In their book The Impact Equation, authors Chris Brogan and Julien Smith explore and qualify variables that burn an idea into people’s hearts. They conclude that impact = C x (R + E + A + T + E). We can apply this equation to evaluate the impact of family physicians in next year’s ACA implementation.
The C is contrast. Family medicine’s scope and philosophy provide us with a distinct advantage. Business is keenly monitoring the unfolding of the ACA. They are deciding whether to comply with the requirements or pay the financial penalty. Data acquisition, mining and analysis are driving business strategy and investment with the expanded health insurance markets and its subsequent disruption of the healthcare delivery equilibrium. Family physicians work with large data sets daily and have the ability to navigate through diverse reference frames seamlessly. We correlate fundal height with gestation dating parameters to decide if a woman’s labor is preterm or not; we interpret newborn bilirubin nomograms for observation or phototherapy; we situate the ECG in the overall context of a patient’s preoperative risk; we discuss the utility of a DEXA scan with seniors. We incorporate the PHQ-9 into the vital signs. We need to lead in this seismic expansion of insured individuals who have been previously marginalized and now need to be integrated into a new era of healthcare.
The R is reach. We connect with the largest panels of patients because we are primary care. And, among primary care physicians, on average, we provide 29.3 standard primary care years of service over a 35 year career. The next closest primary care discipline is pediatrics at 17.6 standard primary care years over the same period. We answer many of the questions and inquiries stemming from specialists demurring “Go see your primary care physician about that.” As for #2014yearfp, we need to continue to reach and to bring the conversation to the public about our role in the ACA.
The first E is exposure. We need to expand our avenues, such as blogging, putting on videos, webcasts. Are we taking to the streets and the web to be identified as the discipline that is talking about bringing solutions to healthcare delivery in the context of the ACA? The A is articulation. As family physicians, we have a challenge. The scope of our work does not lend itself to sound bites or elevator pitches. Other disciplines can be summarized and resonate with patients: orthopedics/bones; OB/pregnancy; pediatrics/children. We have to work harder to connect with our patients and the public regarding the value of our work, especially with the implementation of the ACA.
The T is trust. This should be a non-issue, but we cannot be complacent and overlook how we are viewed by the public. Are our actions to modify the sustainable growth rate (SGR) seen as a money grab?
The second E is echo. What is the feeling our patients and the public when they do connect with us? This is the crux of #2014yearfp. Will cities passing resolutions or even Time magazine selecting the family physician as the person of the year for 2014 be a shared feeling with others outside of family physicians? Or, will this be viewed as a publicity stunt?
The ACA will make an impact on all of us. As family physicians, we should make an impact for all of us.
Dr. Fong is director of the UC Davis Family Medicine Residency Network. His opinions are his own and do not represent UC Davis. He can be reached at ronald.fong@ucdmc.ucdavis.edu.
