I represented TAFP and the San Jacinto Methodist Family Medicine Residency. Also at the table were representatives from other large academic institutions—Texas A&M College of Medicine, the University of Texas Southwestern Medical School in Dallas and Austin, the University of Texas Health Science Center in Houston, Texas Tech University Health Sciences Center School of Medicine, the University of North Texas Health Science Center, and Baylor College of Medicine—plus the Texas Medical Association, the Texas Hospital Association, the Department of State Health Services, and, of course, THECB staff. The coordinating board presented a report they released in April that assessed the adequacy of opportunities for graduates of Texas medical schools to enter residency training in the state. They also presented the ill-fated success story of the Physician Education Loan Repayment Program, which began to address health care access in the neediest areas in Texas before its funding was drastically slashed last session. As TAFP reported in a recent issue of Texas Family Physician, “The Right Kind of Doctors for Texas,” THECB found in the report that
while enrollment in Texas medical schools jumped 31 percent from fall 2002 to fall 2011, the number of first-year Texas residency positions remained flat. If no action is taken, at least 63 graduates of Texas medical schools will not have an opportunity to enter a Texas residency program in 2014 and 180 will not have this opportunity by 2016. To expand the number of GME positions and restore part of the funding to the loan repayment program, the coordinating board has included two exceptional item requests in their budget to present to the Legislature. But because many funding streams pay for the cost of residency training—estimated to be around $150,000 per year per physician—physician members of the board asked if the state should focus on primary care. There was resounding support for not just primary care, but for family medicine. Even internists were clear in their testimony that internal medicine does not have many residency graduates who stay in primary care and that family medicine provides the bulk of true primary care. A committee member asked if the state should provide funds to academic institutions without stipulation and allow them to expand GME positions for any of the specialties experiencing shortages in Texas; he said of 40 specialties we’re only at the national average for three of them. The answer: no. The stakeholders pointed out that fourth- and fifth-year GME positions have a return on investment for institutions and these positions would be more likely to be created than primary care positions. They explained that THECB should continue with their emphasis on first-year positions, with dominant sentiment that the funds should be disproportionately directed toward family medicine, general pediatrics, and psychiatry. This meeting is just one example of the momentum driving lawmakers’ understanding that we need to invest in more family medicine residency positions for the benefit of Texans’ health and our economic stability. The coordinating board is on the right path and the Legislature will be well served with their expert direction. We in the Academy’s leadership encourage all TAFP members to continue talking about the value of family medicine to strengthen our message into the current session and beyond.
Enrollment in Texas medical schools jumped 31 percent from fall 2002 to fall 2011, but the number of first-year Texas residency positions remained flat. If no action is taken, at least 63 graduates of Texas medical schools will not have an opportunity to enter a Texas residency program in 2014 and 180 will not have this opportunity by 2016.
TEXAS FAMILY PHYSICIAN