Uniquely Positioned

The Hospitalist. 2009 July;2009(07):

July 1, 2009 | The Hospitalist

“I would like to do more with the various societies to increase opportunities for family medicine,” Dr. Heim says. “In some ways, primary care is being squeezed all around. How are you going to increase the numbers of FPs when they earn less? You are not going to unless you reform the system.”

Another top priority is advancing the idea of a national network of electronic health records (EHRs). Dr. Heim says a linked EHR system would improve communication and handoffs, and help physicians limit medical errors. “That’s the key,” she says. “Until then, it is going to be a hodgepodge of solutions. As long as it requires multiple steps, there will always be slipups.

“When I was in the military, records were kept electronically, and I learned the value of having continuity of electronic records.”

Dr. Heim says she would like to partner with hospital-based physicians on QI projects. “Any doctor, it doesn’t matter who you are, has a role to play in quality improvement, either in procedures to improve outcomes in the operating room or ICU or ED. We all have a role in that,” she says. “That is one of the reasons we have supported comparative effectiveness research. Guidelines are valuable.”

As AAFP president, Dr. Heim says she won’t forget her family physician roots. Her platform is ambitious: Reform both the practice and the payment of healthcare in this country. “I think the country recognizes that the current way of paying for healthcare—built on volume and procedures rather than patient outcome—has resulted in a fragmented and disjointed process,” she says. “It’s not an even a system. … We have to look at patient experience and outcome, not ‘what procedure did we do to that patient?’

“Right now, we are paying more for lower-quality healthcare, and we are not getting the bang for our bucks. We cannot afford to continue to spend money and not get value; we really have to change this time.” TH

Carol Berczuk is a freelance writer based in New York City.

HM, AAFP Can Work Together

Dr. Heim—who has a unique perspective as a practicing hospitalist and AAFP president-elect—says her organization and SHM face many of the same healthcare issues. Here are her suggestions for working together on two issues central to HM:

Workforce shortage: “I would like to see more opportunities for family physicians to be accepted to be hospitalists. Hospital administrators and boards of trustees often set hiring policy, so we need to educate them. The more hospitals experience us [family physicians], the wider the acceptance will be. … Coming from family medicine, [we] also can help cover for the pediatric population. Pay is a huge driver here. I cannot emphasize enough how huge. For family physicians, another driver toward hospital medicine is the predictability of the hospital schedule. That affects people’s choices.”
QI and coordination of care: “This is definitely an area in which both hospitalists and family physicians need to focus and work on together. Family medicine stresses coordination of care. Many measures used to judge hospitalists’ performance, such as readmission and infection rates, are really contingent upon communication and handoffs with the patient’s primary-care physician. At the AAFP, coordination of care is stressed both in policy and programs.”—CB