In family medicine we most need change agents and least need those who remain stagnant and unable to change the course of health access, of primary care, and of health outcomes for most Americans. We fail in training and in family medicine workforce because we fail in selection and preparation in ways that training cannot address.
The STFM blog highlighted the quality improvement potential of family medicine residents. There is so much more potential for those that begin efforts much earlier and work throughout their lives as change agents.
The Social Beginning Is the Beginning of Change Agents
Potential medical students and others preparing for health and education careers should spend age 14 to 30 years working in their communities improving health, education, and local resources in their communities. These important interactive life experiences should be the most important determinants for selection as nurses, public health officers, or family physicians. Selections should be based on the demonstrated ability to reshape lives toward better health, education, situations, environments, and relationships.
Studies demonstrate difficulty if not impossibility with regard to training medical students in service orientation and empathy. These areas have been linked to primary care careers, but many still lack these important characteristics most important for changing people. It is likely that change agent characteristics are shaped long before medical training.
- Why do we still cling to medical training as able to shape these change agent areas?
- Why do we still believe that medical training can resolve deficits of workforce even with known deficits of the payments to support the workforce to address the deficits?
- We have far too many beliefs and assumptions that prevent needed changes.
As soon as humans become social and most interactive, their interactive abilities should be developed by opportunities to facilitate people change - starting age 14 for some and later in others.
The Culture of Health Required to Change Outcomes Requires Change Agents
The Culture of Health that we most need to improve health outcomes, requires entirely different culture shaping the needed change agents.
Just a few local projects include child development, facilitation of education, enhancements of parent involvement from the earliest years of life, development of community resources, projects mentoring youth, and Community Oriented Primary Care interventions working with local health care and local leaders on specific areas as guided by community needs, preferences, and readiness. Unless you experience the awesome power of community mentorship and community outreach, you will never understand the true assets and resources of even the most underserved and disadvantaged communities.
Our nation cannot be fixed from above.
It can only improve from the ground up.
Anyone who says they can fix America from above
is selling something Americans have bought too much of already.
It can only improve from the ground up.
Anyone who says they can fix America from above
is selling something Americans have bought too much of already.
Culture, Context, Continuity, and Commitment
Only preparation, selection, training, and payment design specific to health access within the context of local community, culture, and practice can address the basic needs of most Americans most behind as well as facilitating the higher primary care, community health, public health, child development, education, and similar functions.
When students are prepared and selected the ways that are best for most Americans, their thoughts and actions and reflections can reshape an entire nation. Lack of making a difference for decades indicates our continued failure by design.
We completely lack the focus on continuity at the highest levels and the focus on commitment at the highest levels for impact at the local level.
Learning the Most from Those Most Different and Those Making a Difference
I have learned the most from those with different backgrounds and those who have experienced different training, often self-engineered (rural, accelerated FM residents, older students or FM grads, previous nursing or public health, activist students and residents, qualitative researchers, faculty that practiced where needed before becoming faculty). At STFM, these were generally seen in the 5 or 10 minute presentations - not the big ticket areas. Much learning occurs when you meet with these individuals and learn from them, between sessions or during sessions. As with curricula, it is the extracurricular that can be most enlightening.
Sadly our nation learns the least from most Americans most behind - and fails them most by designs shaped by those who know them least. They are damaged by lack of awareness to some degree, but mostly by those who focus on "their version" of quality efforts not realizing that what they do is most damaging where outcomes are already worst. The fact that we tolerate Pay for Performance designs is most revealing.
The P4P designs lack evidence basis for health outcomes and have evidence basis for discrimination against providers who care for those most complex with lesser health and most in need of care. Those with different backgrounds, preparation, selection, training, and careers would never tolerate this. Leading a nation to change requires us to change who we are in ways that can help our graduates change others and an entire nation.
Shame on us for accepting the rescue plans of any political party and the sellout of American health care by corporate greed and the many misguided CMS designs. Shame on us for not addressing the substantial error in the literature - particularly regarding medical error and quality improvement. Why do we tolerate the literature shaped by bandwagon assumptions and beliefs? Where is the critique and logical reasoning that should have protected us and most Americans?
Less Focus on Parties and More Focus on People
Political parties obviously have little focus on most Americans. Parties are most important to parties who have parted with people.
Party atmospheres are also promoted by Family Medicine Party associations. I must admit enjoying family medicine parties, otherwise known as STFM Regional and Annual Meetings and Annual Meetings of the Students and Residents. But parties often distract from needed change.
One change that should have been done long ago is breaking up a very expensive Student Resident Faculty party in August in Kansas City. Students going to the meeting are already committed with few going that have yet to decide. There is great potential for intervention before medical school and at state or regional levels.
Changes should include:
- Making it regional or state
- Making it a celebration of Doctors Ought to Care or COPC projects involving age 14 up student projects.
- Making it a health career orientation for secondary education students.
Even a focus of the Kansas City party on medical students just admitted to medical school would be better than those already committed to FM. Some of the best FM interventions were timed before medical school - timing prior to formal curricula that often retards the most important learning.
The focus of early and often interventions would be attracting change agents to family medicine. The benefits at the community level would be enormous, and communities would learn to appreciate local students and their activities. They may also be more willing to support them as students, medical students, or local family physicians.
Isn't it quite clear over 100 years that our nation
- has moved away from the health care needs of most Americans,
- has moved away from the health workforce needed by most Americans,
- has moved away from the support of that workforce
- has moved away from the preparation and selection needed for that workforce
- has moved away from the specific training needed for that workforce
- has moved away from community level resources, projects, promotions, and performance.
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