Back to the why: Rediscovering the meaning and joy in medicine
An excerpt from the inaugural speech of the new TAFP President
By Tricia Elliott, MD
TAFP President
Greetings colleagues. Thank you for the incredible honor and privilege to serve as your president of the Texas Academy of Family Physicians. I am so excited to have this opportunity to serve you, advocating for our discipline of family medicine, our patients, and our communities.
I am profoundly aware of the significance of this moment in time as I stand here – the first black woman as president of this Academy. Recently, a physician’s personal account of a provocative event sparked a social media storm and national debate on what a physician may look like and what gender, ethnicity, or race constitutes legitimacy as a physician. As I look across this room, it’s wonderful to see the spectrum of what physicians look like. I stand here before you today so proud of this diverse state of Texas and this remarkable Texas Academy of Family Physicians that embraces diversity and differences, and I proudly declare this is what a family physician looks like and this is what a president of one of the largest family medicine state chapters looks like.
I am a woman of faith, so I first express my deepest gratitude and love to my God for this moment and for every day of my life as I live the dream. My passion and my priorities have always centered around faith, family, and friends and 20 years ago, I added a fourth – family medicine.
I am a proud family doc practicing now for almost 18 years. I began my career and practice in the Bronx, New York, in the same community-oriented primary care center I trained in as a resident, seeing patients of all ages, doing the broad spectrum of family medicine, HIV medicine, inpatient and ambulatory medicine, nursing home care, and teaching residents as a clinician educator. Returning to Texas 14 years ago, I continued my career in clinical and academic medicine, seeing patients, teaching, and serving in the leadership roles of residency program director, as vice chair for clinical affairs in an academic health center, as medical director, and as managing physician in a large multi-specialty health system. In being a family physician, participating in TAFP and AAFP and through my leadership roles, I have been highly active in policy and advocacy around issues of physician payment, health care delivery systems and practice transformations, along with graduate medical education funding and physician workforce concerns. I’ve participated in and led practice transformation and quality initiatives targeting the Triple Aim of better care, better health and lower costs. Today, I would like to focus on the Quadruple Aim, mainly the fourth component, physician satisfaction.
How do we get back to the “why” and rediscover the meaning and joy in medicine?
Early last year, I was excited to go to the Houston Symphony. While waiting for the concert to start, I noticed a beautiful elderly African-American woman being escorted to her seat. I immediately recognized her; she was my patient for whom I cared for many years in my previous practice. I first met her when she was 87 years old and even participated in her 90th birthday celebration, which was commemorated in Houston with a TV special and a front page spread in the paper.
She has an exceptional life story: being one of the first Fulbright scholars, speaking fluent Italian, traveling the world as an international opera singer, and teaching music for 40-plus years at one of our historic black universities. She is now 98 years old and still sharp as a tack with incredible wit and wisdom.
I rushed from my seat to her side and greeted her with our usual unique welcome we shared over the years: my best operatic “Ta-da!” With an incredible smile, she responded in kind with her melodic “Ta-da!” We hugged and she shouted, “This is my doctor!” After all these years, I was still her “doctor” and she was “my patient.”
She sat me down next to her and inquired about my life and my current career. With her piercing eyes and her charismatic, bold voice, she shared her gratitude for the care she received from me in the past and wanted to be assured that others would continue to benefit from that care. I reassured her that I have always continued to regularly see patients. She then shared a thought with me that continues to resonate with me. “People are born with certain innate abilities, some with the ability to connect to others. That connection would start from the moment you walked into the room. Sometimes the healing was just you being there. Nothing else. Just being there.”
This experience and conversation with my former patient came at a crucial time for me as I was asking “why” and battling with a conflict of conscience and identity as a family physician. I was contemplating the challenges of caring for my patients and teaching my younger physicians in training during a time that felt volatile with change and uncertainty in medicine. Additionally, I was struggling with rekindling the joy in medicine that I had felt for so many years, but now it seemed to be fading as I was bombarded with a spiraling fee-for-service health care model that was focused on generating more and more, reaching and exceeding RVU targets, seeing more patients in less time, prior authorizations, increasing paper work, a love/hate relationship with an electronic health record that afforded greater access to more information but added a significant amount of work after clinic time – or WAC as we like to call it – just to manage closing my encounters and deal with my “in-basket.” In trying to keep up with all the demands, compassion fatigue and the concept of “burnout” starts to creep in.
This chance meeting with this 98-year-old woman reminded me of the “why,” the very foundation of what it means to be a family doc and why I chose to be one. It’s about people, connections, relationships, and the incredible ability of family physicians to connect with patients, families, and communities across the biopsychosocial-spiritual model of care. It is our ability to “be there” in all circumstances.
Burnout is very real and happening across all generations of physicians. So we must also decide how we can “be there” for ourselves as individuals and for each other, to avoid the perils of burnout while rediscovering our values and finding our joy in family medicine. We need to have conversations about our own personal values and how they match to our professional values and our values as family physicians. This member organization – our Academy of family physicians – is our community. It’s our collaborative and supportive environment to have these conversations. We can foster opportunities and space for networking, education, and sharing best practices and tools to ensure our success and sustainability in our practices and in life.
We know there are multiple competing priorities facing us as family docs. These include physician payment and health care delivery system transformations, the opioid crisis and the challenges of how to begin to remedy a system that let Pandora out of its box, ensuring a future family physician workforce with engagement of our students and residents and sustaining graduate medical education funding, telemedicine, maintenance of certification, and of course mitigating physician burnout.
As we ride this wave of health care delivery transformation from fee-for-service to a more value-based payment model, navigating change can be scary and downright unsettling. We are flooded with acronyms such has MACRA, APM, MIPS, PQRS, ACO, PCMH, and more. How can we navigate through uncertainty? By coming together as an Academy and a unified coalition of family physicians, holding true to our values of family medicine patient-centeredness, high quality comprehensive care, true coordination of care, which we have been doing for years, we can be successful in this ever-changing environment. We are the answer to America’s health. Evidence supports we are the solution to ensure a health system that would be more cost effective, and provide higher quality and healthier populations. We will continue through TAFP and AAFP to be at the forefront of these health care delivery discussions to ensure we are paid for all the care we provide for our patients.
As president of TAFP, I look forward to advocating for you and being your voice on the broad health care and systems issues that face us in our daily practices. I hope to inspire the future family physicians in our students and residents to excitedly embrace family medicine as the noble and joyous profession it is. I will also seek to work with you and our staff to develop and integrate activities, tools, and resources to support our physicians in preparing for the broad health system changes ahead. We will work to identify and create specific resources and activities to support our physicians in alleviating burnout.
I am proud to serve you and be your advocate. I look forward to representing you – all of you – from the Piney Woods of East Texas, to the bustling, fast-growing North Texas, to the oil-rich terrain of West Texas, from the legendary Panhandle to the canyons of Big Bend and to the Rio Grande Valley, from the Gulf Coast metroplexes and its beaches to the beautiful Hill Country and Central Texas.
I challenge you to find and remember your “why.” Reflect on those stories that once inspired you and the passions and values that brought you to this remarkable profession and discipline of family medicine. Rediscover the meaning of family medicine to you and the joy it brings. Seek to regularly “be there” for yourself – for your mind, body, and spirit. Be there for your colleagues and know TAFP and I will be there for you. My hope for you is that throughout your day, your week, and the months ahead, you will renew that joy and have that family medicine moment of affirmation where you can declare: “Ta-da!”