October 22, 2014 02:57 pm Sheri Porter – AAFP President Robert Wergin, M.D., of Milford, Neb., is the real deal when it comes to practicing family medicine. In a single day’s work, he might deliver a baby, visit an elderly patient in a nursing home, treat a high-school student’s sports injury and keep a middle-aged mom’s blood sugar in check. In short, Wergin’s typical work day epitomizes the full scope of family medicine.
AAFP News recently visited with Wergin in his practice to learn what makes him tick and to talk about family medicine’s most pressing issues.
Q. Much of your time as president of the AAFP will be spent in Washington representing family medicine. What issues will take top priority as you work with legislators and policymakers?
A. Eliminating the sustainable growth rate formula, clarifying the role of family medicine, pushing for payment reform and prioritizing medical education all are issues of great interest to me.
Q. As a Nebraska native (and self-professed Cornhuskers fan), how will your small-town roots help you connect with your family physician colleagues — especially the thousands of AAFP members who struggle with challenges unique to small and rural practices?
A. I am their voice and I understand those challenges. I will encourage the Academy to provide the clinical, practice management and business resources all family physicians need to help their clinics — big or small — thrive. Even now, as I travel around the country for the AAFP, I encounter family physicians who suggest that Academy leaders may not understand the day-to-day problems faced by practicing physicians, and my response is, “Au contraire, my friend, I understand because I am you.”
Q. During your presidential year, the time available for hands-on patient care likely will be less than what you and your patients would like. Why did you want to take on this leadership role?
A. It was a difficult decision and not easily made. As one family physician, I can impact the health of my patients on an individual basis, but by stepping into a leadership role, I can help the specialty of family medicine reach its full potential.
Q. You’ve said previously that medical school debt is of particular interest to you. What changes need to be considered to ensure that young students can afford to go to medical school and choose primary care careers?
A. Those of us invested in filling the primary care pipeline need to join together to have meaningful discussions about the negative impact student debt can have on students’ choice of specialty. For instance, the prospect of paying off significant loans pushes medical students into subspecialty careers, so perhaps making low-interest student loans available could be part of the solution. Another sure way to get students thinking about primary care is to shrink the gap between specialty and subspecialty pay.
Q. What are the pros and cons of electronic health record (EHR) implementation and use?
A. Quick access to a patient’s clinical record within my clinic and hospital system certainly is a plus. My EHR should help me document patient care and trigger disease management reminders that allow me to provide better care to my patients, although it’s not yet 100 percent reliable. The downside to most current EHRs is the lack of interoperability; if I’m not operating within my system, I can’t access my patient’s record. And EHRs sometimes slow down workflow and productivity in my office.
Q. How can health information technology be made more functional for family physicians?
A. Legislators and health IT vendors must focus more on the clinical aspects of documentation and move away from the current focus on billing; the AAFP is using its voice and expertise to encourage that redirect. After all, the important part of the medical note is the patient assessment and plan and the story associated with that.
Q. Implementation of the ICD-10 code set has been delayed until Oct. 1, 2015. How are you preparing for this big change?
A. I’m marching toward ICD-10 just like everyone else, and we all need the appropriate resources to make this transition as seamless and painless as possible. The AAFP’s tools help. I am particularly sensitive to the challenges faced by small practices, and I often hear family physicians say they don’t need one more thing to take their attention away from patients. The reality is that ICD-10 will provide reams of data important to researchers and policymakers, but this vast expansion of diagnosis codes probably won’t help physicians much in their daily clinical practice.
Q. What role could the direct primary care practice model play in the health care system?
A. I am enthused about this model and its potential to return the joy of family medicine to my colleagues who are overwhelmed. I would say “stay tuned” when it comes to the direct primary care model. I think direct primary care is restoring family medicine as it once was, but I would like to ensure that it is a viable option for our members. The AAFP is creating tools to guide physicians who want to try this or a hybrid practice. The newly formed direct primary care member interest group is a good start where family physicians can share ideas.
Q. Your rural family medicine practice is reminiscent of the Marcus Welby practice depicted in that television series of old. Is this type of practice sustainable moving forward?
A. Yes. I tell students, “You choose your future,” and I truly believe that statement sums up the advantages of family medicine. We can be as comprehensive as we want to be. If I have a patient who needs heart valve surgery, I can’t provide that service. But I can find my patient a good physician who can perform that surgery, and I will be right there with my patient throughout that medical experience. The confidence my patients have in me is immense — they trust me to do the right thing. I tell students they can have that same relationship with their patients no matter where they choose to practice family medicine.
Q. It’s clear you’re passionate about family medicine, but what in particular about this specialty fulfills you above all else?
A. The patient relationship. I have the opportunity to become a part of my patients’ families, and the good health and well-being of those families gives me an extreme sense of accomplishment.
Q. What do you see as your biggest strength?
A. I know comprehensive family medicine. It’s my passion and I put all my energy into that.
Q. When you have time off, what do you for fun?
A. I’ve run 14 marathons — proof that I enjoy strenuous outdoor physical activity. I relax by fishing and spending time with my family.
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