10 questions with AAFP’s new president-elect, Roland A. Goertz, M.D., M.B.A.

By Jonathan Nelson

Roland A. Goertz, M.D., M.B.A., of Waco has been elected president-elect of the American Academy of Family Physicians by the Congress of Delegates at this October’s meeting in Boston, Mass. As president-elect, he will join other AAFP officers in advocating family medicine in Washington, D.C., and across the country as he prepares for his year as president in 2010-2011.

Goertz is the executive director and CEO of Heart of Texas Community Health Center Inc., and president of the McLennan County Medical Education and Research Foundation. He has served on the AAFP Board of Directors for the past three years and he held the office of TAFP president from 1994 to 1995.

He chairs the Texas Higher Education Coordinating Board’s advisory committee on family medicine residencies and is a past president of the Texas Association of Community Health Centers. Goertz represented family medicine on the Council of Academic Societies of the Association of American Medical Colleges from 2000 to 2006. He also served as a member and chair of the Texas Medical Association’s committee on physician workforce and distribution, and was a member of its council on medical education.

We conducted a series of interviews with Goertz during his campaign and immediately after his victory. Here’s an edited version of those interviews.

Q] Now that the election is over, what are your thoughts on being elected president-elect of AAFP?

A] I am very fortunate to have the trust and support of the membership for this position. I thank all the TAFP members who have supported me through the years. I would especially like to thank the campaign team, Drs. Linda Siy, Kaparaboyna Ashok Kumar, and Dale Moquist along with the incredible staff at TAFP. The large Texas contingent at the Boston meeting was incredible to see and their support was deeply felt during the election process. I am excited to have been selected at such an incredible time of opportunity for family medicine. One only dreams of such opportunities. I ask all of our members to stay in touch with the process, sign up for Connect for Reform on the AAFP website and make our voices heard. There has never been a better opportunity to make family medicine the foundation of America’s health care system.

Q] What is the time commitment you anticipate and how will you handle that commitment at the office?

A] The president-elect year is more demanding than the Board years. In my case I was on the TransforMED board and on the AAFP executive committee last year, so I experienced some greater impact last year. Generally speaking it is expected that you will be on the road for the Academy about 100 days a year during the president-elect year. I have regularly discussed the requirements with the people I work with and particularly the leadership team who will be most affected by my election. All have urged me to continue and understand they will need to fill in for me at times. All of my most impacted colleagues, including my foundation board chair, attended the Boston meeting and were there when I was announced the new president-elect.

Q] You hail from rather humble beginnings. What led you to pursue a career in medicine?

A] I grew up on a pretty typical family farm close to Austin, Texas. We never had a lot of money but we enjoyed family and running the farm while everybody (his siblings) was home. When I was about 10, my grandmother had a stroke and there wasn’t much to do for an individual that had a serious stroke in the early ’60s. I often wondered why we couldn’t do more. That’s when I started thinking about medicine as a career.
My goal always was to return home and practice, to take care of family and neighbors and friends. I went through residency training with that in mind and when I finished, I chose a community close to where I grew up. Really, the family and I moved there thinking we’d stay for my entire career. Then along came something called DRGs [Diagnostic-related groups]. My little 30-bed hospital didn’t survive and I had to change my career plans a bit. I never ever gave up on the essence of family medicine as what I wanted to be, but going home didn’t work out and that was difficult.

Q] Is that what interested you in affecting health policy?

A] At that time I made a commitment to learn whatever it took, whatever aspects were needed to make family medicine and primary care more prominent in how health care evolves. I think you have to have some understanding of business. I think you have to understand politics. Let’s face it; policy is not something that’s created de novo. You have to have some relationships; you have to have some understanding of how the political process of influence works. If you understand that, then you’re less frustrated when a cause is not successful on its first pass.

We’ve lived for 25 years believing that if we’re committed to understanding medicine and supporting the principles of family medicine, that should be enough. We’ve realized now it’s not enough. You have to add some things to that if you want success in changing the evolution of our health care system. You have to add some understanding of how relationships in politics work. As a seasoned politician once told me, causes alone rarely get enough votes to pass. It takes the right cause paired with an understanding of politics and relationships to achieve the policy you need or want. It’s rare for the cause alone to carry the vote.

Q] In 2001, you went back to school to earn a master’s degree in business administration. Why?

A] I got frustrated because sometimes when I would pick up a set of financial statements, I wouldn’t understand some aspects of them. In the group and organization that I’m part of, it’s critical that I do that. I didn’t want to just trust someone else to interpret them. I had to think about it long and hard, but I realized that if I really wanted to make the most difference in the future, not just for what I was doing with the group and the organization, also for the residency program, if I really wanted to make a difference for the future working with AAFP, I really felt it would be better if I understood the business side more.

Q] What do you believe are the three most critical problems facing family medicine and the American health care system on the whole?

A] There are a number of things that are critical for us to address. The three most important for me are, number one, re-establishing primary care and specifically family medicine as the core of the future health delivery system from now on. That’s not just important for us in family medicine. That’s important for the public; that’s important for our patients. Number two, payment issues. We can’t skirt around the issue, we can’t talk about it in ways that are not direct anymore. We’ve got to have a reward that’s congruent with the work we do. In America that’s embedded in our system; that’s expected. The third issue is workforce. Admittedly, there are things that can be done for workforce that are separate from the first two, but if we do the first two right, I think we’ll go a long way toward fixing workforce. If we get those three things done, we’ll have a much better system.

Q] You’ve said that we are living in an advantageous time for health care reform. What do you mean by that?

A] I’ve been involved with organized medicine for 25 years, virtually all of that in family medicine but also in my own state medical society and in other venues. I believe that we have a confluence of forces creating an environment that can allow change to happen slightly easier than at any other time. First you have the economic condition of the country that is clearly driven at least partially by unaddressed problems in our health care delivery system. You have the business community that is concerned about the cost of benefits and the ability to continue to operate in this country. You have the public, which is upset with certain aspects of care delivery, and family medicine as a specialty has answers to all of those major issues. Plus, you have enough information and data—Barbara Starfield’s data, Dartmouth Atlas data, and not just those but the examples from health systems around the world—that really show that a primary-care-based system can be both highly effective and less expensive while maintaining good quality. We’ve got to take advantage of this unique point in time.

Q] One of the critical problems you raised is the shortage of primary care physicians and particularly family physicians, which is characterized by the declining interest in family medicine among medical students. How would you promote family medicine to an undecided medical student?

A] Most medical students enter medical school with a heart of a servant to care for patients and somewhere along the way they get intrigued by things and get sidetracked. They get intrigued by science and that’s fine. Some have to become scientists and create new remedies and treatments for us. But the majority of medical students need to focus on caring for patients. Now I can’t ignore the fact that there’s a wide discrepancy between what specialties make. I can’t ignore that students now have higher debt. I mean their debt levels average more than the house I first lived in when I could afford the first one. No one can really tell me that doesn’t influence them to choose specialties other than family medicine.

So if I’m going to promote family medicine to them, I’m going to talk about what we’re doing to try and change payment for them when they’re out in practice. I’m going to tell them about how important I believe family medicine and primary care is going to be in the future for our system. And I may also tell them one other thing. Technology has the potential to do away with some other specialties. Technology will never do away with what we do as a family physician and to me, that’s security.

Q] One of the major initiatives during your time on the AAFP board of directors has been the establishment of the patient-centered medical home. Why do you believe this is important to the future of family medicine?

A] To answer that, I’ve got to lay some groundwork. First, I’ve been involved in trying to influence policy for more than 20 years. Wherever I went in D.C., or in the state capitol, I would get a cordial reception and they would always listen very politely. They would say, “You’re great. You do good things. You’re the good guys, the good ladies.” I’d leave, feel good about myself for a while and then nothing would happen. I’d go back year after year. You know, if you do something the same way time and again and get the same results, you ought to ask yourself a few questions.

To me, that’s what the Future of Family Medicine Project was all about. With that project, AAFP did something no other large medical specialty organization has ever had the audacity to do. It asked patients very probing questions about whether they as a specialty were doing their job. Some of the results we got back, particularly from the focus groups of patients, were positive, and to be honest with you, some of it wasn’t very positive. Our description, our ideal of family medicine didn’t always match what patients reported they experienced. Many didn’t know who we were.

We could have dropped it there and continued doing things the way we had but I would predict that our success in changing policy would have been the same as it always had been. So we did something bold, and I didn’t have anything to do with this but I totally support what happened. We took the FOFM results and formulated them into an action plan, developing the National Demonstration Project, which was eventually overseen by TransforMED. The NDP is the pilot of what the FOFM told us. We asked almost 40 practices to do some things that most practices I don’t think in their entire practice careers would have tried. Lo and behold, they made it through two years, a few dropped out, but we also found out some very positive things out of trying to change those practices.

What was learned was added to the family medicine principles of continuity and comprehensiveness, and the evolution of that is the patient-centered medical home model. Now when I go walk those same halls in D.C. and the statehouses, they know what the patient-centered medical home is. They’ve heard it. The tough part about them understanding it is now we have to show that we can do it.

It’s going to require a critical number of members, a critical number of general internists, a critical number of pediatricians and family medicine osteopaths who are on board with the joint principles of the patient-centered medical home to be willing to step out boldly and prove the next level of the model. We already have policy traction. We already have people saying that it needs to be paid for in a different way. I know change is tough but it’s part of what we have to do if we want something different.

Q] Why are you optimistic about the future of family medicine and the American health care system?

A] I’ve never seen as much interest in family medicine and the larger primary care sphere in D.C. or in the statehouses. If I compared today with 20 years ago, when I’d walk down the halls in D.C. or in the Texas Capitol, I could go into some offices and the staffers or the legislators themselves would still need a little prep about what I was there for. I don’t have to do that anymore. I’ve never ever had the option to start explaining what we really need to have happen. I’ve always had to lay the groundwork. I don’t have to do that anymore and that’s exciting. The second reason is I think the system in our country of health care is at the point where it begs for an answer. It’s not working well overall. And that may be negative, but that’s a golden opportunity for family medicine.