2014: Year of the Family Physician (Part VII)

So far, we have conducted two town hall hot spots discussing the Affordable Care Act [ACA].  Akin to Dickens’ A Tale of Two Cities, it was the worst of meetings and it was the best of meetings.  The first one was held in an independent coffee shop on the outskirts of downtown Sacramento.  The owner was kind enough to set aside a table for us.  However, I had failed to engage him on the purpose and scope of the meeting.  I distributed flyers, posted on Facebook and Twitter, and e-mailed civic organizations.  Still, my efforts lacked connectivity.  I did not convey that the ACA will affect all of us given its magnitude.  Nor did I inquire what questions and feelings people had about the ACA.  We arrived and saw urban hipsters connecting with their laptops and mobile phones.  Their heads were buried in cups of java.  No one came in to take part in the discussion.  I interrupted the room and announced our presence to the scattered patrons and they nodded politely, but quickly returned to their original activities.  Most were in either their mid-twenties or early thirties.  Perhaps, this demographic did not anticipate any changes in 2014 or did not consider them germane.  An hour passed and no one came to our table.  At this point, the chirping crickets decided to leave.  We came away with a goose egg.

The next town hall was better; how could it have been worse?  This time, I had community allies such as Oma Rostami, a small business owner for senior care, and Amanda Freeman, a community relations director for a senior community, whose facility hosted the event.  They contacted business colleagues and also notified the facility’s residents of the meeting.  The audience of approximately forty was divided in terms of demographics and concerns.  The professionals providing senior care wanted to know how the ACA was going to affect their delivery of goods and services to their clients.  The residents of the senior community voiced concerns whether the ACA would revoke their Medicare coverage.  Both groups expressed uncertainty and were seeking reassurances.

Their collective anxiety was palpable.  Some of the questions were beyond our expertise and place to answer.  Still, this was an opportunity to frame the ACA as a talking point for the value of family physicians.  We reminded the audience that insurance coverage does not equate to access.  We informed them that medical schools and residencies are not ramping up their numbers to accommodate the additional 30 million Americans who will have health insurance on January 1, 2014.  We reaffirmed our commitment to our patients and to the communities that we serve and to keeping family physicians at the forefront to provide the level of care we all deserve.

Even though family physicians will be a large part of the solution to the successful implementation of the ACA, we cannot do this alone.  As with the more successful turnout of the town hall, we need partners.  To this end, we cautiously challenged our participants to step up and forward in ensuring no patient is left without access.  We encouraged them to contact their elected officials and ask legislators what they are doing to encourage medical students to choose family medicine.   This is a simple directive to help ameliorate the feelings of helplessness.  We can empower our patients to assume greater input in shaping our healthcare work force.  We can be there for our patients through the harsh, unsettling times of change, just as we have been there to help them navigate the cycles of life.

I encourage my colleagues to go forth in your communities and strike up conversations about the ACA and family medicine.  Ask for assistance from community leaders and create a shared experience of synergistic enrichment.

Next:  Family Medicine Education Consortium, Inc.

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.

Author: Ronald Fong, MD, MPH

Dr. Fong's opinions are his own and do not represent UC Davis. He can be reached at ronald.fong@ucdmc.ucdavis.edu.

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