President's Welcome (continued)

July 2, 2010

To My Fellow Program Directors,

HHS recently announced new funding of $168 million for additional residency slots for primary care residencies (family medicine, pediatrics, and internal medicine). On initial blush, this sounds like a good first step. Astutely, many directors have questioned the addition of new residency slots when there are already many slots unfilled. In the current medical school climate, less than 10% of American medical school graduates choose primary care for a career. Many ask why build more infrastructure when the present system of primary care residency education is not close to being full. The fact that the new funds are only appropriated for a limited time does not help.

The AFMRD email discussion list has certainly been active and vocal with comments on this topic among other hot issues. It should be made clear that the AFMRD, AAFP and CAFM were not directly consulted in the development of the Primary Care Residency Expansion grant announced by HRSA on June 17, 2010. I can clarify that the AFMRD has joined the other family medicine organizations to seek relief for programs who are over their cap and aren’t receiving payment for those positions. We have called for the development of incentives to attract medical students into primary care and educational reforms that enhance the production and quality of primary care training.

I hope you can see what a major endeavor this is. Congress is having a difficult time with many issues including new Medicare-related legislation. The climate is volatile. All of us are dealing with the proposed ACGME duty hour rules. Many of our programs are struggling to survive in this tough economy. Recruiting is more difficult each year.

The problems with primary care production are multi-factorial, and we are trying to pursue action in many areas to resolve these problems. Our members and professional staff are working to obtain legislative language that would allow a pilot project to fund programs/educational entities, rather than hospitals for programs involved in the pilot. We are also looking at other avenues of relief.

To learn more about AFMRD/CAFM Policy position on GME, go to the CAFM Policy Web page at http://www.stfm.org/advocacy/issues/gme.cfm. Please know that your AFMRD Board is listening and working diligently to protect all our programs.

Joe Gravel, Jr., MD
AFMRD President

May 10, 2010

To My Fellow Program Directors,

It is with great pleasure that I announce to you that the AFMRD Board has released the organizational strategic plan that will act as the blueprint for our members and the board for the next 3-5 years.
Your board has spent a considerable amount of energy this past year in dialogue to create a strategic plan. We sought input from Family Medicine thought leaders who have served in AFMRD leadership positions as well as up and coming new leaders. Their input was extremely valuable. In addition, the board engaged an outside facilitator to challenge our thinking and to sharpen our focus.

The product of our work is a new strategic plan that can be found on our website.

I would invite you to carefully review the plan and to carefully consider how you can contribute to the organization. AFMRD was founded on the principle of program directors providing mutual aid. With this plan we can together build on our history of helping one another achieve success.

It has been a great experience serving you this past year and I thank you for the opportunity!

See you back in Kansas City for our annual Program Directors’ Workshop

Stan Kozakowski, MD
AFMRD President

April 23, 2010 

To My Fellow Program Directors,

I have been a program director of 14 years. Among my many blessings during that time has been the chance to work with two terrific program coordinators. Karen retired a year ago after working in our institution for 35 years, the last 23 of them as the family medicine residency coordinator. Kelly started a year ago, and she has brought many talents including her intellectual curiosity, communication and problem solving skills, and enthusiasm to the job. 

An effective coordinator is worth their weight in gold. I know that many of my long term program director colleagues would agree. When I was an Associate Program Director I believed that the program coordinator was just a super secretary. I was wrong. A well trained coordinator is a crucial member of any leadership team. My coordinator Kelly’s roles include, but are not limited to, coordinating recruitment and other events, managing payroll, the planning and implementation of our electronic residency management suite, coordinating housing (we are landlords for a residency housing complex), some secretarial functions, managing my schedule, being a “Mom” to the residents, and being there for me when I need to close the door and vent and occasionally cry. (Yes I will admit publically that “real program directors” do occasionally cry.)

One very important element for Kelly’s professional development has been her membership in the Association of Family Medicine Administrators (AFMA). AFMA has been a great source of new ideas and support for her. It has a discussion list for the exchange of ideas, much like our AFMRD discussion list and with a different and fresh perspective. They also produce a number of products including Webinars for professional development, a guide for program coordinators, and a staffing survey. Each year the annual AFMA meeting (along with the meeting of the Family Medicine Residency Nurses Association) is held in conjunction with the Residency Program Solutions (RPS – formerly known as RAP) meeting.

I am truly grateful for having a reliable, high quality residency leadership team. This has been especially true this year when I have been on the road during my tenure as your AFMRD President. I could not do this without Kelly and the rest of my team.

Stan Kozakowski, MD
AFMRD President
 
March 18, 2010

February 22, 2010

I want to update you on the activities of the board and board leaders since my last communication in January.

Elissa Palmer, Joe Gravel, Jay Fetter, and I represented our membership in the semi-annual meeting of the Council of Academic Family Medicine (CAFM) and Working Party. CAFM is composed of the four family medicine academic organizations – AFMRD, STFM, ADFM, and NAPCRG. Working Party is composed of the same academic organizations plus the ABFM, the AAFP and the AAFP Foundation.

The CAFM organizations discussed areas of common interest including our ongoing advocacy efforts, the PCMH and mental health integration, engaging the Veterans Administration in education, and others projects. A more complete list of projects can be found at the CAFM website at http://www.academicfamilymedicine.org/

One measure of our advocacy impact is that the AAMC and others have singled out organized family medicine, represented by the AAFP and the academic organizations of CAFM, for their joint positions taken during the recent health care reform debate. I have heard, and I agree, that it is especially powerful to have the signatures of the four presidents and the chair of CAFM in each letter. The signatures represent the fact that these organizations, all with diverse member needs, are agreeing on an issue. That represents a powerful coalition. The voices of these groups do not get lost in a homogenized way as in other specialty disciplines. (You may recall that our recent survey of our membership indicated that over two-thirds of our members believe that the unique needs of our program directors cannot be met by having only a single academic organization.)

Two new CAFM strategic priorities for the coming year include residency innovation and preparing a response for the anticipated release of the RC-FM new program requirements in the fall 2010. On a final note regarding CAFM, I am pleased to report that I have been elected as chair of CAFM to a one-year term beginning in August 2010.

The AFMRD board just completed its winter meeting to further develop the strategic plan for the next three years. The plan will be released at the Program Directors Workshop in June and pieces of the plan will be highlighted in the Annals of Family Medicine over the next 12 months. While the plan is not yet ready for release at this time, I can tell you the focus of the plan will be to raise the bar for quality in residency education. We are also working to increase the transparency of the board, improve its governance and increase the participation of non-board AFMRD members in the ongoing committee work of the organization.

If you have an interest running for a board position, it is not too late. Please contact Elissa Palmer or any other board member to get more information. If you would like to serve on an AFMRD committee, please contact a board member or the AFMRD staff.

Stan Kozakowski, MD
AFMRD President

January 13, 2010

January, named after the Roman god Janus, is often depicted as having two heads. One head is looking backwards to the past and the other head looking forward into the future. In that spirit, I want to briefly look back at the past year and look forward to the next year from my perspective as your AFMRD president.

The year 2009 was historic in many ways for program directors. The economic downturn that impacted much of the year put additional strain on already challenged residency programs. Unfortunately we have continued to see very good family medicine residency programs close their doors. Our new president, Barack Obama, has also given new hope to not only the American people for reforming our healthcare system, but also to us in family medicine. I still have goose bumps every time I watch the video of our own Ted Epperly being called on by the president to speak for America’s physicians. It is great to know that the legislature is interested in what we do and how we train our family physicians.

Our efforts at advocacy extend well beyond healthcare reform. We have had the opportunity to weigh in on important matters such as the proposed Institute of Medicine revisions to the ACGME Duty Hours. AFMRD took the lead in developing a proposed revision to the Maternity requirements for the next revision of the Residency Committee for Family Medicine (RC-FM.) We joined with our sister academic family medicine organizations in developing a comprehensive set of recommendations to the RC-FM to reform the accreditation standards.

Within the governance of AFMRD we have said goodbye to Shanna Eiklenborg who, among many other tasks, organized and ran the annual Program Directors’ Workshop. We welcomed the promotion of Katy Robb to assume these challenging responsibilities. Our board and staff developed a whole new web site design so as to make the site both more useful and more user friendly.

Looking ahead to 2010, many of the same challenges remain for our members and the board. In the near future we will be finalizing a strategic plan so that we can improve our effectiveness in serving all of you. We will continue to strive to improve our annual meeting, to improve our communications with you, to provide improved resources for program director development, and to have our voice heard to promote graduate medical education in family medicine.

Wishing you success in 2010!

Stan Kozakowski, MD
AFMRD President

December 3, 2009

I want to provide you with a status report on the ACGME Residency Review for Family Medicine (RC-FM) requirements update process.

AFMRD has now completed two surveys of our membership in order to obtain and distill major themes of recommendations. We have recently completed a process in which our themes were integrated with the themes developed by the other Council of Academic Family Medicine (CAFM) organizations. Elissa Palmer, our Immediate Past President of AFMRD, has served as the co-chair of this CAFM process.

The recommendations from CAFM will be delivered to the AAFP Commission on Education (COE). Of note, the previously developed Maternity Guidelines developed by AFMRD from the input of our membership has already been sent on to the RC-FM. In January, the COE will vet the recent general recommendations and pass them to the RC-FM, who will meet in March 2010 to draft changes in the requirements.

Two other organizations, each with their own unique perspective, will contribute their recommendations to the RC-FM before the March 2010 meeting. The RPS panel of consultants met in September and drafted a series of recommendations based upon their collective experiences in providing consultative services to residency programs throughout the country. The P4 executive committee met on December 2 and reviewed the findings of the P4 evaluation group from the Oregon Health and Sciences University. The P4 programs have been in a unique position of innovating and undergoing intensive evaluation by the OHSU evaluation team. The full steering committee of the P4 project will vet these recommendations from the executive committee and then deliver their recommendations to the RC-FM.

It is anticipated that the RC-FM will draft a new set of program requirements over the spring and early summer of 2010 and have a period of public comment and potential modification as needed. The anticipated implementation date for the new requirements will be July 2011.

I want to personally thank all of our members who provided comment and input into the proposals for the RC-FM revisions. Again I would like to especially thank Elissa Palmer for her leadership in this process

Stan Kozakowski
President, AFMRD

October 25, 2009

I had the unique and wonderful opportunity this past weekend to be an observer of the National Institute for Program Director Development (“NIPDD”) Fall 2009 session.

As a part of this weekend I sat in with the Academic Council as they conducted their business meeting and completed their final planning for the session. I want you to know that this is an extremely talented and dedicated group of individuals who have come together to produce one of the best educational opportunities for new and aspiring residency program directors. They do this work with very little reward and recognition. These teachers all deserve a note of gratitude from us all.

Also deserving recognition are the staff of the AAFP Division of Medical Education, particularly Sam Pener and Vickie Greenwood, who do an incredible “behind the scenes” effort to support the teachers and participants both during and in between sessions.

Most exciting for me on a personal level was to “be a fly on the wall” with 49 participating enthusiastic (and sometimes anxious) individuals who have committed themselves to the course work ahead. They represent people from a broad geographic and educational background. Most importantly they represent our future as the leaders in graduate medical education. Be sure that continually give them your support and encouragement for having the courage to do this needed work.

Stanley M. Kozakowski, MD
President, AFMRD

October 1, 2009

With the passing of summer most of us are back into the busy routine of the residency year with recruitment occupying a lot of our energy. Unfortunately most of us get so busy that we lose the energy to be creative or to think outside of the box. We can all use a little help from time to time so that we do not have to “reinvent the wheel” in our programs.

Family physician Jim Mold has previously challenged the family medicine community to become a learning community. His wonderful article “Best Practices Research” (Mold JW, Gregory ME. Fam Med. 2003 Feb; 35(2): 131-4.) describes how family medicine docs learn from each other and share their learnings. What I found most interesting is that no one doctor had a corner on having practice processes across the board. Mold’s point is that we all have an opportunity to improve if we share our “best practices” with each other and we learn from these exemplars.

The AFMRD Board encourages you to actively participate in discussions on our listserve and to share your “best practices” (e.g. policies, forms, etc.) with our membership by sending them to our staff for posting in our Program Director’s Toolbox section of our website. Send your submissions to Vickie Greenwood. She may also be reached at 800-274-2237, extension 6738.

Sharing our “best practices” and actively asking questions will help our AFMRD members to become a real learning community. I challenge each of you to share something that you think that you do well with the rest of us.
 

Stanley M. Kozakowski, MD
President, AFMRD

September 23, 2009

Recently I asked you to participate in a survey of our membership to assist the AFMRD board with strategic planning. The survey was focused on understanding the participation of our members in the other family medicine organizations.

We had 187 of our 410 program director members respond to this short survey.

We learned that 99% of all of our members are members of the AAFP; 21% are members of the Association of Departments of Family Medicine (ADFM); 11% are members of the North American Primary Care Research Group (NAPCRG); and 86% are members of the Society of Teachers of Family Medicine (STFM).

One of the goals of the survey was to understand your perceptions about other members of the "Family of Family Medicine" organizations and your belief as to whether or not these organizations could adequately represent the needs of family medicine residency program directors.

We concluded the survey with the question, "Do you believe that a single academic family medicine organization should replace the four current organizations (AFMRD, ADFM, NAPCRG, and STFM) as in some specialties?" Of our members responding, 38% responded "Yes" and 62% responded "No."

There was a consistent theme in the responses received that, of all of the family medicine organizations, only AFMRD is able to adequately represent the unique needs of residency program directors.

I suspect that few of our members have heard of and understand the purpose and work of the Council of Academic Family Medicine (CAFM).

In January 2008, the four academic family medicine organizations officially launched CAFM as a new way of working together, coordinating activities where there is overlap and acting upon strategic initiatives that support academic family medicine and the discipline. As your president, I've had the opportunity to represent AFMRD on CAFM over the last 16 months. I want to assure you that we are working with the other member organizations who are part of CAFM on projects which serve all of our organizations and where a single unified voice is advantageous.

I would invite you to visit this link for a more detailed description of the goals and principles of CAFM as well as some of the projects that we have worked on for the common good.

Stanley M. Kozakowski, MD
President, AFMRD

August 24, 2009

Today I had the opportunity to participate in a half daylong conference call as the AFMRD representative to the planning committee of the 2010 PDW meeting. Like many of you, I am looking forward to returning to downtown Kansas City in 2010. We highly value your feedback from the 2009 meeting and we hope that we can make the 2010 meeting even more effective for you.

I was most pleased to review the 80 workshop submissions for the meeting. A separate call will be going out in the near future for poster submissions, along with a call for proposal for the Rapid Fire session. I continue to be amazed at the creativity and energy of people wanting to present at PDW in 2010 and hope you will consider submitting an abstract for either a poster or an Innovation Ideas session, or both.

I hope that many of those who submitted their proposals for workshops will consider sharing their ideas on our newly-designed web site. We truly have an opportunity to create an innovative learning community.

Stan Kozakowski, MD
President, AFMRD

June 2009

I have always been struck by the energy expressed on our AFMRD email discussion list around certain topics. These “high-energy” topics typically involve the things that strike a nerve for many of our members – e.g. the Match, funding, discipline problems, our relationships to other specialists and those to whom we may report, the RRC, and the rules and regulations that demand our attention.

Why is it that these topics become so difficult and challenging? I would posit that each of these topics represent “Difficult Conversations” as defined by Stone, et al. in their must read book of the same title. (This is a must-read for every program director, chief resident, and everyone that you care about in your family.) Stone and his colleagues define a difficult conversation as any conversation that you are reluctant to have. Conversations become difficult on one of three levels. First, either party may miscommunicate the facts or the content of the conversation. Second, conversations may become difficult if they are charged with emotion. Third, and perhaps the most difficult, are conversations that challenge our identity.

Our identity as program directors continues to evolve. It seems to me that this uncertain or lack of a unified identity may be at the core of the issues that we struggle with today.

This occurred to me as I learned more about the recently deceased Lynn Carmichael, MD, one of the founding fathers of family medicine. I was impressed by the challenges that he and others faced in forming our “new specialty” in the 1960s. It seemed to me that his ability to form a clear identity as a physician and to communicate that identity to others was the key to his ultimate success. Two quotes gave me particular insight to his identity as a family physician1:

“I had, like most people, been raised with the idea that diseases existed and that our job was to treat diseases. I found out that diseases don’t exist. What exist are people who have different kinds of health problems. We don’t treat diseases; we take care of people.”

“When I talk about family medicine or family practice or whatever it might be, I’m not talking about the family as a unit. . . . But the meaning of family in family medicine, to me, is not that the family is the unit of care as much as it is the process of care. It characterizes that type of relationship that you have with a person, a family-type relationship.”

I will use this forum as well as other AFMRD communication tools to share with you my perspective on the opportunities and threats that shape our world. I encourage you to continue to be active in using the Web site, program directors Listserv and regular member surveys to focus our communication, deal with the emotionally charged issues, and to develop clarity in our identity as program directors. We have many difficult conversations ahead and we have the collective wisdom to develop solutions that would make our founding fathers like Lynn Carmichael proud.

Stanley M. Kozakowski, MD
President, AFMRD