SHAPING HEALTH-RELATED POLICY IN THE UNITED STATES: 1 FAMILY PHYSICIAN AT A TIME

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The Affordable Care Act will profoundly influence health care delivery in the United States. Here, Dr Randy Wexler, an Associate Professor of Family Medicine at The Ohio State University, describes his health policy interests and activities. Through the years, Dr Wexler has worked with local-, state-, and federal-level policy makers. We hope that by sharing his experiences, family physicians will become interested in and prompted to be more involved in shaping health-related policy related to the delivery of primary care. As a busy family physician, how did you become interested and involved in health-related policy activities? My interest in policy issues really evolved out of my frustration with the overall health care system. During my family medicine residency training I began attending my local Ohio Academy of Family Physicians affiliate and things just evolved from there. I think all family physicians must be engaged in health policy-related activities in some manner. You have to make the time to be involved. So many of the decisions made by state and federal agencies impact how family physicians not only practice, but also the manner in which we deliver care. To not engage in any form, even just a little, allows others to determine how we practice. It is just like the old saying, “you can pay (a little time) now or pay (a lot of time) later.” A family physician is seeking to be involved in health-related policy efforts. What advice could you provide him/her in getting started? Fortunately, there are many ways to get involved. At the local level one can engage with their state American Academy of Family Physicians affiliate. To impact federal issues the American Academy of Family Physicians (AAFP) has many options. For example, the Family Medicine Political Action Committee (FamMedPAC) advocates for family medicine in Washington, DC. Information about FamMedPAC is available at http://www.aafp.org/online/en/home/policy/fammedpac.html?navid=fammedpac. The AAFP also has a “Speak Out” Web site (http://capitol.aafp.org/aafp/home/) that encourages family physicians to contact their members of Congress and provides a comprehensive list of sample talking points on pertinent issues. Finally, one can call the office of their General Assembly or member of Congress and request an appointment. Often you will meet with an aide, but aides are the sergeants of government and good relationships to establish. While most meetings will be just 15 or 30 minutes, it is always beneficial to place a follow-up phone call a few days after each meeting. Building relationships with elected officials is the key to establishing a voice for family medicine. As a whole, NAPCRG advocates for increased primary care research funding. Again, how do you suggest family physicians lead this effort? The most important thing NAPCRG can do is educate policy makers on the importance of primary care research and the impact such research can have on the nation. The late Dr Barbara Starfield and colleagues demonstrated that primary care services reduce both morbidity and mortality, whether primary care is characterized by primary care provider supply, source of primary care, or which components of primary care are utilized.1 Further, they found that primary care—in comparison to specialty care—results in not only equitable distribution of health resources and improved outcomes, but also reduced costs. Primary care research is well suited for evaluation and interpretation of “real-world” problems and can focus improvements on managing health services toward more efficient and higher quality care. Primary care research can be especially relevant in addressing new and emerging issues, in addition to the consideration of questions such as “how the provision of care can be improved.”2 Furthermore, primary care is ideally positioned to deal with issues related to disparities in health care delivery by addressing areas necessary to resolve such inequities. Rust and Cooper3 argue that we must: (1) conduct research in real-world, high-disparity primary care settings; (2) develop community partnerships; (3) address the complex mix of disparities in chronic disease risk factors and outcomes; (4) focus efforts on the triangulation of patient, community, and provider; and (5) test dynamic, constantly improving interventions. Research in primary care is ideal for addressing such needs and inequities fomented by the current health care system.