Leadership in family medicine

Saturday, November 01, 2014 12:13 PM

Lesson in advocacy complements local doctor’s practice

by Gina Martin, MD, and Kim Marvel, PhD, executive director, Commission on Family Medicine

Editor’s note: Gina Martin, MD, practices in Delta, Colo., and wrote this article in collaboration with Kim Marvel, PhD, who is the executive director of the Commission on Family Medicine.

As a senior resident, I was accustomed to advocating on behalf of my fellow colleagues. However, the GME Summit provided me with the opportunity to take my advocacy skills to a new level. The summit was an exciting change of roles that expanded my appreciation of the wide range of skills and expertise required by a leader in family medicine. In mid-June I was on the resident team for the inpatient medicine service at St. Mary’s Hospital in Grand Junction; three days later I was standing before 120 congressional health care staffers in the Capitol Visitor Center in Washington, D.C., delivering a message of reform. How did this happen?

I had jumped at opportunities for leadership roles throughout my education, beginning as an undergraduate at Oregon State University. I was president of the Student Health Advisory Committee, organized bone marrow donor registration drives and was vice president of morals in my sorority. I received an international award for my advocacy and work to increase the number of minorities registered to be bone marrow donors. During medical school at Oregon Health and Sciences University I continued my volunteer efforts with the National Marrow Donor Program. Further I was very involved with our Health Policy Group where I worked with a team of students to create a large-scale annual free health clinic for the homeless. We were successful in serving more than 450 uninsured and underinsured patients in a single day by providing health screening exams, vaccinations, medications and referrals to local clinics.

Thankfully in medical school I also became involved with my county and state medical societies, which led me to attend an AMA conference and be introduced to CMS leadership. It was there that I decided a residency in Colorado would be the best environment to grow my involvement in organized medicine and advocacy. While I had hoped to train at a residency on the Front Range in order to be more involved with CMS, I fell in love with St. Mary’s Hospital and was lucky to match to their program in 2011. After moving to Grand Junction, I immediately joined the Mesa County Medical Society (MCMS). Under the guidance of exceptional leaders, such as Michael Pramenko, MD, Chuck Breaux, MD, and Sherm Straw, MD, I expanded my leadership by becoming MCMS president in 2013. Eventually my involvement led to my introduction to Kim Marvel of the Colorado Commission on Family Medicine (COFM), who asked me to join in an educational summit in Washington, D.C.

Pushing for GME overhaul
For several years, the COFM has been pushing for the graduate medical education (GME) payment system to be overhauled. The commission was established in 1977 when two legislators saw the need for a board to advise the legislature about the primary care needs of the state, including the training of family physicians. At that time, Sen. Harvey Phelps, a pulmonologist from Pueblo, and Rep. Tilly Bishop from Grand Junction, established the commission by state statute. Today, the commission is composed of 19 members including nine program directors of the state’s family medicine residency programs, seven governor-appointed citizens from the congressional districts, the deans of the University of Colorado School of Medicine and Rocky Vista University College of Osteopathic Medicine, and a representative from the Colorado Academy of Family Physicians.

Frustrated by the chronic underfunding of family medicine residencies and the 1997 cap placed on the number of residency training positions, the commission brought together leaders of family medicine education from throughout the West and Midwest in 2011. The meeting, deemed the GME Initiative, resulted in a letter signed by seven U.S. senators requesting the Institute of Medicine (IOM) conduct a study of the GME payment system.

Fast forward to the spring of 2014. The IOM has announced that the Committee on GME Governance and Finance will soon release their recommendations. In response, the commission planned the GME Summit in Washington, D.C., to coincide with the release of the IOM report. The summit was designed to educate legislative health care aides about the deficiencies of the current GME payment system and to recommend specific changes. For example, the current system is not producing sufficient primary care physicians and provides significantly higher payments per trainee for residencies on the East and West coasts compared to the middle of the country.

Suggested changes are to set a goal to increase the primary care workforce to at least 40 percent of physicians and make payments directly to programs and sponsoring organizations where primary care training occurs, such as teaching health centers, educational consortia, and residency programs rather than teaching hospitals. I was thrilled to be invited to join the team to carry this message to policymakers at the nation’s Capitol June 19-20.

Our two-day itinerary included individual meetings in congressional offices and a “Hill briefing” in the Capitol Visitor Center. To prepare for the individual meetings the first day, we split into two small groups, identified a primary speaker, and reviewed a list of responses to frequently asked questions. The challenge was to provide succinct explanations about the extremely complex GME payment system.

Both groups had a tight schedule to meet with 10-12 offices. We had 15 minutes to make our case then walk quickly to the next office, often catching a taxi between the Senate and House office buildings. We found the knowledge base of GME funding varied widely among the health care aides. While all health care aides were familiar with GME, many were not aware that current GME bills, written to increase the primary care workforce, if passed will actually continue to produce more sub-specialty physicians while the percent of primary care physicians will continue to decline.

We were pleased with the interest shown by health care aides and their appreciation for understanding the specific wording needed in bills to increase the primary care physician workforce.

On the second day we conducted a 90-minute panel presentation to a standing-room-only audience of health care aides and media representatives in the Capitol Visitor Center. The first speakers made the case for GME payment reform. During my time at the podium, I told my journey of choosing to become a family physician. I described the challenge of mastering a broad range of skills, the satisfaction of building relationships with patients and their families, and the important role family physicians play as advocates for their patients’ health. As we recently learned at the CMS spring meeting, I found that my personal stories added meaning to the data provided by researchers and national experts.

There is one more personal dimension to this experience. A basic tenet of family medicine is treatment of the whole person. One could say the same for family physicians – they commit their whole person to their work. At the time of the GME Summit, my four-month-old daughter was home with my husband. During the two-day event, I periodically ducked into private rooms to pump breast milk. In retrospect, my roles of mother, physician, leader and advocate were seamlessly intertwined on this journey.

A short two weeks after the GME Summit I graduated from residency and joined a small practice in Delta, Colo. In my new location, I will continue to provide full-scope patient care, look for new leadership and advocacy opportunities, and spend time with my family.