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#SaveToledoFM - Deema's Story

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In a previous post, I reported the impending closure of the Toledo Hospital Family Medicine Residency Program which will have huge implications in the delivery of primary care and Family Medicine in that community.

Deema Yousef, MD, is a current resident of the program. She reached out to me to share her perspective of someone scheduled to graduate from the program later this year. My questions are in bold below. Here is Deema's story, in her own words...

1) My first question is about Family Medicine in general. How did you come to choose Family Medicine as your specialty and residency? Why do you love Family Medicine, and why is Family Medicine care important to the Toledo community? 

I chose to go into Family Medicine towards the end of my first year of medical school. This was after interacting with a fantastic mentor who led our clinical medicine group. She is a Family Medicine Physician. For our clinical medicine learning, she shared her unique patient experiences that ranged across different ages and complexities. She even practiced obstetrics. Her experiences in medicine, as I was hearing them, highlighted what I thought the role of a physician really is growing up - trained to care for each member of the family.

During third year of medical school, clinical rotations solidified my decision to go into Family Medicine. I really enjoyed rotating through the different specialties, and I didn't want to focus on one area of interest. More importantly, I enjoyed creating relationships with patients to know how to best care for them.

When I was considering residency positions, I traveled to Toledo to solely interview at the Toledo Hospital Family Medicine Residency Program. I immediately connected with the people at the program. It was evident from my interview day, this program includes a comprehensive multidisciplinary learning approach to prepare me to practice the full spectrum of Family Medicine.

Toledo is a city which high obesity rate and with that, there is a high rate of obesity related chronic conditions that impact the quality of life. Preventative and comprehensive care is needed to counteract. and treat these conditions. Also, the shortage of primary care physicians that is felt across the country is certainly recognized in Toledo. Most primary care practices in the city are not accepting new patients and if they are, the wait to be established is a period of at least 2-3 Months. Toledo certainly needs more primary care physicians, and the answer is to expand residencies like ours, not close them down.

2) Tell me (and my audience) about how you learned about the closure of the program, and how it was announced to the residents and the program.

This past Thursday afternoon (January 12, 2017), the faculty, residents, and clinical staff were all either paged, or telephoned, to attend a mandatory meeting that same day. The hospital staff divided the faculty, residents, and clinical support staff into three respective groups. We were all notified of the decision by hospital executives. After they made the announcement to the resident group, they allotted time for questions and discussion. The executives who spoke to the residents were both empathetic and genuine in their concern for the changes that lie ahead.

3) What has been the reaction to the announcement from the residents and the faculty at the program?

The following morning, I was scheduled to see patients in the office all day and it was hard to be working as everyone appeared disheartened. There were many mixed emotions shared by the staff, faculty, and my fellow residents; mainly sadness, frustration, and confusion.

4) In your opinion, why is it important for the Toledo Hospital Family Medicine Residency program to remain open?

We have a mission statement (click here). It beautifully and comprehensively captures the answer to this question. I invite you to please read it.

5) What kind of response would you like generated from the local community, the residency program alumni, and the Family Medicine community in general?

Already, the response has been tremendous. Our alumni are contacting community leaders, hospital executives, local business owners, and the local media to voice concerns about this decision. We are working together to request that ProMedica executives reconsider their decision in "phasing out" this fantastic residency program. 

Also, our local and national Family Medicine chapter leaders, including those with AAFP (American Academy of Family Physicians), MAFP (Michigan Academy of Family Physicians), and OAFP (Ohio Academy of Family Physicians), have been incredibly supportive; they have already extended helpful advise to us, and used their social media accounts to raise awareness of ProMedica's decision.

We kindly ask this movement of support to continue in hopes of compelling ProMedica Health to reconsider their decision to close our residency program.

#SaveToledoFM - The Resident Manifesto

In a previous post, I reported the impending closure of the Toledo Hospital Family Medicine Residency Program which will have huge implications in the delivery of primary care and Family Medicine in that community.

As you can imagine, individual residents have been hesitant to speak freely. However, I did receive a message from a resident at the program, and that person wanted me to share their "mission statement," which they hope will shed some light on their thoughts as a group during this difficult time (disclaimer: the photo above is a stock photo, and not of actual residents in the program) Their "mission statement," what I call their "Resident Manifesto" follows below...

We Are Family Medicine

We are Family Medicine resident physicians. Our specialty is people. We treat patients from the moment they enter the world until the day they depart. We practice obstetrics, pediatrics, geriatrics, and more, often in the same day. If we cannot manage a problem, we become the quarterback, directing and coordinating care between specialists, and other health professionals.

We train at the Toledo Hospital Family Medicine Residency Program, also known as W.W. Knight Family Practice. We are a multi-disciplinary team of physicians, nurse practitioners, pharmacists, experts in social work and psychology, registered nurses, medical assistants, and many other wonderful people. Together we take care of more than 5000 patients in the office, hospital, and skilled nursing facilities. Many of our patients have complex medical issues and live below the poverty line. They often find a home at WW Knight when they have no where else to provide their healthcare needs. We take pride in providing excellent care to a complex and underserved population. Our patients are the reason we rise for work each day. We strive to act as their advocates. and to fight for their well being.

According to the Health Resources and Services Administration, there will be a shortage of 20,400 doctors in the United States by the year 2020. Each year, we add six physicians to that shortfall. In Toledo, this gap is felt acutely. It commonly takes three months to schedule with a primary care provider, if a provider is taking new patients at all. For over 40 years, WW Knight has trained high-quality physicians, 65% of whom practice in the local community. Our residents and alumni care for tens of thousands of people in this region, and yet more is still needed.

Unfortunately, it has been decided that WW Knight should be shut down. Our current intern class, scheduled to graduate June of 2019, will be our last. We were told that the program, at this time, does not meet evolving community needs. On paper, our residency does not look profitable. While that loss is significant, we do not believe it captures adequately our value to the community. We provide a safety net for thousands of people who, bluntly, would have difficult time finding another provider in an already overtaxed system. At this time, we do not know what will happen to them.

We empathize that healthcare is a business, and a difficult one at that. We cannot, however, accept termination of our residency as a sustainable solution to this quagmire. Family Medicine is the foundation of American health care. If the base of the pyramid is weak, the entire structure is at risk. Although we face an uncertain future, our present is simple: We will continue to work and fight for our patients. We will continue to provide outstanding and compassionate care.  We will do so until they shut our doors. Our specialty is people. We are Family Medicine.

#SaveToledoFM - Katie's Story

In a previous post, I reported the impending closure of the Toledo Hospital Family Medicine Residency Program which will have huge implications in the delivery of primary care and Family Medicine in that community.

Katie Karhoff, DO is a recent graduate of the program. She reached out to me to share her perspective as an alum. My questions are in bold below. Here is Katie's story, in her own words...

1) My first question is about Family Medicine in general. How did you come to choose Family Medicine as your specialty and residency? Why do you love Family Medicine, and why is Family Medicine care important to the Toledo community?

I chose Family Medicine so I could be involved in all aspects of patient's care and could care for them across the lifespan. I didn't want to focus on just one area because to me the whole person was important. I love the personal connection I have with my patients and now that I've been an attending for 3+ years, I have really gotten to know my patients and it's almost like seeing a friend when they come in for a visit. I love that I have sometimes three generations of families that I care for. I love that they refer to me as "their doctor." As whole, the WWKnight residency plays a huge impact in Toledo. We would often care for people who might not have primary care otherwise, and I can only see a negative if the program is closed.

2) Tell me (and my audience) about how you learned about the closure of the program?

I learned the news through a Facebook post of another graduate of the program. I am a 2013 grad of the program.

3) What has been the reaction to the announcement from the residents and the faculty at the program?

I'm still friends with a lot of the staff, and I know they are heartbroken. Some have worked there for many years and have cared for the same patients for quite a while. The whole program is like a family and to close it would be devastating.

4) In your opinion, why is it important for the Toledo Hospital (WWKnight) Family Medicine Residency Program to remain open?

The program focuses on training competent, well rounded Family Physicians. Coming out of residency, I felt very equipped to handle so much on my own. We get a great breadth of educational training at a tertiary care center, and can take this knowledge to smaller towns that way, we don't always have to send our patients elsewhere. As I stated above, the community that the residents care for might not have access to primary care otherwise, so they provide much needed care. Many of our grads stay in the Northwest Ohio region, so if the residency would close, I'm not sure you would still see that same statistic. With a shortage of primary care physicians, we need to keep the caliber of doctors in the state.

5) What kind of response would you like to see generated from the local community, the residency program alumni, and the Family Medicine community in general?

As an alum, I was heartbroken to hear of the closing. Being established for over 40 years, I have never thought a program of that caliber would be closed down. It was a highly sought after residency and we had so many applicants each year and had no problem filling the spots for each class. I have nothing but respect for the attendings I trained under and still keep in contact with many of them. I really feel like my education was top of the line and think it would be a shame for this program to no longer exist. I really hope that all of our efforts can raise awareness and perhaps a better outcome will happen for this amazing program.

#SaveToledoFM - OAFP President Speaks Out

In a previous post, I reported the impending closure of the Toledo Hospital Family Medicine Residency Program which will have huge implications in the delivery of primary care and Family Medicine in that community.

Ryan Kauffman, MD, FAAFP, President of the Ohio Academy of Family Physicians (OAFP), issued a statement on January 16, 2017 entitled, "ProMedica Toledo Family Medicine Residency Should Not Be Closed When We Have Shortage of Primary Care Physicians in Ohio." The statement follows:

"It is most disturbing to hear that ProMedica plans to close its Family Medicine Residency Program at Toledo Hospital at at time when we have a shortage of primary care physicians in Ohio.

According to the Robert Graham Center for Policy Studies, Ohio will need an additional 681 primary care physicians by 2030 based upon changes in the number and age of the population of Ohio.

We know without a shadow of a doubt that a strong primary care-based health system leads to better health, better care, and lower costs. Evidence shows that access to primary care helps people lead longer, healthier lives. In areas of the country where there are more primary care physicians per person, death rates for cancer, heart disease, and stroke are lower and people are less likely to he hospitalized. Adults in the United States who have a primary care physician have 33% lower health care costs.

ProMedica's claim that the decision was based on national trends shifting Family Medicine residency programs from large, tertiary care medical centers to community hospital settings seems disingenuous given their decision just over two years ago to close the Family Medicine residency at Flower Hospital, which is a smaller community hospital.

Granted residency slots for primary care don't generate the money that subspecialty residency slots generate. Therefore, subspecialty residency slots are favored. Nevertheless, we should be producing the types of physicians that meet population health needs, not the ones that are going to make the most money for the hospital system.

The bottom line - patients who have access to primary care, experience better health and better care at lower costs. It makes no sense to close a Family Medicine residency program when we have a shortage of primary care physicians in Ohio."

#SaveToledoFM - Holly's Story

In a previous post, I reported the impending closure of the Toledo Hospital Family Medicine Residency Program which will have huge implications in the delivery of primary care and Family Medicine in that community.

Holly Dickman, DO is a recent graduate of the program. She reached out to me to share her story and to share her perspective, being on the ground there in the Toledo community.  My questions are in bold below. Here is Holly's story, in her own words...

1) My first question is about Family Medicine in general. How did you come to choose Family Medicine as your specialty and residency? Why do you love Family Medicine, and why is Family Medicine care important to the Toledo community?

I chose Family Medicine because I wanted to know the full picture and learn a patient's entire story, not just a chapter of it. Going to an osteopathic school also made me value primary care what I could do for patients on a daily basis.  I love the challenge of Family Medicine: Every patient is something completely different from the one before. I will see a newborn followed by a 92 year old patient. Reminds me of the complexity and wonder of medicine on a daily basis.

2) Tell me (and my audience) about how your learned about the closure of the program.

I am an alumni of the program (graduated July 2016). I was informed by current residents and employees. I then learned the news from an article in the local paper.

3) What is your reaction to this announcement? 

Watching it as an alumni: Disbelief, shock, overwhelming sadness, and fear

4) In your opinion, why is it important for the Toledo Hospital Family Medicine Residency Program to remain open?

There are so many reasons, but will choose my top two. First, the service provided to the community. This program delivers high quality care to a mainly low-income and underserved population that not many other practices can accommodate at this time. In a world where insurance companies are changing how they pay doctors, not many practices will take in these patients who tend to be "non-compliant" due to lack of funds, transportation, etc. These patients will fall through the cracks without these residents, faculty, and staff caring for them. The staff at this residency program take patient care personally. That won't be the standard of care if these patients get relocated to another practice.

Secondly, Toledo is in dire need of Family Physicians. The Ohio Department of Health identified Lucas County as one of four counties in Ohio that are a "priority" due to their Healthcare Professional Shortage (see link, page 40). Losing this residency program means losing a source of Family Physicians to the area thereby increasing that deficit instead of acting to solve the problem.

5) What kind of response would you like generated from the local community, the residency program, alumni, and the Family Medicine community in general?

I would like the community to understand what this decision means. Loss of high-quality care to those who cannot otherwise receive that care. Fewer Family Doctors in the area in the future. Physicians, nurses, medical assistants, support staff, pharmacists, social workers, behavioralists, and so many more who are losing their jobs. A job that they are truly passionate about. A job that affects so many others in the community on a daily basis.

Get Ready! 100 Days until #AAFPNCCL #AAFPACLF

With the presidential inauguration happening later this week, there has been a lot of talk about the first 100 days of the presidency and what may or may not get done. However, more importantly, about 100 days from now will be one of the most important Family Medicine leadership conferences of the year, aptly named the AAFP Leadership Conference

There are two tracks of this meeting, both occurring at the same time: The National Conference of Constituency Leaders (NCCL) and the Annual Chapter Leader Forum (ACLF). In these sessions, participants receive training in skills like advocacy, while being updated in the hot health policy topics of the moment.

From a personal standpoint, this gathering is more than a a meeting to me. It's an opportunity to catch up with long time friends, and to make new friends. Family Physicians coming together to find common ground - which is to be advocates for our patients. In addition, through the years, it has been a great opportunity for me to sharpen my leadership skills.

And oh yeah, we have a lot of fun doing that, as you can see from the photo below, which is one of my favorite memories from the meeting, ever.  Register by March 30th and Save $50. The pre-conference sessions begin April 26th with the main conference taking place April 27-29, 2016. We'll again be using the following hashtags for the meeting: #AAFPNCCL and #AAFPACLF. Also follow @AAFP for the latest updates! For my Family Medicine friends and colleagues, save the date, register early, and I'll see you at the AAFP Leadership Conference!

Save Toledo Hospital Family Medicine Residency! #SaveToledoFM

Last week, it was announced that the Toledo Hospital Family Medicine Residency Program is phasing out and will not accept any new residents into their program. The final class of residents will graduate in 2019 (Toledo Blade).

This is tremendously sad news. This program has graduated Family Physicians for more than 40 years. The eventual closure of this program will potentially limit more access to primary care and Family Medicine services for the Toledo community, in a time when the United States needs more access to primary care.

Here are some Fast Facts about national Family Medicine that you may not be aware of:

  • Family Medicine takes are of One in Five office visits, often where no one else takes care of patients
  • We are the only specialty where adding another physician to the community improves the morbidity and mortality, often while lowering costs
  • We are the only specialty that crosses all age groups, genders, and organ systems - The Lifespan. We provide more mental health care than psychiatrists.

I challenge my friends and colleagues in the Family Medicine community - the Family Medicine Revolution, or #FMRevolution, to raise awareness of this story. It's always sad when a training program shuts down, but possibly more tragic when it's a Family Medicine program. Let's raise awareness on this! Use #SaveToledoFM hashtag on Twitter!

Anatomy of Civil War: Summa Health Day Six

It's been six days since New Year's Day when the leadership at Summa Health replaced the Emergency Room physician group. Some physicians are now publicly taking sides, as noted in last night's medical staff meeting as reported by the Akron Beacon Journal

More than 250 voted "no-confidence" in the CEO and leadership team, and called for their resignation. The medical staff totals more than 1000. The vote occurred after a two hour contentious meeting, which at times, possibly sounded like a political convention. Of note, the resident physicians already voted "no-confidence" in the CEO earlier this week.

In addition to the ER physicians being out, it was also announced that the contract for the respiratory and critical care physician group will not be renewed. However, the anesthesia group signed on for another year. What will be the fate of other specialists at Summa? Time will tell.

The best quote from the night came from primary care physician Dr. Rodney Ison. (disclaimer: I worked with Dr. Ison during my Family Medicine residency at Summa Barberton). He called the "no-confidence" vote "ridiculous" and also said this:

"Not once were patients and patient care and what's in the best interest of our patients in the room tonight. We can't have political wars and political battles of 'What's in My best interest and What's in Your best interest' - We're Physicians."

As I stated in my previous post, the Akron community is now seeing this Civil War play out in a very public way. They are seeing the grabbing for profit, the push for power, and the play for politics. But what about patient-centeredness? The longer this drags out, especially in a public way, no one wins, the patient loses, trust in Summa Health plummets, and the closer we'll get to the "End Of An Akron Icon."

Summa Health: End Of An Akron Icon?

As a medical student in the 1990s, I remember one of the first times I walked into Summa Akron City Hospital. I was overwhelmed with the hallways being tremendously busy, and seeing teams of white coats rushing to wherever they were going. I also got a sense that the city and the community trusted this hospital to give them the care that the needed. I even did my Family Medicine Residency training at Summa Barberton Hospital (then known as Barberton Citizens Hospital), and I knew I was going to be receiving the training I needed to be a good doctor.

This past week, Summa Health is mired in controversy and in a public relations nightmare. The summary of the issues are well done by the following two blog posts in the past few days: "The Rape of Emergency Medicine, 2017 Version" by GruntDoc and "What we know about the Summa Health shake-up, and why this goes beyond the ER" from Rubber City Politics. 

What is the big picture meaning for the Akron community? From what I've heard, the hospital across town, Akron General Medical Center (associated/owned by the Cleveland Clinic) is "packed to the gills" with the highest patient census "I've ever seen it." (quotes from a recent e-mail that was shared with me). 

For the most part, the Emergency Room is the doorway into the hospital for patients, and for hospitals, the doorway into generating revenue for the institution. If the Akron community is sensing the uncertainty in Summa Health, with all of its infighting, will the community continue to come to the Summa ER?

No matter how this Summa Health situation ultimately plays out, its reputation has taken a major hit this week. When the fighting finally stops among all of the factions, there has to be some kind of healing of the hospital community, even before it can reach out to Akron to ask for their trust again. If the finger pointing, the negativity & vitriol, and the PR war continues, this may be the beginning of the end of another Akron iconic company...

Suicide: Youngstown's Taboo Topic

Laura Steele, 46, was a local news anchor here in the Youngstown, Ohio area. Last week, it was announced publicly that she passed away. But, on facebook it was discussed that she "took her own life." Her funeral will be later this week.

My curiosity lead be to do a search of "Youngstown Ohio Suicide," and I was surprised what I found. Laura Bowman, 13, passed away on August 13, 2016 after questions of bullying. Cassandra West, 19, and Christopher Ocasio, 21, were found "hanging in their room," in April 2015 in Boardman, Ohio. Colin Hart, 18, and Jamie Serich, 17 had self-inflicted gun shot wounds in December 2009 in Youngstown.

I remember the announcement of the death of Robin Williams in 2014, and this was the first time that I saw actual public discourse about the topic of depression and suicide. But, like all news cycles, the discussion faded. And, in local communities, like Youngstown, Ohio, topics like suicide are hardly brought up publicly or privately.

Know the warning signs of suicide. The American Association of Suicidiology has identified these eight signs to watch out for: Ideation, Substance Abuse, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, and Mood changes. The easier to remember mnemonic: "IS PATH WARM"

Unfortunately, progress raising awareness about suicide prevention occurs following tragedies like this one. I know the stigma is still there, and this topic is very difficult to talk about. But, imagine, if we get the courage to talk about suicide and raise awareness about suicide prevention,  can we prevent one future tragedy from happening? I think we can...