*LA Family Physician V16#2 03 - Louisiana Academy of Family ...

FROM THE
PRESIDENT
A Movement
As family physicians, you know the
state of health care in our State from living
it daily as you care for your patients.
You see the epidemic of diabetes and
obesity, the increasing burden of poor
access to healthcare that so many of our
citizens experience, the waste and
redundancy in administering a dysfunctional
system, and the defensive medicine
that so many physicians feel obligated
to practice. You also know the
unique value that you as a family physician
bring to your patients: your
breadth and versatility as a generalist;
your whole-person, whole-family orientation;
the value of long term relationships
with patients and families; your
interest in preventing, not just treating,
illness; the importance and, even the
superiority, of listening, talking, supporting,
as opposed to inappropriate or
unnecessary technology.
You’re family physicians. You live
these things. You understand them
intuitively.
You also know that what you have
to offer as a family physician is an
essential component of the complex
solution needed to fix the health care
system problems that our state and
country are experiencing. Our legislators
need to know what we do. So do
the Deans of the medical schools and
the new governor and her staff. And
medical students—there are still many
students, a majority I would argue,
who enter medicine for altruism and
find service and humanism compelling
reason to consider a career as
a primary care doc.
Know your facts so you can talk to
your legislators. Point out that Louisiana
• ranks 49th, the second worse in the
nation, in health indicators.
• led the nation in diabetes death rates
for the last 3 years
• ranks 2nd in percent of low birthweight
babies, 5th in neonatal
deaths, 4th in infant mortality;
• has the 6th highest rate of obesity in
the country;
• is 48th in the nation for women over
50 who have obtained mammograms
within 2 years;
• has breast cancer and cervical cancer
rates for African-American women
above national rates.
• ranks 6th worse in access to health
care, with 20% of the state’s population
lacking access to primary care
• contains Health Professionals
Shortage Areas (HPSAs) in all but 10
of our 64 parishes, with 26 parishes
designated as whole-parish and
another 28 parishes as partial HPSAs.
Make the point that poor accessibility
to and availability of primary care
physicians contribute to these health
indicators, and is further exacerbated by
the rural nature of the State. (Sixty-three
percent—40 of 64—of our parishes are
rural with 1.35 million of the state’s 4.2
million, or 32% of the population, living
in rural areas.) Family Medicine is the
only specialty whose physicians
demonstrate a predilection for locating
in rural areas, up to eight times more
likely to settle and practice in rural
areas. Yet, despite the increase in the
supply of US physicians over the last 20
years, the percentage practicing primary
care and the proportion of all physicians
practicing in rural areas relative to
urban areas have both declined.
We know from published research
that countries and, in the U.S., states
with more primary care physicians—
but not more specialists—have better
population-based health indicators,
and that continuity of care, more likely
when care is provided more by
generalists then specialists, is associated
with lower hospital utilization,
greater use of preventive services and
lower costs. Without better access to
Rick Streiffer, MD
primary care services and an accompanying
shift towards more prevention
and early treatment, Louisiana
will have little opportunity to reduce
the disturbing trends.
Be sure that they know that less
than 1/3 of Louisiana physicians are
dedicated to primary care practice,
while many are aging and nearing
retirement within a relatively short
time. (About 25% of the 1,183 Louisiana
FP/GPs are age 60 or above.) In lieu of
access to PCPs, many people seek care
in emergency rooms. This drives disproportionate
spending in institutional
and emergency room settings, giving
Louisiana the 2nd highest per capita
state government expenditure for hospitals
in the country.
Louisiana must invest in family medicine
for the health of the state—there is
no question about that, and that family
physicians are the primary care specialists
of choice to address the unique
needs of this state. Louisiana’s leaders
must assure that we train adequate
numbers of family physicians for our
need, in the highest quality training programs,
and then find ways to support
practitioners once they take on the challenges
of daily practice and, especially,
of rural practice.
Talk to your legislators. Write your
local newspapers. Tell your community
leaders, your patients. Like Arlo Guthrie
suggested in Alice’s Restaurant—you
can help make this a movement. Join
the LAFP in creating greater awareness,
momentum, a movement.
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