Dr. Wes Dean (l) being installed as 62nd president of TNAFP at recent meeting in Gatlinburg

Wes Dean, MD, FAAFP, became the organization’s 62^nd president when he was installed on Oct. 27. Dean, a founding physician of Emory Family Practice in Powell, Tenn., took the reigns from Scott Holder, MD, of Winchester. Although Dean’s five-physician practice is now part of the expansive Summit Medical Group and located in a bustling suburb of Knoxville, he and partner Ronald Barton, MD, remember what it was like when they went into practice 21 years ago on a two-lane road that didn’t even warrant a traffic light. That perspective has helped Dean empathize with rural practices across the state faced with a growing number of issues that threaten sustainability of the sole family provider or small group practice business model.

Dean said the sheer variation of family practitioners makes it difficult to meet everyone’s needs. He noted that in addition to meeting the needs of practices of different sizes and in different geographical locations, TNAFP must also address concerns of physicians working across a broad range of services, as well. Some practices have family physicians working in obstetrics, others in emergency medicine; some work almost exclusively with patients who have no insurance; others practice concierge medicine; and some large practices rival the volume of community hospitals. “A challenge for the American Academy of Family Physicians and the Tennessee Academy of Family Physicians is how do you support all these people? How do you give them all the tools they need?” he questioned. Dean said the looming national shortage of family medicine practitioners is another stressor on the field.

Perhaps one of the most difficult challenges is pushing forward amid the uncertainty that surrounds the delivery of healthcare in America over the next few years. “There are a lot of unknowns with healthcare reform so I think a lot of people are in a watchful waiting situation,” Dean said. He added the ‘unknowns’ make it difficult to plan from a business standpoint.

One certainty, though, is the push for all practices to adopt electronic health records. “There’s a huge cost to do that, and it’s a huge time issue making that transition,” Dean pointed out. While the ultimate outcomes might be positive, Dean said it doesn’t make the process less onerous.

“We made the transition about a year-and-a-half ago. It takes a good six-12 months to work through it,” he said of his practice’s move to EHR. “Just in the last few months, we started feeling more comfortable with it. Now, I’m really starting to appreciate it.”

Dean said there’s no question EHRs have the potential to improve quality and care coordination, but it’s equally certain that the transition changes workflow. While that isn’t necessarily a bad thing … and ultimately should benefit the practice … the process is disruptive and expensive.

Cathy Dyer, executive director of TNAFP, noted the association dedicated an entire afternoon to the topic of EHRs at the recent meeting. “A lot of rural physicians are confused and a little bit scared … especially when they are in solo practice,” she said.

To address those concerns, a national speaker spent two hours taking attendees through the entire process from homework prior to choosing an EHR system to installation and training. The next 90 minutes were dedicated to members in practices of varying size sharing their experiences in transitioning to EHRs. QSource’s Jennifer McAnally, tnREC (Tennessee’s Regional Extension Center) director, also addressed the group and outlined the resources available statewide and the process for tapping into federal stimulus dollars.

Dyer, who serves alongside representatives from a number of healthcare organizations on the Health Information Partnership for Tennessee Communications Committee noted, “We’re all in agreement that education is the key, and educating our leadership is a top priority.” She added HIT isn’t a topic that would be addressed once and then tabled. “We have a practice enhancement seminar next March, and I feel like this is going to be a large part of that seminar.”

Dean also said practical education and effective communication are key concerns for TNAFP in the current, challenging practice environment. With so many varied practice styles, it’s important, he said, to make sure the membership has access to tools and resources that meet day-to-day operational needs.

From a clinical standpoint, Dean’s focus is on prevention in two areas that impact a host of health conditions — obesity and tobacco use. “This is the first generation of kids where their life expectancy is not greater than their parents … obesity plays a role in that,” he said.

Recognizing the barriers that exist — including busy schedules and the higher cost of nutritional foods — Dean said it’s still a conversation physicians need to have with patients. He added that it doesn’t have to be an awkward encounter. “It’s not like it’s a surprise to patients,” he said. “You just have to fashion it that this (weight and sedentary lifestyle) is hurting your health.”

As for making inroads on tobacco usage, Dean said primary prevention is key. “Our Tar Wars program is something our Academy has supported quite a long time. It targets fourth and fifth graders. It’s trying to do that initial prevention. It would be much better to get our young people not to start,” he said.

A national AFP program, Dyer underscored the importance of reaching out to elementary school kids in this tobacco growing state. “You try to catch them right before they start,” she said. “From the statistical information we’ve gotten from Tobacco Free Kids in the past, we know the average age children begin smoking in Tennessee is about 11 years of age.”

When the program launched in Tennessee 11 years ago, Tar Wars had a presence in about 10 schools. This year, information was mailed to nearly 350 schools in Tennessee. Through the Tennessee Coordinated School Health Program, school nurses handle onsite programming and solicitation of entries for the national poster contest.

While Dean believes primary prevention is a more effective model than cessation, he said that doesn’t mean physicians should stop trying to get patients to give up tobacco. “Physicians personally talking to patients is probably one of the more effective ways to get people to stop smoking, but it’s still an uphill battle,” he said. Dean added that tight appointment scheduling compounds the difficulty of having long conversations with patients but said physicians should seize every opportunity to discuss tobacco cessation. “If someone comes in with a respiratory illness, use that as a teaching moment,” he counseled.

The burdens facing family medicine are significant … from the enormous cost to the system of treating comorbidities associated with overweight and tobacco use to the concerns of transitioning to a paperless office and the looming provider shortage. Despite that, Dean said being installed as president of TNAFP is a true honor and a great opportunity to try to be of service to patients and other providers.

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