Keith Davis, MD
2008/2009 IAFP President
Shoshone, Idaho
It is my honor and, truly, great pleasure to lead your Idaho Academy of Family Physicians as president this year. It is the high point of my medical career in Idaho these past 23 years. As many of you know, I've been in Shoshone as a private solo physician, first arriving to repay my National Health Service Corps (NHSC) scholarship. I have had to make payroll every month for 23 years and I know that it has been getting more difficult to do so every year. I am really a medical missionary to rural Idaho. I'm the only physician in a county larger than Rhode Island. My wife and I have three children and our "baby" is now a 20 year old junior in college. If ever there was a time to move, it would be now. But we have elected to stay and I added hospital employment earlier this year – a few ER shifts each month – to help pay the bills. It doesn't seem right to me that a busy rural physician should have to add work outside the community they serve in order to stay in practice but that's where primary care in America seems to be in 2008. Don't get me wrong: I love what I do and clearly after 23 years, I'm dedicated to it. But we must advocate strongly for better payment for our services or nobody will be entering the Family Medicine pipeline. Our legislators, employers and patients (i.e. voters!) all seem to finally be "getting it." It will be very exciting to see the pendulum finally swing back in favor of the true value of primary care as practiced by family physicians.
Since my installation at Coeur d'Alene in May, the year has already been busy. For example, direct entry ("lay") midwives are considering bringing back legislation to the 2009 legislative session that would allow voluntary licensure. The IAFP, with the IMA and other organizations, are working to craft a bill that will be sufficient for everyone involved. As family physicians, we must be diligent in protecting the public from those who would present themselves as care providers with less than full accountability. Voluntary licensure should not be acceptable to any health care organization, legislator or citizen. I employ a certified nurse-midwife (CNM) so I'm no stranger to midwifery. The bill presented last year was not well designed and ultimately that is really what killed it.
What a difference a year makes! One year ago the presidential election was on the horizon. Now we will soon be deciding if the next president is the first African-American to be president or the next vice-president is the first woman to hold that position. Either way, a historic election is upon us. One year ago, Dr. Ted Epperly was campaigning to be President-Elect of the American Academy of Family Physicians. I was able to be in Chicago for the 2007 AAFP Scientific Assembly where he was successfully installed as President-Elect. In a few weeks, Dr. Epperly will be installed as our AAFP President. The second time in history the AAFP president has been from Idaho. I look forward to attending the 2008 AAFP Scientific Assembly in San Diego for his installation as our AAFP President. Ted and I are friends and I believe we share a common set of values regarding Family Medicine. We believe, as I suspect most of you do, that Family Medicine is an essential part of the health care system of our country. The promotion of better health for our patients must, logically and essentially, include advocacy for Family Medicine. As you know, the promotion of Family Medicine includes improved payment for our services, improved workforce with more students and residents in the education pipeline to Family Medicine, and development of the “Patient-Centered Medical Home” in such a way that Family Medicine is the premier practice in the country. Those with a Family Medicine “Medical Home” will be those getting the best care and the best value for their health care dollars. That's the "big picture" I see in the year ahead and for many years to come. I couldn't be happier that Ted will be leading the AAFP in that mission.
As your president, I want to know what issues you have and particularly in those areas of payment reform, workforce and the “Medical Home.” I will be networking with other state associations and family physicians across the country to help bring information to you and best practice ideas to Idaho. It is easy to go day to day and "not know what we don't know." I hope to help you with that. My personal priority – as I said in Coeur d'Alene – is the development of the “Medical Home” by all IAFP members. We are already “Medical Homes” but we need to be sure we have the organization and resources in our practices to be the best medical homes possible. More on this, next issue!
Past Issues of the Idaho Family Physician