A Career Alongside Family Physicians

I celebrated 30 years of working with and for you in 2019. Here are just a few wise sayings I have learned from various past presidents along the way:
Never, ever give up asking someone if they are ready to change (to quit smoking, to lose weight, to increase exercise, to eat healthier). The next time you do may be the catalyst for change. Stephen Rittmann, MD
See the possibilities in everyone you meet. Carolyn Lopez, MD
You or your replacement will get this done. Bruce Steffens, MD
When things seem bleak and without hope, remember there is as much energy around in dark times as in bright times. Michael Brummer, MD


I think family medicine chose me and I responded in 1989 when I joined IAFP. I chose a new personal physician, William Hulesch, MD, an IAFP and Foundation past president. He continues to care for my family throughout all our patient and ‘no-so-patient’ health adventures. I was in the office of another past president, Raymond Weber, MD, when I received the call that my wife, Patty and I, were approved to adopt our second child.
I’ve been blessed to observe you in practice, from circumcisions to C-sections to daily practice. The framework of my journey as your chapter executive is much like the Academy’s motto: Devoted to Advocacy, Education and Action.

Advocacy
Some issues IAFP advocated for in the 1990s are the same ones we face in the 2020s:

  • Scope of practice: We focused then on protecting hospital privileges and still do, but there are challenges with scope in ambulatory practice today 1
  • Evidence based practice: Focused then on mandating the length of hospital stay for vaginal and C-section deliveries 2 and today, we support for immunizations amidst societal trends that ignore evidence
  • Managed health care: Establishing then the role of family medicine in effective health care delivery 3, and now working to eliminate unnecessary administrative burdens 4
  • Public health: Advocating for clean indoor air 5 then, and now fighting to safeguard teens against nicotine exposure and addiction 6
  • Medical malpractice liability: Illinois has twice enacted limits to restrict non-economic damages and twice they were struck down by the courts. The specter of lawsuits casts a shadow over clinical practice and the health corporations than employ you. 7
  • Work after clinic (WAC): Completing charts was usually an after-clinic task in the 1990s and even now with EMRs, WAC is an unfair burden you carry on your backs and in your homes. Your job is to care for patients, not to complete many administrative ‘clicks’ before your day ends that benefit the payer more than you or your patients. Scribes could diminish WAC, but they must be affordable and accessible. 8

Education
IAFP provides the continuing education you need to stay current on the newest clinical information and to assure you meet professional and licensing requirements. We focus on developing CME by family physicians for family physicians. Here’s how education formats have developed and evolved over my three decades here.

  • In the 1990s IAFP had a regional CME program, Medicine for Today, in 20+ locations providing 30 hours of education each year. This volunteer-led program ended in the early 2000s as CME regulatory demands outstripped our volunteers’ capacity for administrative work! (Sound familiar?)
  • IAFP responded by partnering with other organizations to provide CME opportunities and by engaging in quality improvement projects that had critically acclaimed results. 9
  • As the strength of evidence-based (E-B) medicine has grown, IAFP partnered with family medicine E-B gurus to offer Essential Evidence Update, a 12-credit conference covering 20+ topics. 10
  • Monthly webinars cover hot topics, like Ethylene Oxide; updates on immunization schedules; state-required CME on opioids and preventing sexual harassment; and guidelines for sports medicine. You can hear these live or the recorded sessions when you have time. 
  • In a return to in-person meetings, the brand, Medicine for Today, has been revived for day-long conferences this year. 

IAFP has also helped strengthen the pipeline for family medicine. There are now 32 residencies in Illinois. IAFP provided activities and programs to attract and keep family physicians in our state:

  • IAFP worked closely with Illinois Department of Public Health (IDPH) and Illinois Primary Health Care Association in the 1990s on a scholarship program for Illinois medical students who wished to become family physicians and work in medically underserved areas.
  • Hundreds of Illinois medical students participated in the state-funded Summer Externship program, which placed rising M2’s in practices state-wide for a four-week family medicine experience. Currently, the IAFP’s Family Health Foundation of Illinois offers a summer externship experience for an Illinois FMIG leader.
  • What started as an Illinois-only residency fair grew into the Family Medicine Midwest Conference, a multi-state regional conference for scholarly works and recruitment. 

Action
I think you are the only physicians who really understand that patients are born and that patients die. You are wonderful life coaches, helping patients through differential diagnoses; setting priorities on their ‘problem list’; and helping them to plan for the next steps in their lives.
I am blessed to serve like a coach to board members. They are the stewards to the family medicine message in Illinois. Whether attending IAFP board meetings, or AAFP business meetings and conferences, I am impressed with their thoughtfulness, ingenuity and leadership. It is a privilege to represent you because I wake up every morning thanking the Creator that I get to work with you. Your values are my values.
The presidents I have served deserve special recognition. The relationship during that year is intense and demanding. Our presidents are barraged with emails and texts from me, taking time from practice and family to attend our events or testify before government bodies. You are always well-represented by your IAFP president and I was always thrilled to be along for the ride! 11

Vince Keenan, 1989Vince Keenan, 2019
Vince in 1989                 Vince in 2019

The Family Medicine Team
Working well and closely with your colleagues creates synergies in your office practice. You know how important it is to organize and lead a clinical team to address all the aspects of practice: prevention; acute care and chronic disease care. Observing how you build clinical teams has helped IAFP staff team up to provide advocacy, education and action in support of family medicine values. My teammates and I have 162 years of combined service to IAFP. 12 I am in awe of the talents, experience and competence they bring to their jobs. We work to serve you!

Read our history of the Academy’s first 60 years 
Catch up on the years 2007-2017 

View a slideshow highlighting Vince's 30th Anniversary President's Tour
Click here to open the video in a new window

Endnotes:

1. Jerry Suchomski, MD; Edward Hirsch, MD; and others were strong advocates for family physicians obtaining privileges through a hospital family medicine department and not through another clinical department; and not being excluded from hospital services, such as Emergency Room (Kevin Sherin, MD)
2. Christine Petty, MD, testified at an Illinois General Assembly hearing about lack of evidence for mandating 48-hour and 96-hour stays after deliveries for all mothers.
3. Ronald Johnson, MD, testified at an Illinois General Assembly hearing about the guidelines needed to ensure a proper role for family physicians during an era when you were assigned as “gatekeepers”
4. Alap Shah, MD and Farah Chaus, MD, have been nominated by IAFP to serve as family physician representatives on the Illinois Department of Insurance -- Task Force on a Standardized Prior Authorization Form  
5. Luke Burchard, MD, was the proponent behind the first efforts to pass a Clean Indoor Act of 1982, and IAFP was instrumental in supporting the Smoke Free Illinois Act in 2007. IAFP continued to advocate for proven tobacco policy with the successful passage of Tobacco21 in 2019.
6. See the next edition of Family Physician for an update on our 2017 article by Monica Fudala, MD, on e-cigarettes and vaping.
7. In the early 1990s, family physicians doing obstetrics faced high premiums. Today, malpractice claims also involve missed diagnosis and EMR documentation. IAFP has worked with ProAssurance since 1991 to offer malpractice insurance coverage and risk management education to family physicians.
8. When family physicians and scribes can develop a long-term relationship that is ‘hand-in-glove’, it is beneficial to family physicians and their clinical team. Recently, virtual scribing has worked for some of our members’ health systems. From CME presentation by Sachin Dixit, MD; Timothy, Ott, DO and Johnny Tenegra, MD at 2019 Family Medicine Midwest Conference.
9. IAFP served as the medical education contributor to the Illinois Medicaid programs from 2006-2012. Rick Leary, MD; Margaret Kirkegaard, MD, Carrie Nelson, MD and Alvia Siddiqi, MD were integral to assisting IAFP in developing its online CME education presence. These programs, Illinois Health Connect and Your Healthcare Plus, were amazingly successful in reducing the trajectory of costs for the Illinois Medicaid program
10. Essential Evidence Update was developed by John Hickner, MD; Mark Ebell, MD; and Gary Ferenchick, MD. Since 2014 it has been offered in Chicago, and more recently included events in Peoria and Springfield 
11. Road trips with presidents to AAFP conferences were ongoing adventures, building strong relationships and reducing travel costs. Here a few: Columbus, Ohio (Edward Blumen, MD); Detroit (Javette Orgain, MD, Patrick Tranmer, MD); Memphis (David Hagan, MD; Steven Knight, MD, and Kathleen Miller, MD); Kansas City (Ellen Brull, MD; Carrie Nelson, MD); New Orleans (Christine Petty, MD; Tim Vega, MD, Raymond Weber, MD); South Carolina (Christine Petty, MD)
12. Photo: Top row, left to right: Ginnie Flynn, 21 years; Sara Ortega, 8 years;  Gordana Krkic, 23 years and Vince Keenan, 31 years. Bottom Row: Jennifer O’Leary, 28 years; Diana Hernandez, 20 years; Kate Valentine, 18 years and Desma Rozovics, 13 years.   

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