College faculty present at AAFP annual meeting

“The landscape of American health care is changing. Payment will be tied to value, and value means quality. If we as family docs don’t talk about what we do in a convincing way, we aren’t going to get anywhere,” Dr. Richard Streiffer, dean of The University of Alabama College of Community Health Sciences, said at the opening session of the annual meeting of the Alabama Academy of Family Physicians held in June in San Destin, Fla.

CCHS faculty were speakers at many of the session held at the annual meeting.

The opening session was titled the “Principles and Benefits of Practice Transformation and the Patient-Centered Medical Home Model.” In addition to Streiffer, speakers included: Dr. Paul Grundy, global director of Healthcare Transformation for IBM; Dr. Reid Blackwelder, board chair of the American Academy of Family Physicians; Dr. Jane Weida, past president of the American Academy of Family Physicians Foundation and associate residency director for the College; Dr. Robert Moon, medical director of Alabama Medicaid; and Dr. Lloyda Williamson, director of the College’s Telehealth Division and an associate professor in the Department of Psychiatry and Behavioral Medicine.

Grundy explained that the patient-centered medical home (PCMH) is a house for data, and with data physicians can manage patients and populations and ultimately improve health outcomes. “Data will make clear what is happening. The future of medicine will be based on data.”

“Doctors were the data repositories, but as data became more complicated we specialized to the point that we couldn’t connect,” Grundy continued. “Those with the most exotic data (specialists) were paid more. Now what’s going to be valued is a doctor who manages a population and guides patients through the healthcare system.”

He said the PCMH will make primary care physicians relevant. “We don’t need episodic care for diabetics; they need to be managed and this is what a PCMH can provide. When we reward the most exotic information, the primary care doctor is not important. But when you’re repositioned from doing small things to managing patients that makes you relevant.”

Blackwelder acknowledged that payment reform could create hurdles for physicians. “We want to be paid for value, but it might require more paperwork.”

Still, he said including primary care physicians so prominently in the discussion about health care reform, “and to be asked for our opinion is huge. But we don’t just need to be at the table. We need to be in the kitchen setting the table.”

Weida, who has guided a practice through the PCMH process, outlined the steps to follow to complete the transformation: decide on the PCMH level to attain; get buy-in from your organization; decide when to certify the practice as a PCMH; know what the standards are (patient-centered access, team-based care, population health management, care management and support, coordination and performance measurement and quality improvement); create a core team that meets regularly; create a support team; keep track of everything; keep everyone informed; and be prepared for backlash.

Williamson spoke about and provided a demonstration of the College’s telehealth activities to show the importance of including technology in the PCMH transformation process “since it can help reduce health-care costs.”

CCHS’s Telehealth Division has provided more than 300 patient consultations to clients of the DeKalb Youth Services Center in Rainsville, Ala.; educated 50 patients and family members through its Diabetes Self-Management Education Program; and provided asthma education to 44 students, parents, teachers and bus drivers at the Ruhama Junior High School in Fort Payne, Ala. These services have been provided in rural areas of the state where access to patient care and patient information is often limited.

“With the limited time physicians have during patient visits, and the limited access many patients, especially those in rural areas, have to health care, we need other resources so that patients can have a better understanding of their disease process and they can have better outcomes,” Williamson said. “Using telemedicine as part of the PCMH adds value to the PCMH model.”

Moon gave an update on Regional Care Organizations (RCOs) in Alabama. RCOs provide for the delivery of medical services to Medicaid beneficiaries on a managed-care basis through regional organizations. RCOs in Alabama will begin providing services on Oct. 1, 2016.

Key features of RCOs are that they are regionally based (there are five regions in Alabama), provider-driven and provide at-risk managed care. “Two-thirds of the Medicaid population in Alabama will be covered by an RCO program. RCOs will look for outliers and provide case management,” Moon said.

He noted that Alabama’s Medicaid program currently covers half of all children in the state, half of deliveries and supports scores of nursing homes and children’s hospitals.

Another session at the AAFP annual meeting focused on unnecessary medical tests and procedures. Streiffer said overutilization of tests is not new, that 53% of physicians order unnecessary tests, but that 85% of physicians are interested in best practices showing that many tests are not needed.

Among the most over-utilized tests in family medicine are EKGs, pap smears for patients under the age of 21, bone scans and tests or imaging for back pain. Reducing the number of tests lowers costs and improves the patient experience, Streiffer said.

Dr. Tom Weida, the College’s chief medical officer, provided a module for physicians to use with a patient suffering from back pain: summarize the exam, elicit patient concerns, show empathy, provide clear recommendations (and a patient handout), avoid imaging and explain the possible harm of MRIs, provide a clear and personalized plan for improvement and confirm the agreement the patient and physician have reached.

Dr. James Robinson, who holds the College’s endowed chair for sports medicine, said while the most common injury in the recreational athlete is knee pain, MRIs are given too often and the need for surgery is rare.

“The reason to do an MRI is if you do need to have surgery. If you don’t need surgery, it will get better. MRIs, diagnostically, are used way too much.”

Instead, patients should be treated with rest, ice, possibly a brace and most definitely hamstring stretching, Robinson said.

The AAFP meeting also included several medical student sessions at which Dr. Richard Friend, director of the College’s Family Medicine Residency spoke. One session focused on “Interview Guidelines for Residency Programs.”

Friend said the residency interview score is often based on the following: commitment to family medicine, ability to work with a program and as part of a team, communication skills including eye contact, professionalism, intellectual ability, work ethic and maturity. He said previous life experiences are important, as is the application’s personal statement. “Spend time with that because it tells us about you; it sets you apart. We want to know why you’re interested in family medicine, that you get it and that it fits you. We want to know that you’re a leader, have discipline, take feedback well and strive for excellence.”

At another session, Friend provided a demonstration for medical students on proper insertion of breathing tubes.

Brandon elected to lead Alabama Academic Family Medicine Council

Dr. John Brandon, medical director of the Rural Medical Scholars Program at The University of Alabama College of Community Health Sciences and a family physician in Gordo, Ala., has been elected chair of the Alabama Academic Family Medicine Council.

The council, which is made up of family medicine academic leadership from across the state, focuses on family medicine in Alabama, from medical student education to recruitment and retention of practicing physicians.

Since Brandon started serving on the council in 1996, it has shifted from its initial focus of advising the dean of the University of Alabama School of Medicine (it was formerly known as the Primary Care Advisory Council), to addressing family medicine in Alabama as a whole, he says.

Brandon says the council, which meets four times a year, is unique because few, if any, states have an organization for academic leadership in family medicine to share information, discuss issues and make recommendations.

“Since the council is independent, it can advise elected officials, state policymakers and the public about issues of concern in preparing family physicians to serve in the state,” Brandon says.

The council is made up of leadership from each medical school in Alabama, including each regional campus of the University of Alabama School of Medicine, which is headquartered in Birmingham. One of the College’s functions is serving as the Tuscaloosa Regional Campus for the School of Medicine and providing clinical education for a cohort of third- and fourth-year medical students. Leadership of family medicine residencies and rural health programs in the state, such as the College’s Rural Medical Scholars Program, also make up the council. Leadership from the Alabama Academy of Family Physicians also serve.

“The council’s biggest accomplishment in recent years is the work with the Alabama Academy of Family Physicians and the Medical Association of the State of Alabama to advocate for the state scholarship for rural service,” Brandon says.

Serving on the council with Brandon from the College are: Dr. Richard Streiffer, dean of the College; Dr. Richard Friend, chair of Family Medicine and director of the College’s Family Medicine Residency; Dr. Drake Lavender, assistant professor in Family Medicine and president of the Alabama Academy of Family Physicians; and Dr. Julia Boothe, adjunct instructor in Family Medicine and chair of the Alabama Academy of Family Physicians Board of Directors.

College welcomes 20th class of Rural Medical Scholars

The 20th class of the Rural Medical Scholars Program will start in August, and The University of Alabama College of Community Health Sciences will celebrate the program’s 20th anniversary during the 2015-2016 academic year.

The incoming class of Rural Medical Scholars will attend orientation on Aug. 18 at Camp Tuscoba Retreat Center in Northport, Ala.

The 20th class of Rural Medical Scholars are:

Anooshah Ata, Scottsboro, Jackson County
Helen Cunningham, Barnwell, Baldwin County
Tanner Hallman, Arab, Marshall County
Carson Perrella, Salem, Lee County
Gloria (Storm) McWhorter, Prattville, Autauga County
Johnson (John) Pounders, Leighton, Colbert County
Jayla Robinson, Addison, Winston County
Harriet Washington, Carrollton, Pickens County

The Scholars were selected in May 2015 after an interview process. The Rural Medical Scholars Program is exclusively for rural Alabama students who want to become physicians and practice in rural communities. The program includes a year of study, after students receive their undergraduate degree, that leads to a master’s degree in rural community health, as well as early admission to the University of Alabama School of Medicine. Rural Medical Scholars spend the first two years of medical school at the School of Medicine’s main campus in Birmingham and then return to the College for their final two years of clinical education.

“Orientation for the Rural Scholars is more than introductions and program expectations; it is the starting point to a year of anticipation and preparation to pursue their goals,” says Susan Guin, CRNP, associate director of the Rural Medical Scholars Program. “This year will be a time of developing lasting relationships with their peers and mentors who will be a source of friendship and support as they continue their education and into their careers. Through the years, this support has come in many forms and from many sources, so we invite partners from around the state to join us in welcoming the newest class of Scholars.”

The Rural Medical Scholars Program is part of the Rural Health Leaders Pipeline, a sequence of programs that recruit and support rural Alabama students who want to be primary care physicians in rural and underserved communities in the state.

The College will celebrate the two decades of the Rural Medical Scholars Program throughout the academic year with events for alumni, many of whom are practicing in rural Alabama, as the program intends. About 60 percent of Rural Medical Scholars have chosen to practice in rural Alabama, and 90 percent of Scholars in practice are located in Alabama.

Six Rural Community Health Scholars will also attend the orientation on Aug. 18. The Rural Community Health Scholars at the College this year are:

Januar Page Brown, Enterprise, Coffee County
Amellia Cannon, Duncanville, Tuscaloosa County
Dylan Drinkard, Thomasville, Clarke County
Caleb Mason, Guntersville, Marshall County
Johnny Pate, Moundville, Hale County
Kristin Pressley, Harvest, Madison County
Jeremy Watson, Tuscaloosa County


Lavender serves as AAFP president

Dr. Drake Lavender, assistant professor in Family Medicine at The University of Alabama College of Community Health Sciences, has been appointed president of the Alabama Academy of Family Physicians. He was sworn into his position at the AAFP’s annual meeting in June 2015 in Sandestin, Fla.

“I’m looking forward to a year full of opportunities and challenges,” Lavender said at the meeting.

More than 900 members and more than 400 students and residents across the state make up the AAFP, and Lavender says he hopes to lead in advocating for them on both a local and national level.

“Our leadership will be working directly with third-party payers, our legislature and stakeholders from around the state to ensure that family physicians remain the backbone of the health care delivery system in Alabama,” he says “Family physicians are the most dedicated and hard working health care providers not only in Alabama but across the country.”

Lavender joined the College in 2013 after being in private practice in Gordo, Ala. He grew up in Eutaw, Ala., and is a graduate of the College’s Rural Medical Scholars Program, a program for rural Alabama students who want to become physicians and practice in rural communities. He attended the University of Alabama School of Medicine and received his third and fourth years of clinical education at the College, which operates as the Tuscaloosa Regional Campus for the School of Medicine. He was chief resident at The University of Alabama Family Medicine Residency, operated by the College.

He has served as president of the medical staff at Pickens County Medical Center and served on its board of directors. In 2010, he was appointed vice president for Northwest Alabama for the AAFP.

Lavender’s year in this AAFP role will be the second of a three-year leadership appointment. He was named president-elect at the 2014 annual AAFP meeting. In 2016, he will be chair of the AAFP Board, a position now held by Dr. Julia Boothe, an adjunct instructor in Family Medicine at the College who held the role of president before Lavender.

Lavender said an example of how the board has succeeded in its efforts to serve family medicine in Alabama is its recent success in increasing state funding for the state’s two rural medicine programs, the Rural Medical Scholars Program at the College and Auburn University’s Rural Medicine Program.

“These two programs have been very successful in producing primary care physicians that continue to fill the needs of rural Alabama,” he says. “I believe our members recognize that while they continue to spend countless hours taking care of their patients, our leadership will be at the table, continuing to fight to protect the scope of practice that is constantly being encroached on by outside entities.”

He says his wife, Joann, and children, Lane, Ashley and Beth, are to thank for their support as he takes on this role. He also says Dr. Rucker Staggers, his family physician as he grew up in Eutaw, Ala., has served as an inspiration. He treated his asthma, and Lavender says he relied on him for emergency visits and house calls.

“As a child I didn’t realize I wanted to be a family physician, I just knew I wanted to be like Dr. Staggers. Without his influence, I may not have decided on medicine as a career and would not have this wonderful opportunity.”
He adds, “I am very honored to have been chosen as president of this member-driven academy,” he says. “I look forward to working closely with my fellow family physicians as we continue to face a changing health care environment. I will work hard to represent our specialty on a state and national level, while continuing to be an advocate for our patients. I am looking forward to a wonderful year.”

A Bridge to Health Care

“We need a new Civil Rights bridge, parallel to the Edmund Pettus Bridge, to reduce health disparities, and we need to broaden our definition of health to include social factors,” Dr. Pamela Payne-Foster said during a seminar to participants in the Democracy Project’s Summer Leadership Institute at The University of Alabama.

Payne-Foster’s talk to about a dozen 14-year-old boys from Alabama’s Black Belt region was titled “Bridging Civil Rights and Health Care.” The Edmund Pettus Bridge, which spans the Alabama River in Selma, Ala., was the site of Bloody Sunday on March 7, 1965, when armed policeman attacked peaceful Civil Rights demonstrators attempting to march to the Alabama state capital in Montgomery. Payne-Foster is an associate professor in the College’s Department of Community and Rural Medicine.

The Summer Leadership Institute works to help prepare young people for high school, college, and their work lives and careers. Participants hear lectures on civic engagement, entrepreneurship, social responsibility, health and nutrition, and engage in educational and cultural exchanges. The institute held July 14-17 at UA was coordinated by Cynthia Moore, director of the College’s Rural Health Scholars Program.

Disparities are differences between groups of people, Payne-Foster said – “one group has better health, another group has worse health.” There are a number of factors that contribute to health disparities, she said, including economic factors and differences in treatment and screening. “The poorer you are, the less access you have to health care,” she said. “More white women are diagnosed with breast cancer, but more black women die of breast cancer because they don’t have access to screening.”

Payne-Foster shared memories of her father as a young boy growing up in Selma and how liked to watch the ebb and flow of the Alabama River. “He was on the oppressed side. Think about a bridge in regard to health care. On one side of the bridge is cardiovascular disease and cancer and HIV/AIDS, and care and treatment is on the other side. But you can’t cross a river without a bridge.”

She added: “Medical students need skills in public health and population health. The younger generation will lead us across that new bridge of health care and saving lives.”

Faculty honored with Argus Award

Two faculty from The University of Alabama’s College of Community Health Sciences received an Argus Award, an honor given annually by medical students to faculty and mentors for outstanding service to medical education.

Dr. Elizabeth Cockrum, who worked with medical students as a professor and clinician in the Department of Pediatrics and as associate dean for the College before retiring in May 2015, received an Argus Award along with Dr. Brian Gannon, assistant professor in the Department of Pediatrics. The two tied in the Clinical Awards category for Best Clinical Educator at the Tuscaloosa Regional Campus.

Those who received nominations in the category were: Dr. Julia Boothe, adjunct instructor in Family Medicine; Dr. Andrew Harrell, assistant professor in Surgery; Dr. Ben Lucy, assistant professor in Psychiatry and Behavioral Medicine; Dr. Heather Taylor, associate professor in Pediatrics; and Dr. Joseph Wallace, professor and chair of Surgery.

The Department of Pediatrics also received an Argus Award in the category of Best Clinical Department at the Tuscaloosa Campus. Other departments nominated were Family Medicine, Psychiatry and Behavioral Health, and Surgery.

One of the College’s functions is serving as the Tuscaloosa Regional Campus for the University of Alabama School of Medicine, which is headquartered in Birmingham. A cohort of third- and fourth-year medical students receive their clinical education at the College.

The Argus Awards were created in 1996 to recognize faculty members and allow medical students the opportunity to honor their professors and mentors for their service and dedication to medical education. Faculty are nominated for the awards by their course evaluations, and students vote to select winners in each category.

Medical students inducted into Gold Humanism Honor Society

Medical students at The University of Alabama College of Community Health Sciences were inducted this month into the Gold Humanism Honor Society.

Wyman Gilmore, Russell Guin and Elizabeth Junkin are the Class of 2016 inductees at the College, which serves as the Tuscaloosa Regional Campus for the University of Alabama School of Medicine, headquartered in Birmingham. Steven Allon and Courtney Newsome are inductees from the Class of 2017.

The society is a signature program of the Arnold P. Gold Foundation established to recognize medical students, residents and faculty who practice patient-centered medical care by modeling the qualities of integrity, excellence, compassion, altruism, respect and empathy.

The students were nominated by their peers who offered their observations of the students characteristics consistent with humanistic values. A selection committee then evaluated the nominees’ academic eligibility, assessments by their program directors and essays indicating each student’s’ willingness and qualifications to serve, if selected. About 10 to 15 percent of each class is selected to membership. More than 22,0000 Gold Humanism Honor Society members train and practice nationally.

LOCAL Q&A: Dr. James Robinson, head team physician for UA Athletic Department

In 1985, Dr. James Robinson, a New Orleans physician, came to Tuscaloosa as a professor and practitioner of family medicine. Four years later, he became head team physician for the University of Alabama’s athletic teams, a position he still holds today, in addition to an endowed chair at UA.

University Medical Center opens Northport location, WVUA reports

University Medical Center, which is operated by the College of Community Health Sciences, opened its new location in Northport on July 1. The center will provide the community with comprehensive patient-centered care in family medicine and obstetrics.

Dr. Richard Friend, chair of Family Medicine for the College, spoke to WVUA about the opening of UMC-Northport, which features 12 exam rooms and a procedure room.

“As the largest primary care provider in West Alabama, we’re very excited to be able to expand our services out into the Northport community and provide a much needed service for that community,” Friend said to WVUA.

Watch the entire report here:

UMC-Northport opens, grand opening to be held in August

University Medical Center, which is operated by The University of Alabama College of Community Health Sciences, opened a new location in Northport July 1.

University Medical Center-Northport, located in the Fitness One building on McFarland Boulevard, is a relocation of UMC-Black Warrior Family Medicine. The focus of UMC-Northport will be on providing comprehensive healthcare for its patients, as well as training residents, interns and medical students. The move was done to make more space and be more accessible to citizens on that side of town.