Posts Tagged ‘family physicians’

Eight things I learned from my tonsillectomy

By Janet Hurley, M.D.

Having been a patient not too long ago, I am convinced that doctors should be patients more often.  As we continue to talk more in health care about “patient-centeredness” and the “patient experience,” I have a few thoughts on things I learned during my convalescence period after a tonsillectomy in 2009.

1)       My surgeon, my anesthesiologist, and the surgical center staff were GREAT.  As providers, the things we do become routine to us, but to patients they are extraordinary. Taking the time to explain a procedure carefully and thoughtfully can make a big difference.

2)      Follow directions.  Patient handouts have important information in them and the treatment team knows what they’re doing.  I must remember to listen to their advice and review the patient materials when I have questions.

3)      Don’t be your own doctor!  If you have questions about medications or symptoms, ASK SOMEONE ELSE.  You may choose to be a highly educated patient, but not your own doctor.

4)      I am not too tough for pain medications.  While I dislike the mental fogginess they create, I had to keep in mind steps I prescribe to my patients—maintain better hydration, better nutrition, and keep my throat moist—to make myself more comfortable.

5)      I will never even think about accessing my Electronic Medical Record from home until fully off narcotics.  Impairment was obvious. 

6)      When on narcotics, I communicate better with my fingers than my tongue. You can’t rush recovery, even when you know you have important work to do. E-mail communication with others kept me connected when my speech was slurred and my throat hurt.

7)      I have great clinic coverage partners.  I had no worries about who would check my messages, approve refill requests, and see my patients when I was out.  We must remember that good patient care during such times requires that we receive help from our colleagues.

8)     Don’t undervalue the significance of family and friends.  I am grateful to my husband who took care of our kids and took care of me, and the friends and neighbors who looked for ways to help out during my recovery.  It’s okay to lean on those closest to you in times of need!

Janet Hurley, M.D., is a family physician at Trinity Clinic in Whitehouse, Texas.

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Help wanted: Send us your ideas for the Primary Care Rescue Act

As a die-hard fan of the Texas Longhorns, I have no shame in telling you that after last year’s 5-7 record, I was glad the college football season was over. Even though I’m a self-admitted policy wonk and political news junkie, I was equally relieved—even somewhat jubilant—when the 82nd Texas Legislature finally closed up shop and went home. If you followed the frustrating struggle to balance the state budget without additional revenue, and witnessed the resulting cuts to higher education, public education, and health and human services, you might have been just as ready for it to end as I was. At least when they’re not in session, they can’t do any more damage, right? Now is not the time to bury our heads in the sand. In fact, the legislative interim is perhaps our best opportunity to formulate and articulate our most effective arguments for renewed investment in Texas’ primary care infrastructure. We can document the ill effects of the drastic reduction in state support for graduate medical education, especially in family medicine residency training, and we can illustrate the broken promise of access to primary care physicians for underserved communities made manifest by the 76-percent cut to the state’s Physician Education Loan Repayment Program.

And now is the time to begin preparations for a major initiative in the next legislative session. In the late ’80s, rural medicine in Texas was in terrible need of state investment. Health care organizations and advocates rallied around a broad set of goals encompassed in what was called the Omnibus Rural Healthcare Rescue Act, which the Legislature passed in 1989. The law created the Center for Rural Health Initiatives and the Office of Rural Health Care, and it contained tort reforms, benefits for rural hospitals, several reforms to strengthen the state’s trauma care infrastructure, and new recruitment and training programs for primary care physicians. Family medicine won funding for third-year clerkships, among other valuable reforms.

As our state demographics change, and following the decision of the 82nd Legislature to withdraw almost 80 percent of its investment in programs intended to increase the state’s primary care workforce, we believe primary care in Texas is in desperate need of something like that landmark omnibus package of reforms and initiatives. Let’s call it the Primary Care Rescue Act. Obviously we would want to include the restoration of state support for GME, especially the funds that go directly to family medicine residency programs through the Texas Higher Education Coordinating Board. Also we would include full restoration of funds for the Statewide Primary Care Preceptorship Program, and the Physician Education Loan Repayment Program. But what else should we include?

We wish to engage you—the membership of TAFP—in this endeavor from the very beginning. What state reforms would make your practice easier, more efficient, and provide better care for your patients? What kind of administrative simplification requests should we make in state programs? What about managed care reforms? Would a standardized pre-authorization process help? Standardized contracts? Real-time claims adjudication? What could the state do to make primary care more attractive to medical students?

The sooner we can begin to craft a set of reforms to use during the election cycle, the more likely our success becomes. Remember, politics drives the process that sets policy. That’s why we want to hear your ideas for the Primary Care Rescue Act. Use this space, here on the blog, to comment with your ideas, and we’ll pay close attention to the discussion. If you’d rather send us your ideas individually, feel free to e-mail me, Jonathan Nelson, at jnelson@tafp.org. Or you can e-mail Tom Banning at tbanning@tafp.org, or Kate Alfano at kalfano@tafp.org. However you choose to share your ideas, we are eager to hear them. The legislative interim can be a time filled with promise and hope, and it’s the perfect time to lay the groundwork for big initiatives in the next session. Let’s take advantage of that opportunity.

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Asking for honest feedback – what did you like (or not like) about AS social media?

This Annual Session ushered in a new era of communication, and we asked members to interact with us, their fellow attendees, and their colleagues from around the state and country. Now that the dust has settled on a busy conference filled with CME, business meetings, and special events, we want to encourage you to continue the commentary.

So…what did you think? How were our posts/pictures/tweets? What can we do to improve our communication and interaction with you? And, in a very simple sense, what did you like or not like about our effort (so we can be better next time)?

TAFP's Kate Alfano and video wizard Herb Holland after the conclusion of the live stream

As a recap, the total effort centered around the Annual Session Social Media Portal – http://tafp11.txfamilydocs.org/ – a page within our TXFamilyDocs.org blog. We had an ASSA Flickr stream updated nightly, as well as a daily news wrap. Staff tweeted more frequently than posting on Facebook, but that goes along with the urgency of the platforms.

The highlight of the conference was our live stream of the lecture “Know Before You Sign! What to Look for in a Physician Employment Contract, Including Employment by Non-Profit Health Corporations.” Though it occurred from 5:15 – 6:15 p.m. on a Saturday afternoon, we had about a dozen viewers join us live, and we continue to have hits on the archived video on our Ustream channel: http://www.ustream.tv/channel/texas-academy-of-family-physicians. We even received a shout-out from Dr. Sevilla on his Family Medicine Rocks blog for this effort.

As fleeting as it seems, there is a certain longevity to social media tweets and posts, and I encourage you to revisit them. There is still time to upload pictures to our Flickr account (become a member and join our group: http://www.flickr.com/groups/txfamilydocs/), and it only takes a minute to scroll through our tweets and Facebook posts.

And, as mentioned above, this conference provided the building blocks for what we hope will be a larger effort to draw in our members and connect them beyond the walls of a host hotel. Watch as we work to further integrate all of our social media platforms at future conferences, and also please continue sending your suggestions. That’s the beauty of social media – it’s not about the person with the account password, it’s an fluid stream of interaction constructed for and by its contributors.

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Notice a new top tab? Connect with colleagues through Annual Session Social Media

TAFP is embarking on a new experience for the 2011 Annual Session and Scientific Assembly, July 27-31, in Dallas. We have developed the Annual Session Social Media Portal, a new blog page on TXFamilyDocs.org that presents an opportunity for all TAFP members to participate, provide input, and interact with our fully-integrated social media program during the entire gathering.

This page, http://tafp11.txfamilydocs.org/, will be your hub for a live-streamed lecture; TAFP’s social media feeds; and discussion topics before, during, and after Annual Session. We encourage all to participate, especially if you can’t physically attend Annual Session in Dallas.

On this page we’ll post the latest news, gather attendee feedback, and stream a lecture from the 2011 Annual Session, TMLT’s “Know Before You Sign! What to Look for in a Physician Employment Contract, Including Employment by Non-Profit Health Corporations” with Douglas Kennedy, J.D.

If you tweet during the conference, don’t forget to follow TAFP on Twitter and include the hashtag #TAFP in your tweets so it’s logged in our conference feed. Also make sure to check in on TAFP’s Facebook page. Post your thoughts on speakers, special events, and exhibitors. Shooting photos? Sign up through Flickr and upload them to our group, www.flickr.com/groups/txfamilydocs, so they’ll be displayed through the social media portal. Be sure to tag them to our set “TAFP Annual Session 2011.”

Not only will you be able to keep up with your colleagues in Dallas, but you’ll also be able to enrich your experience by connecting with your colleagues around the state, our top-rated speakers, vendors, and staff, and participating in discussions of your choosing— all right here through TAFP’s blog, TXFamilyDocs.org. For more information about Annual Session, go to www.tafp.org/education/programs/2011as.

Need some more convincing? Check out this great post from The National Association of County and City Health Officials on the top 10 reasons to use social media at a professional conference. The short version is that you get to connect to people you might not otherwise, extend your professional network, stay on top of meeting logistics, and provide information to those who aren’t able to attend. I found it useful to follow TAFP’s Twitter feed during AAFP’s NCSC and ALF conferences so I could get the scoop on concurrent sessions!

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Farewell to a great advocate, researcher

Last Friday, the medical community was shocked and saddened by the sudden death of pediatrician and primary care advocate Barbara Starfield, M.D., M.P.H. During her decades spent at Johns Hopkins, she authored and co-authored numerous studies on the value of primary care that provided proof that many of us believed in our hearts but couldn’t quantify—that patients are healthier and costs are lower in a system based on primary care.

However, her work provided more than just facts; it provided the footing for a movement to redesign the fragmented system to one that is better for patients. She inspired us to really take a look at family medicine’s contribution and advocate for its importance. The process has been slow, but her momentum kept it going.

 Because of her tremendous contributions to health care research and patient care, several organizations have released poignant and appropriate statements in tribute that must be shared. The first is the full statement from Roland Goertz, M.D., M.B.A., president of AAFP, and the second is an excerpt from Richard Roberts, M.D., J.D., president of the World Organization of Family Doctors.

A statement from Dr. Goertz:

“Patients throughout the world lost a dedicated advocate Friday, June 10, with the sudden death of Barbara Starfield, M.D., M.P.H. We have lost a committed scientist whose work focused the attention of policymakers and the entire health care community on meeting the needs of patients.

“As the University Distinguished Service Professor at the Johns Hopkins University Bloomberg School of Public Health and School of Medicine and as Director of its Primary Care Policy Center, Barbara was a tireless advocate for primary medical care. Her prolific research demonstrated that patients’ health, community health, and the nation’s health care system improved when people had access to primary medical care. She showed the world that family physicians’ expertise is essential to individual people, the communities where they live, and the soundness of the nation’s health care. She reminded family physicians why they chose their specialty—to help people improve the care they received and create a system that respected each person, regardless of their station in life. She painted a new vision for what family medicine could be and urged us to fulfill that vision.

“As a result, Barbara taught the nation that primary medical care is instrumental in turning the ship of health care policy toward a system that serves the needs of the people with efficiency. Her work earned her numerous awards, including the American Academy of Family Physicians’ highly prestigious John G. Walsh Award for Lifetime Contributions to Family Medicine. In giving the award, the AAFP cited Barbara’s dedicated, long-term and effective research in the advancement and development of family medicine.

“We will greatly miss Barbara Starfield’s energy, her commitment to building a system that serves patients and her leadership in teaching all of us about the value of the work we do. We have lost a good friend, an inspiring teacher and an exceptional researcher whose work helped make the world a better place for all of us.”

An excerpt from Dr. Roberts:

“She opened the eyes of family doctors to the considerable abilities we have, the weighty responsibilities we carry, and the unrealized possibilities we represent. She saw family doctors as the best hope for health care. Many times, she challenged our vision of what family medicine should look like, and nudged us to see further and clearer.

“She will be remembered for her passion for social justice, incisive intelligence, and incredible energy. Great people have an extraordinary vitality, which makes them seem immortal and lulls us into thinking we will have them forever. And then they are gone. The best tribute we can offer Barbara is to continue to work toward her vision of a world in which everyone has access to quality health care centered in a trusted relationship with a compassionate, competent, and comprehensive family doctor.”

Read the full statement from Dr. Roberts here.

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Without investing in physician training, health care bill creates aims without the means

An important piece of legislation designed to improve quality and lower costs in our fractured and inefficient health care system has received a second chance in the Special Session after dying in the House when time ran out on the 82nd Texas Legislature. However, because of other actions taken by our legislators that defund primary care residency training and other programs to bolster the physician workforce now and in the future, Senate Bill 8’s laudable goals are left without the means to achieve them.

The overarching goal of S.B. 8 is to reverse the negative trend in our health care system, to bend the cost curve by testing and implementing various performance-based payment methods that provide incentives for improved patient outcomes. It achieves this through two key mechanisms: the creation of health care collaboratives and the creation of the Texas Institute of Health Care Quality and Efficiency.

As envisioned in the bill, health care collaboratives clinically integrate physicians, hospitals, diagnostic labs, imaging centers, and other health care providers, aligning financial incentives to keep patients healthy and out of the hospital and emergency room. They are designed to move the delivery system away from a fee-for-service based system—where physicians and hospitals are paid for quantity of services over quality—to one in which doctors, hospitals, and other providers are accountable for the overall care of the patient and the total cost of the care provided.

Mounting evidence supports improved outcomes and lower costs achieved through this type of coordinated care. It works because patients receive care from a medical team, led by a primary care physician, that integrates all aspects of preventive, acute, and chronic needs using the best available evidence and appropriate technology to ensure patients receive the right care, at the right time, in the right place, at the right value.

Equally as important is the Texas Institute of Health Care Quality and Efficiency, which provides a safe harbor from antitrust laws for hospitals, insurers, and physicians to experiment with alternative payment and delivery systems.

A dedicated institute emphasizes experimentation at the state and community level, further encouraging the testing of health care provider collaboration, health care delivery models, and coordination of health care services to improve health care quality, accountability, education, and contain costs in Texas. Through regulation and rulemaking, our state and its agencies can ultimately shape how reform occurs, and this legislation provides the necessary medium for trial and error, adjustment and adaptation.

It is no secret that Texas faces a severe physician shortage, especially among the primary care physicians who are uniquely trained to address a variety of disorders and chronic diseases across multiple organ systems. By 2015, Texas will need more than 4,500 additional primary care physicians and other providers to care for the state’s underserved population.

Over the past few sessions, the Texas Legislature has put in place several provisions designed to increase the number of primary care physicians in our state and to draw those physicians to the rural and underserved areas of the state that need them most. Our elected officials expanded primary care graduate medical education and training, implemented education loan repayments for primary care physicians, and supported medical student primary care preceptorships—each proven to make a positive impact on increasing the primary care workforce.

How easily these gains can be reversed. The 82nd Legislature took a giant step backward when it chose to cut state support of medical residencies by 44 percent, from $106 million in funding for the current biennium to $59.6 million in 2012-2013; slash loan repayment programs, allocating $5.6 million to one repayment program for the first year only and zeroing out another program set up to meet the needs of Texas children; and completely eliminate the Statewide Primary Care Preceptorship Program.

Texas’ 28 family medicine residency programs prepare about 200 new family physicians each year for practice and these programs manage primary care clinics that deliver well-coordinated, cost-effective care to communities that need it. A significant portion of the care they provide is for Medicaid and CHIP patients, Medicare patients, and the uninsured. Many programs already operate at dangerously narrow margins, often teetering on the brink of closure, and proposed budget cuts could be the final nail in the coffin.

Cuts to the loan repayment programs alone could affect up to 1.1 million Texans, by the Texas Higher Education Coordinating Board’s estimate. Because of lack of funds to recruit new physicians to underserved areas, 750,000 patients could see diminished access to care, and the 426,000 currently served by 142 doctors in the program would likewise have difficulties finding a replacement physician to care for them.

Studies of the preceptorship programs in Texas indicate that exposing medical students to primary care clinical experience early in their training, like that provided by the Texas Statewide Preceptorship Program, is an effective method of increasing the number of primary care physicians and expanding access to primary care in underserved populations. Not funding this program further deteriorates our state’s ability to produce the next generation of primary care physicians.

In addition to patient care, physicians contribute to the state economy, which can be of particular benefit to rural and underserved communities. A March 2011 study by the American Medical Association revealed that through supporting jobs, purchasing goods and services, and generating tax revenue, office-based physicians contributed $1.4 trillion in economic activity and supported 4 million jobs nationwide. And the study found that office-based physicians are unique in the health care system in that they almost always contribute more to state economies than hospitals, nursing homes, and home health agencies.

Without investing in an adequate primary care base our state will not have the network of physicians it needs to care for a population ballooning at both ends of the age spectrum, and health care costs will inevitably continue their unsustainable march higher.

All is not lost. Texas has a narrow window of opportunity to identify state-based strategies that will trigger dramatic improvements in our health care delivery system, empower patients to better understand their health care choices and responsibilities, increase competition in the insurance market, and lower overall costs.

Should S.B. 8 pass during the Special Session, its goals can be achieved eventually; the bill lays the foundation to re-engineer the fractured health care system to one that serves patients and bends the cost curve to make the system sustainable long term.

The 82nd Legislature fumbled on ensuring we have an adequate workforce to make these goals a reality, but we hope that future legislatures will recommit to primary care for the sake of Texans’ future. Because without the primary care physician workforce, the potential achievements of Senate Bill 8 are just hollow promises.

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It’s time to read up on the RAC

Okay, if you haven’t started getting serious about educating yourself about the Recovery Audit Contractor program, it’s about time you should.

RACs are third parties hired by the Centers for Medicare and Medicaid Services to ensure that physicians are being paid correctly for Medicare Part A and B services. They identify all “improper payments,” whether the physician received too much or too little, and in return receive a share of the booty—I mean, spoils—I mean, identified payments. [Don’t mind me, it’s Friday.]

CMS released an update in late April that showed that in its first 18 months, the permanent RAC program had identified a total of $365.8 million in total improper payments—$312.2 million in overpayments and $52.6 million in underpayments. The agency attributed the four big reasons for improper payments to incorrect coding and billing for bundled services.

The three-year demonstration was wildly successful, too, with more than $900 million in overpayments collected from physicians and suppliers from six states (California, Florida, New York, Massachusetts, South Carolina, and Arizona) and less than $38 million in underpayments repaid.

RACs came to Texas in March 2009 and Connolly Healthcare won the contract for our region, Region C.

Bradley Reiner, TAFP’s practice management consultant, recommends that physicians be involved in the billing process, and implement a compliance plan so employees are aware of potential errors and how to fix them before they become big problems.

The compliance plan is detailed in the second part of an article Bradley wrote for Texas Family Physician in fall 2010. “Ready or not, Recovery Audit Contractors are coming” explains how the program works, how to minimize the risk of being audited, and what to do if you are. Bradley wrote another article in the winter 2009 issue, “Are you ready for the RAC?,” that details the demonstration project.

Both of these will help get you thinking about the RACs so you’ll be prepared if they knock on your door (rather, send a letter). TAFP members can also contact Bradley by phone at (512) 858-1570, or by e-mail at breiner@austin.rr.com for a consultation and discounted services.

The take-away message is that you can’t ignore them. As Bradley says, “If they continue to be successful there is no doubt everyone will have a RAC audit sooner or later. In almost every practice a RAC can find some billing, coding, or documentation issue during any given audit … . The rules are too complex and differ from payer to payer.”

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The Twitter diagnosis: A doctor’s dilemma

Several miles into a long run last week, I started to feel a pang of pain with which I had grown familiar. I knew I would need to stop to “shake it out,” then slow my pace substantially until I could regain my stride and run through it. Because I’d had the same pang around the same mile for the past two weeks, I started thinking that I should talk to my family doctor about it. My first thought wasn’t to call her office – it was early on a Saturday morning, after all – it was to tweet it.

In addition to my personal Twitter account, I am one of the administrators for TAFP’s account and I know several of our family physician members who follow our feed. My tweet (from my personal account) would have gone like this: “Need advice: Sharp pain in the outside of my left knee near my kneecap around mile 7. Is this serious? Should I wear a brace?” With the remaining 15 characters, I would have tagged a few physician friends, none of whom is my personal family doctor.

As I kept plodding through the miles, I decided it would be unprofessional for me to use TAFP members — even those I consider to be friends — to give me a free diagnosis. However, I wondered if it would even be possible or ethical for a physician to give a diagnosis in 140 characters.

The way people communicate is obviously changing. Thanks to smart phones, we’re always plugged in checking e-mail, texts, and social media apps like Twitter and Facebook. More people post more information about themselves online, and connect with others by reading a digest of friends’ activities rather than calling, visiting, or (gasp) sending a letter.

Doctors are no exception. A growing faction of physicians supports expanding the use of social media to hash out ideas and drive reform for our health care system, market their practices, and share health information with medical students and patients. Some of these tweets are traceable through their hashtags, including #FMrevolution and #hcsm.

As explored on a recent blog post from KevinMD.com, the author writes that the application of social media to health care is “a strong candidate for bottom-up change.”

“It’s at least worth considering that, appropriately utilized, social media could do something for the doctor-patient relationship akin to what Facebook and Twitter is doing for family, friends, and business relations all over the world. … Many physicians and medical students that I know have not yet begun to wade into the Twitter waters or explore blogging. These tools must be engaged with before they are applied. I think there’s reason to believe that the very act of engagement will stimulate ideas for implementation. If big changes in health care are going to be bottom-up, and these social media tools are truly useful, then simple exposure to physicians on the ground may likely instigate much progress.”

 To satisfy my original question, I sent a tweet that tagged a few active tweeting doctors. In their experience, had they come across any barriers working with social media? Did they think these applications could only be used for social purposes, or could they be expanded for clinical purposes as well?

Respondents said that they had come across barriers, the biggest being concern for patient privacy that limits what a doctor can actually say. There are also personal-professional boundaries. However, they resoundingly supported social media being used for more than just making friends.

They said that patients seem more prepared to incorporate some social media into their medical care than doctors, and that physicians must overcome larger mental and perceived barriers for adoption. One said he faces the task of convincing skeptics that social media can be used for professional purposes, particularly when on the job. If he checks medical apps or blogs on his phone, “it’s viewed as disinterest or assumed that I am texting friends.”

There are obvious differences between having a living, breathing patient on your exam table for a 15-minute office visit and reading a string of patient-written micro-posts. Particularly for primary care, which often calls for a multi-organ-system diagnosis, Twitter consults could oversimplify a patient’s care and take the doctor out of the driver’s seat. That may be why one responder said that patients could benefit from Twitter consults with some specialists.

As a benefit, Twitter provides access to a wide database of information-sharing and knowledge that, in one source’s opinion, can be beneficial to educating medical students. To me, this is the whole point. Twitter can either mean throwing information out into a larger audience to gauge response (as I did for this post), or it can mean tagging a specific person to have a semi-private conversation (as long as both agree in its use).

In the end, I scheduled a visit to my family physician and had a conversation much longer than a 140-character tweet. She inquired about things I hadn’t considered, and I walked away with a wealth of helpful advice to keep my knees in good shape for the race and in the years to come. We can talk Twitter on my next visit.

[Special thanks to @DrJonathan, @mdstudent31, and @danamlewis for contributing to this post. To all — please comment and let me know what you think. How are you using social media in your personal and professional life?]

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The family physician’s role in smoking cessation

In testimony before the House Public Health Committee on March 2, Dallas physician John Carlo, M.D., put forth his support for a statewide smoking ban that would prohibit smoking in public places and workplaces. Advocates tried to pass similar legislation last session and failed, for various reasons. Now as it comes up again as House Bill 670 by Rep. Myra Crownover, R-Lake Dallas, and Senate Bill 355 by Sen. Rodney Ellis, D-Houston, public health groups are gearing up for another push.

Dr. Carlo said that physicians and the public at large have known conclusively since 1986 that secondhand smoke is dangerous to children and adults, and that there is no risk-free level of exposure to secondhand smoke. As medical professionals, you understand the biological explanation why secondhand smoke exposure causes damage to blood vessels and the heart. Study after epidemiological study demonstrates an increase in cardiac disease and mortality with increasing exposure to secondhand smoke.

While 33 Texas municipalities have passed some type of smoking ban in public places, including the largest cities in the state, many rural communities haven’t. Some say a smoking ban is an infringement on an individual’s right to smoke; others say it will hurt local businesses like bars and restaurants (which, by the way, isn’t true according to a January 2011 survey by Baselice and Associates, Inc.).

A March 1 press conference held by Smoke Free Texas and the Texas Public Health Coalition—of which TAFP is one of 27 members—highlighted several bills, including the smoking ban bills. Representatives spoke about the economic damages caused by tobacco use—that the annual direct medical expenses of smoking, loss of workplace productivity, and premature death cost Texas more than $20 billion. A report prepared for the American Lung Association showed while the average retail price of a pack of cigarettes in 2010 was $5.52, the actual cost to the Texas economy was $21 per pack—a heavy price. Find coverage of the press conference at http://www.tafp.org/news/stories/11.03.03.1.asp.

What do the physicians say? You know your patients better than anyone else. As a rural physician, what steps do you take to encourage patients to quit? Do you meet resistance from these patients? We’ll continue to follow this issue as it progresses. Tell us what you think.

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BCM on the closing of Kelsey-Seybold FMRP: “They just didn’t want to be in the education business”

The Senate Finance Committee has held hearings for the past two weeks on every section of the budget, and because so many primary care programs suffered cuts (as did most other programs), many interesting exchanges have come to light. In all the discussions, though, both lawmakers and those testifying agree that primary care is of the utmost importance to ensuring Texans’ access to care.

Because residency programs play such a large role in producing the primary care physician workforce, here enters Paul Klotman, M.D., president and CEO of Baylor College of Medicine. He testified during the Feb. 8 hearing of the Senate Finance Committee, and Sen. Bob Deuell of Greenville questioned him on the closing of the Baylor College of Medicine Kelsey-Seybold Family Medicine Residency Program. Here’s their exchange.

Sen. Deuell: A family medicine program closed. What’s your take on that?

Dr. Klotman: Our family medicine program is doing fine. [Person in audience speaks]. Oh, are you talking about Kelsey-Seybold?

Deuell: Yes.

Klotman: My understanding is they just didn’t want to be in the education business, that they didn’t want to continue to have residents there.

Deuell: Was that because of finances?

Klotman: They’re driven by patient care, they’re at risk now, they need efficiencies in their system. It’s hard. One of the challenges is working in the educational piece into efficient organizations, but I actually believe you can do that. It just needs to be done in an integrated way and I don’t think that’s their primary mission.

My understanding is they just didn’t want to be in the education business, that they didn’t want to continue to have residents there.

–Paul Klotman, M.D., President and CEO, Baylor College of Medicine

So why did the program close? It turns out that it was financial. As Jonathan Nelson writes in “On the Brink,” the cover story of the first-quarter 2009 issue of Texas Family Physician, it began in 2006 when the program’s primary teaching hospital, St. Luke’s Episcopal Hospital, cut support for the program in half.

That sent Baylor and Kelsey-Seybold FMRP scrambling to find new sources of funding, none of which were stable from year to year. By fall 2009, they agreed that the program was no longer financially sustainable. Kelsey-Seybold needed a subsidy from BCM of between $400,000 and $450,000 to keep the program viable. But Baylor, which has operated at a substantial deficit for the past several years, couldn’t save the program.

Baylor College of Medicine’s 2010-2011 appropriation for GME formula funding— money intended to support their affiliated residency programs—is $15.3 million. That’s $2.5 million more than they received in the previous biennium.

The program closing certainly wasn’t because of lack of interest from the faculty or the applicants. Again, from “On the Brink”: In an era when family medicine residencies only manage to fill 45 percent of available residency positions with U.S. medical school graduates, 97 percent of the recruitment classes at the Kelsey-Seybold program over the last three years graduated from U.S. medical schools. More than 600 physicians applied for the four open positions at the residency in 2009, and of the four chosen, two are from out of state. “I’m constantly bombarded with people that would just love to come to our program,” says Tricia Elliott, M.D., F.A.A.F.P., the residency’s program director.

Read the full article here.

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