Preventing physician burnout and helping practices get up to speed on payment reform are top priorities for AAFP president-elect John Cullen, MD, director of emergency medical services at Providence Valdez Medical Center, in Valdez, Alaska.
Cullen became president-elect at the meeting last week. He's practiced family medicine in a rural Alaskan community of roughly 4,000 people for the past 21 years, according to .
He has also served on the Alaska State Medical Board, on the Center for Medicare and Medicaid Services (CMS) National Advisory Committee on Rural Health, and as past president of the Alaska Academy of Family Physicians. He is an associate clinical professor at Dartmouth College in Hanover, N.H., and has been teaching residents and medical students for more than 18 years.
鶹ý asked Cullen about his plans for his term as president-elect. This phone interview has been edited for brevity and clarity.
鶹ý: As president-elect of the AAFP, what are your priorities for the coming year?
Cullen: We need to, as an academy, make sure members stay resilient. Studies have shown that for every hour of patient care, we're spending about two hours documenting or doing other tasks that don't impact patient care. That's just driving up costs in the system, and it interferes with the patient-physician relationship.
Another priority is getting our membership up to speed on the Medicare Access Chip Reauthorization Act (MACRA) -- the new way physicians are paid. Family physicians are really dedicated to taking care of patients. Unfortunately, we're spending so much time doing that part, that there's not a lot of extra time to look at new ways of payment.
Payment reform is especially challenging for small group practices, because, for example, they have to have fairly sophisticated computerization. A lot of times, small practices don't have the resources to do this.
MPT: In your speech as a candidate for president-elect, you spoke about the loss of your mentor and partner to suicide. Can you describe how this tragedy impacted you professionally?
Cullen: Family physicians are dealing with a lot of the emotional issues of our patients, and we're already looking at an enormous deficit of providers. We need to get to a point where we're not losing physicians to suicide or to burnout.
During my time on the Alaska State Medical Board, those physicians who were planning on practicing in rural and remote locations, we brought them before the board to make sure they were okay.
We also interviewed physicians who were having difficulty and would brainstorm with them how to address those issues. We tried not to be punitive, but to come up with solutions.
MPT: In the AAFP candidate debates, you also spoke about how being a teacher can help counteract burn-out. How so?
Cullen: Teaching is such a gift for the teachers. Being involved in teaching makes you aware of what it is that you're doing and that sort of mindfulness is a really important part of preventing burnout.
The last 20 years or so, we've been having medical students and residents come stay with us. I try to teach them work-life balance, and get them out into nature. It's been fun and I've kept in contact with most of them.
MPT: What are your thoughts on single-payer healthcare?
Cullen: As an academy, we really believe in universal coverage, and have been pushing it since 1989. We're less concerned philosophically how we get there.
MPT: One of the measures passed by the Congress of Delegates last week focused on developing policy favoring a publicly funded universal primary care program. What's the significance of this step?
Cullen: We know that in countries that spend more on primary care, their healthcare systems are less expensive. Our healthcare system doesn't do that, and as a result it's more expensive and we have worse outcomes.
When you make it difficult for people to see their primary care physician, for example, with high-deductible plans, patients end up being sicker. We don't know precisely how this resolution will play out, but anything that improves the ability to help people see their primary care physician improves the cost of healthcare.
MPT: One of the challenges family physicians spoke about at last week's meeting was obtaining durable medical equipment.
Cullen: The rules around DME are very cumbersome and they don't seem to protect our patients from vendors who don't have a social mission. That's one area that we need to fix. It's complicated to get patients things that they need.
I have a patient who has a broken walker that needs new wheels. We started this process in April. The amount of time that I've spent on the back-and-forth with insurers explaining why he needs the walker, changing language on forms, all of that adds cost to the system.
MPT: Are there obvious solutions?
Cullen: A lot of the rules that are there, are in place to prevent fraud. If I had a perfect solution it would be that Medicaid, Medicare, or insurance companies would just trust us to do the best we can, and I think we would end up saving money that way. As family physicians, we all went into this for the right reasons, and it wasn't for the money.
MPT: Why did you choose to be a doctor?
Cullen: I was planning on doing research. I was also really into wilderness studies. Back when I was an undergraduate and working in a lab on genetic engineering, I was also taking kids with cancer rock climbing and backpacking, and I just realized I enjoyed working with people more than test tubes.
MPT: When you spoke at last week's meeting, you likened the turbulence in Washington to Alaska's own storms. What storms do you anticipate AAFP will face in the coming year?
Cullen: I have no idea. I know that we will be continuing to stand up for our values and making sure that our patients are well cared for.
What we want to see from Washington is a very methodical, bipartisan approach to fixing the Affordable Care Act. There is so much chaos right now and when you have that kind of environment where there is that lack of clarity, it drives up costs for everyone.
It drives up premiums for insurance companies, and for physicians, they don't know whether they can afford to expand or take in new doctors.
MPT: The AAFP denounced efforts by Congress to repeal the ACA all summer. When you think about repeal, what worries you most?
Cullen: I spoke to a mother, a Medicaid patient, who before the ACA, had to choose between insulin and food for her children.
I am so proud of my senator, Sen. Lisa Murkowski (R-Alaska). She's someone I had been having conversations with about the importance of Medicaid and the marketplace for patients. I think that she really, really cares for the people of Alaska.
MPT: What healthcare related problems do you hear about most from your patients?
Cullen: For a lot of my patients, just having insurance for the first time in years has been a real godsend. But many of our patients are on expensive prescriptions, and they are concerned, because of the chaos in the system, about whether they are going to have coverage or not, and they're worried about lifetime caps.
MPT: What else keeps you up at night?
Cullen: We need to make sure that the next generation of physicians is ready take the place of my partner and I. That's one of my worries about the future. I'm a professional worrier.