{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/7m03x85h6d/manifest","type":"Manifest","label":{"en":["Dr. Jerry Kruse"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer: The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Description"]},"value":{"en":["\u003cp\u003eIn his Oral History segment, Dr. Kruse dives into his career in health care, academics, and his time with various organizations. Since the interview is based mostly around the FMAH initiative, he spends a lot of time addressing the challenge of informing the specialty, informing the government, and informing the payers of what needs to be done. As well as an in depth explanation of FMAH as an organization, a break down of The Working Party, and his views on the need for universal coverage for all Americans that goes further to address health care issues than the Affordable Care Act. \u003c/p\u003e (summary)"]}},{"label":{"en":["Date"]},"value":{"en":["2019-02-12 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Herbert Young (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","family physician","American Academy of Family Physicians","Family Medicine for America's Health"]}},{"label":{"en":["Subject"]},"value":{"en":["Jerry Kruse, MD, MSPH (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"summary":{"en":["\u003cp\u003eIn his Oral History segment, Dr. Kruse dives into his career in health care, academics, and his time with various organizations. Since the interview is based mostly around the FMAH initiative, he spends a lot of time addressing the challenge of informing the specialty, informing the government, and informing the payers of what needs to be done. As well as an in depth explanation of FMAH as an organization, a break down of The Working Party, and his views on the need for universal coverage for all Americans that goes further to address health care issues than the Affordable Care Act.\u0026nbsp;\u003c/p\u003e"]},"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162443/file/295867","type":"Canvas","label":{"en":["Media File 1 of 2 - KruseJerry_01_Access.mp3"]},"duration":1780.8291,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162443/file/295867/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162443/file/295867/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/867/original/KruseJerry_01_Access.mp3?1761142556","type":"Audio","format":"audio/mpeg","duration":1780.8291,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162443/file/295867","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162443/file/295867/transcript/85502","type":"AnnotationPage","label":{"en":["Dr. Jerry Kruse Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162443/file/295867/transcript/85502/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Dr. Young:   This is side 1 of tape 1 of the Oral History of Dr. Jerry Kruse, a member of the board of Family Medicine for America’s Health, recorded on February 12, 2019. I’m Dr. Herbert Young, a volunteer at the Center for the History of Family Medicine.\n\nDr. Kruse, do we have your permission to record this interview?\n\nDr. Kruse: Yes, you do.\n\nDr. Young: Thank you. Could you give us your name in full?\n\nDr. Kruse: My name is Jerry Kruse.\n\nDr. Young: And your present title and position?\n\nDr. Kruse: I’m the dean and provost of the Southern Illinois University School of Medicine and the CEO of SIU Medicine, which is the multi-specialty group practice of SIU. I am a professor of both family and community medicine and of medical education.\n\nDr. Young: Can you give us sort of a thumbnail sketch of your professional background before your current positions?\n\nDr. Kruse: I’m from rural central Missouri. I completed all of my education, including medical school, family medicine residency, MSPH degree, and Robert Wood Johnson Fellowship in Academic Family Medicine at the University of Missouri.  In 1984, I joined the faculty of the Southern Illinois University School of Medicine, at the residency training program of SIU Family Medicine Quincy. I became residency program director there in 1991 and remained in that position for twelve years.  I was chair of the Department of Family \u0026 Community Medicine for the SIU School of Medicine for 16 years.  After that I moved into central administration for the school as Executive Associate Dean and CEO of SIU Medicine.  Since Jan. 1, 2013, I have been Dean and Provost, in addition to the CEO position. On a national level, I served as chair of the Academic Family Medicine Advocacy Committee for a number of years.  I was also the president of the Society of Teachers of Family Medicine and am currently the chair of the board of the American Board of Family Medicine.  From 2008 to 2011, I was a member of the Council on Graduate Medical Education of the Council of the Department of Health and Human Services.  This council gives physician workforce recommendations to the secretary of HHS and to the two authorizing committees for healthcare legislation in Congress, the Senate Health Education Labor and Pensions Committee and the House Energy and Commerce Subcommittee On Health. \n\nDr. Young: So you have quite an extensive background within not only academic family medicine but more broadly with organizations that have great impact upon the specialty.\n\nDr. Kruse: I think some of them do, yes.\n\nDr. Young: How did you get involved in Family Medicine for America’s Health?\n\nDr. Kruse:  As president of the Society of Teachers of Family Medicine, I had a seat with the Working Party of Family Medicine at the time when the discussion began about an update of the Future of Family Medicine project of the early 2000s (FFM 1.0).  Over a period of three Working Parties, the idea of a FFM 2.0 blossomed into a project called Family Medicine for America’s Health.\n\nDr. Young: What knowledge and skills do you think that you have brought to this project, particular skills that have been very helpful and knowledge that’s been very helpful?\n\nDr. Kruse: I’ve had significant experience in advocacy for family medicine and for medicine in general.  I’ve developed a significant knowledge of workforce issues.  And I think I have a good understanding of elements of healthcare systems and practices of family medicine that meet the Triple Aim of better population-based healthcare outcomes, lower per capita cost and improved access and experience for all.\n\nDr. Young:  Are those issue areas that have taken on any change in priority say compared to ten or twenty years ago?\n\nDr. Kruse: Yes, and certainly compared to twenty years ago. In 2004 and 2005, there was a synthesis of the world’s literature about the characteristics of effective systems of healthcare that improve outcomes and lower costs.   Barbara Starfield and her colleagues at the John Hopkins Bloomberg School of Public Health published articles in The Journal of Pediatrics and in the Milbank Quarterly which summarized their research and analyzed hundreds of studies across the world and from the United States.  Researchers at the Dartmouth Institute, Katherine Baicker in particular, used Medicare national and state databases to examine quality outcomes and costs for Medicare beneficiaries, senior citizens who benefited from a system of universal healthcare coverage in the United States.  These studies from Hopkins and Dartmouth showed without doubt the leading role that family physicians should play in improving healthcare in the US.  Twenty years ago, most family physicians from twenty years ago had a good feeling about the effectiveness of the type of care that they delivered.  The work of Starfield and the Dartmouth Institute cemented that feeling and took it to a much higher level – family medicine was the key to better healthcare and better health in the US, and nothing else could even come close to that level of potential effectiveness.  Since 2004 and going forward, we have had rock solid data of the effectiveness that the type of care that a family physician provides, in the US and across the world – the effect that a usual source of comprehensive longitudinal care has on individual patients, on families, on communities and on total populations as well.\n\nDr. Young: Why did it take so long for that to essentially be the type of questions that needed to be asked and answered?\n\nDr. Kruse:  The greatest body to answer those questions came from studies in western Europe, and to lesser degree from the United States, done from 1980 to 2004.   Until the 2004 Starfield reports, these studies had never been organized into a cohesive body of knowledge. All along, family physicians and the specialty of family medicine in the US thought too little of itself.  The general body of family physicians has a seeming inferiority complex about their work.  Many doubted that the comprehensive, longitudinal care could not be as important as subspecialty care.  In many ways, that attitude was drilled into family physicians during their training.  Only a small number of family physicians at that time had the real vision of the effectiveness of usual sources of comprehensive longitudinal care and of what family physicians could do. And even since the publication the material in 2004 and 2005, that attitude has not changed enough. It certainly hasn’t taken hold with the people who make policy, with those who insure healthcare and with systems external to the discipline of family medicine.  And for some reason, it is still hard to find family physicians who fully understand their value and the value of their discipline. I’ll speak as the medical school dean now – medical schools certainly do not understand that value.  There are competing priorities that have been given financial incentive and prestige incentive in medical education that move family medicine to a much lower priority level.  There is a glimmering hope right now. The last few meetings of the Council of Deans have provided discussions that indicate a slow turnaround of attitudes about the things, including family medicine, that are essential for good population-based healthcare outcomes at lower costs.\n\nDr. Young: So does Family Medicine for America’s Health deal essentially with this challenge of informing the specialty, informing the government, informing the payers, et cetera about these issues?\n\nDr. Kruse: Yes. Family Medicine for America’s Health has had both a strategic planning process for the discipline and the development of a communications process for the discipline of family medicine. I will say that we have moved down the road in Family Medicine for America’s Health to the idea that trying to influence legislators in Washington, D.C. has taken a higher priority than actually the communications with those other areas. Now, we do have some communication with insurers and other people that are influential. But for the communication of the FMAHealth     \n\nplan itself, we did make the decision in the middle of the process of Family Medicine for America’s Health communication plan to go just with Washington, D.C. I’d also say in that strategic planning process there was one of the strategies of comprehensive payment reform that in the document was listed as the single essential element for all of the other six strategic initiatives to be successful. And I think we’ve only moved baby steps toward payment reform in the United States. I think overall – well, certainly I have and other members of the Family Medicine for America’s Health board have been disappointed about how slowly that has moved. And we still understand that it is a key element for meeting our strategic initiatives and improving the healthcare system in the United States.\n\nDr. Young: So when you say it’s been moving very slowly, meaning within our society, within the various parts of the healthcare system that pay for it, that invest in it, et cetera? Or within Family Medicine for America’s Health was it moving too slowly?    \n\nDr. Kruse: I would say in both of those areas. There still has been slow uptake on the part of policymakers, governments, insurers and industry to move those things forward as fast as they should. Certainly there are pockets that have moved very rapidly, but as a whole it hasn’t moved as fast as it should have. And then within Family Medicine for America’s Health and within the discipline of family medicine, I will say that it has taken us too long to agree upon the system for which we want to advocate. Looking back on it I would say that would have been job No. 1, to sit down and determine initially and immediately what that strategy was and how Family Medicine for America’s Health board and its tactic teams and how the other organizations of family medicine were going to attack that problem, as a team. \n\nDr. Young: You have a number of different organizations that participated in Family Medicine for America’s Health. Did that present a problem, the different facets of family medicine trying to come to agreement, or was there more agreement than I may be guessing?  \n\nDr. Kruse: There was certainly some agreement on a variety of issues and some agreement on the elements of payment reform. But I would say you are correct that, yes, it was difficult for the various organizations and the board of Family Medicine for America’s Health to come together and to see eye-to-eye on this one. I will also say though that the very process of struggling with this issue has actually led to a great desire on the part of the eight organizations that are represented on the FMA Health board to actually make recommendations to the Working Party about structural changes that will move us forward more cohesively as a discipline in the future. That played out very well at the last Working Party meeting in San Diego in January 2019.  I think we’re starting to see some progress with that right now.\n\nDr. Young: And when you say structural changes, in how the organizations interrelate? Or in what way? \n\nDr. Kruse: Right. For example, at the Working Parties we have made a definite attempt to move away from standard reportings and to make that a smaller amount of the time and to make a larger amount of the time devoted to group interactions and discussions of strategic and generative issues. We’ve moved toward more planning before the meeting to get everybody prepped. We’ve moved to developing strategies that would move us on towards the next Working Party meeting. I just believe that all of those things grew out of FMA Health and the way that the board and the tactic teams brought people together from various organizations and now it’s actually moving into the Working Party structure itself.\n\nDr. Young: It probably would be helpful to hear from you a little bit about what is the Working Party. Who comes from the organizations? How often does the Working Party meet?\n\nDr. Kruse: The Working Party meets twice a year for two days. The Working Party is made up of two practice organizations, the American Academy of Family Physicians and the American College of Osteopathic Family Physicians; One foundation, the American Academy of Family Physicians Foundation; one certifying organization, the American Board of Family Medicine; and four academic family medicine organizations, the teachers, the Society of Teachers of Family Medicine, the chairs and administrators, the Association of Departments of Family Medicine, the researchers, the North American Primary Care Research Group, and the residency program directors, the AFMRD, Association of Family Medicine Residency Directors. Those eight organizations make up the Working Party. There are four to eight representatives from each organization at any one particular meeting. I will also say that there is now some discussion about having a committee structure that lingers between the meetings that will focus on the future of family medicine. So that’s a step forward too.  \n\nDr. Young: So that would be an extension of the work of Family Medicine for America’s Health?\n\nDr. Kruse: In large part, yes. Also continually getting new ideas and looking into the future, analyzing new data and coming up with new, creative and innovative ideas also.\n\nDr. Young: As you look at the state of healthcare in the United States, how would you fix it? And I know that’s a broad question.\n\nDr. Kruse: I would fix it first by going to the evidence. And I know that convincing other people of the evidence is the big issue right here. So again, from the literature of 2004 and 2005 it is crystal clear that the things that are needed are universal healthcare coverage and access for all that’s guaranteed by a publicly accountable body. The United States moved a bit toward that with the Affordable Care Act but certainly not completely. We still lag behind all other OECD nations in the world in access. Also, it was shown that regional planning and regional resource allocation is needed. The United States has nothing like that. Related to practice, something as simple as no out-of-pocket expenses for primary care services which means really, in essence, no deductible and no copay for what family physicians do would be important. Another one is a narrow range of incomes for all physicians. So that gets down to the income ratio. It’s been well shown that when primary care physicians make 80% or more of what consulting specialty physicians make that we naturally get a workforce of medical students who choose careers in primary care. The United States hit a low on that percentage of about 48% in 2007 and since that time it’s risen to about 57%. But it’s still very far short of the 80% that’s needed for effective systems. Another one is a high supply of primary care physicians which is defined as 40 to 45% of the physician workforce.  That was the genesis for the development of the Twenty-five by thirty recommendation of Family Medicine for America’s Health. The last one from Starfield was a relationship with the usual source of comprehensive longitudinal care and that then led to the definition of the Patient-Centered Medical Home which was published at the very same time with its seven essential functions. Since that time it’s been well-shown by the researchers at UCSF and the Patient-Centered Primary Care Collaborative that a highly regulated health insurance function is also something that’s very, very important to a system that leads to better outcomes and lower costs. \n\nNow, that being said, we can take a look at the Affordable Care Act. The ACA did a lot of those things that I mentioned. It certainly brought us closer to universal healthcare coverage. It had a 10% incentive added to primary care pay. It had a clause for a National Healthcare Workforce Planning Commission. So it was going down the right path. Now, the problem was that the ACA authorized many things. It had appropriations for a few but other things needed appropriation legislation. And then with any large piece of legislation like that there needed to be companion pieces of legislation that were enacted year after year to make sure that the elements were instituted and to make sure that it was updated because any big legislation like that would certainly have some kind of loopholes that developed. The unfortunate thing with the Affordable Care Act is there was no follow-up legislation and there was no legislation for further appropriations. So the National Healthcare Workforce Planning Commission never met. After two years the 10% primary care pay incentive sun-downed, and it was not reauthorized. And then some of the other pieces of it have been dismantled, like the individual mandate and some other things. So something that showed a lot of promise to moving America where it needed to go has been watered down and has not received the support that was anticipated and that was need to move toward a better healthcare system. \n\nI think we need the elements that I mentioned.  They are all crystal clear.  I think we do have some of those elements that we see here in the U.S.  And Medicare is the universal healthcare system and the outcomes for our senior citizens in the United States compare very well with the rest of the world. But all the rest of our population lags far behind in healthcare outcomes compared to our senior citizens. So we have the data right in front of us and somehow we need to get a cohesive, unified look at this to get a system in place that moves us forward.\n\nDr. Young: Was this one of the reasons that Family Medicine for America’s Health shifted its emphasis to elected officials?\n\nDr. Kruse: Yes, it was. We obviously knew we needed to increase our influence with the elected officials. We also realized that with the amount of money that we were funded that we couldn’t reach everybody else, so we had to pick a priority. And that seemed to be the best one. And particularly as we were moving toward another election year, we wanted to make sure that all of those officials in Washington, D.C. were informed about better healthcare systems.  \n\nDr. Young: Can one be optimistic about convincing elected officials with scientific studies, outcomes?\n\nDr. Kruse: Historically speaking there has been some trouble with that. That is a very interesting thing. Over the years I’ve developed a good relationship with Senator Dick Durbin from Illinois and he is a brilliant senator and he does understand the background information. But I have noticed that when he makes his pleas and when he gives his orations about healthcare that he brings in testimonials and illustrations from individual patients to try to make that argument with other people. Even though he knows the data, he seems not to lean on that as much as using individual examples. So I think the way politicians communicate, get information processes, act on it, is very, very complex indeed – and we’ve got a ways to go. \n\nDr. Young: What are the next steps then in terms of the work of Family Medicine for America’s Health? You’ve mentioned the Working Party evolution to pick some of this up. And I’m asking both at the global level overall goals but also in terms of the tactic team work.\n\nDr. Kruse: Yes. The tactic teams were responsible for various strategies that had been developed initially by our early consultants for FMA Health, CFAR.  There were many products.  We are trying to assure that each of those products, programs, initiatives that have shown some promise and have been developed will be cared for very well by the family medicine organizations in the future.  For example, in the Workforce \u0026 Education tactic team, one of the things that came out was a preceptor initiative. The Society of Teachers of Family Medicine took that over and runs it and the American Board of Family Medicine Foundation helps fund that project – a nice collaboration.  The same tactic team developed the Twenty-five by Thirty Initiative, which is a goal of 25% of all American medical students, including allopathic and osteopathic, will become family physicians by the year 2030.  That project is now the responsibility of the American Academy of Family Physicians, but has the enthusiastic support of all the other organizations in Family Medicine for America’s Health.  All of the research initiatives were taken over by the North American Primary Care Research Group and that’s moving rapidly. The practice teams developed a program called Measures That Matter.  All of us realize that how we measure quality and how we reward quality for family physicians and for healthcare practices is fragmented and doesn’t focus on the things that really make a difference. This initiative is now led by Rebecca Etts and Kurt Stange in the Larry Green Center, and is funded by the American Board of Family Medicine Foundation.  Early in the FMAHealth project, we recognized that we didn’t have an organized strategy for health equity, justice and fairness. So the Health Equity tactic team was formed and moved forward rapidly.  The AAFP has developed an office for that and other organizations have developed other tools that are very influential there. For example, the American Board of Family Medicine has developed a Population Health Assessment Engine which will fit right in with some of the other diversity inclusion and equity issues that come with that.\n\nDr. Young: We’ll pause at this point in order to turn over the tapes.\n\nDr. Young: This is side 2 of tape 1 of the February 12, 2019 interview with Dr. Jerry Kruse, a member of the Board of Directors of Family Medicine for America’s Health. Dr. Kruse, you had been talking about the tactic teams and how their work has been carried forth now by one or more of the member organizations. Did you have anything else you wanted to add in that area?\n\nDr. Kruse: I gave you a few examples there. I certainly don’t want to be giving an exhaustive list of all of the great things that were done by the tactic teams, so I’ll just stop there with that one. \n\nAnother product of the entire process was the series of Starfield Summits that came out that addressed issues that were germane to the process. I think that there is eagerness on the part of Working Party to move forward with more of those summits.  This is part of the generative and strategic work that Working Party can do to help make the discipline more cohesive as it moves forward.  I believe that specific recommendations from FMAHealth board and from the Working Party, can merge to give us good momentum.\n\nDr. Young: The overall project is Family Medicine for America’s Health. To what extent are other members of the healthcare team, both medical specialties and non-physician providers, a part of what you all considered?\n\nDr. Kruse: We’ve engaged people from other areas. In some of the planning sessions we had relatively large gatherings in a retreat-like format that gathered people from other healthcare professions and from a variety of other areas that would be stakeholders for better health and for improvement of the social determinants of health. Throughout the entire tenure of Family Medicine for America’s Health, there was significant engagement with the Patient-Centered Primary Care Collaborative and several of the FMAHealth projects will be taken on by the PCPCC. I think the discipline of family medicine would be well served to expand those engagements with stakeholders and other healthcare professionals going forward.\n\nDr. Young: So has the model of how family medicine is practiced evolved and is that part of any of the planning here? \n\nDr. Kruse: It is part of the planning and it does tend to be a significant concern as well. We know from data, mainly from the American Board of Family Medicine, we’ve had an advantage of being able to administer surveys whenever recertification and certification tests are done, and that the comprehensive nature of the practice of family physicians has been declining for some years now. The comprehensiveness of care is the single most important evidence-based characteristic of usual sources of comprehensive longitudinal care that leads to better patient outcomes and lower costs.  It also leads to lower burnout rate among family physicians, which is a very important issue now.  We’ve noted that the very same thing is happening in Canada, a nation that has a high supply of family physicians.   The College of Family Physicians of Canada lists this as a major issue of concern.  This will be one that the discipline of Family Medicine in the United States and worldwide will need to take on. Part of the waning comprehensiveness in the US is caused by the low supply of primary care physicians.  It’s easy to fill up your practice with routine, but important, visits that squeeze out comprehensiveness.  Also, a much greater proportion of physicians are now employed by healthcare organizations. Those organizations, to satisfy the desires of their consulting specialty physicians, sometimes restrict the practice of family physicians.  So it’s a multi-factorial issue.  Going forward, we really need to embrace the changes in technology. That might help bring about a partial solution.  I say that for several reasons. First of all, there are technological changes in the type of devices that can be used in the office. I’ll give one example: Point-of-care ultrasound, POCUS. There is sometimes resistance on the part of healthcare organizations for that type of technology to move out of the radiology centers and into the primary care office.  POCUS is better for patients, so we should move it forward.  Another type of technology is new means of communications with patients.  The use of tools like Facetime and Skype to engage them would likely lead to a more efficient and comprehensive practice and more satisfaction with practice.  The third piece of technology that I’ll mention is the use of artificial intelligence, or a machine intelligence-human intelligence interaction, to improve point of service decision making and the ease of using electronic records.  That will help dramatically to make the practice more efficient.  With the technology, we have to be careful to balance the use of technology with our historic emphasis on our personal and healing relationships, but I have no doubt that it can be done.             \n\n    \n\nDr. Young: What’s the role of education at the medical student and particularly at the resident level in acquiring the skills for use of these new technologies?\n\nDr. Kruse: There are two parts that are important. The first one is for medical schools, residency programs, and the organizations that accredit them to recognize that standards for learning about and using new technologies is important. Those licensing, certifying, and accrediting agencies must understand that it’s important for those kinds of skills to be developed by family physicians.  This process will need q significant advocacy efforts. I’ve long thought that having a summit that would convene all of the major accrediting, certifying, and licensing agencies to discuss a common mission and quickly address changes in technology and health workforce needs is very important.  Maybe that would be the next Starfield Summit. What do you think? That could be really good. So I think at the very highest level there needs to be a push for those kinds of things to be required in the curricula. Then I think everybody would get onboard with that. The other piece to this window is this: I think that one of the characteristics of the profession of medicine, of any of the learned professions, is teaching the next generation of professionals. And we have seen a significant decline in the percentage of family physicians who are actively involved in education of medical students and residents. I think that should be an obligation of 100% of the family physicians, to be involved in that in some way. And if that were to occur, I think the changes in education that were needed would happen. \n\nDr. Young: Why do you think that has happened, that there isn’t that commitment?\n\nDr. Kruse: Some of it is the pressure of practice.  I think there are some organizations that discourage their physicians from teaching, with the thought that it might decrease their productivity.  Quite frankly, it is difficult to find evidence of that.  There is no information that shows that teaching medical students and residents lowers the productivity of family physicians. The Society of Teachers of Family Medicine has developed a Preceptor Initiative to provide students with the tools that will allow them to help make their preceptors’ offices and practices more efficient and benefit the physician who teaches.  Programs are being developed that are better for both teachers and learners.  Some attitudes will need to be adjusted for this important issue.\n\nDr. Young: Certainly I have heard some stories of organizations that are large, integrated systems that have encouraged having residents go through the offices of their paid for, employed (I’m not sure exactly what the arrangements were). But the idea was that they then would be able to recruit those resident graduates.\n\nDr. Kruse: Absolutely. And that’s a great recruiting tool – you know, where you trained them, they will stay. The old Field of Dreams really comes true. \n\nDr. Young: When you said that the medical students would go to practices and bring knowledge, was that medical knowledge or how to organize the practice, how to use your staff more efficiently? What sort of things?\n\nDr. Kruse: I’ll give an example. Part of it has to do with utilization of electronic health records. Medical students should come to preceptorships with knowledge of electronic records and how to improve the efficiency of use. They should come with some knowledge of quality improvement processes and practice analysis, so they might help start a project. That would be beneficial to many family physicians.  There are a number of other things that are being examined.\n\nDr. Young: You’ve referenced the Future of Family Medicine in the past and that came out with, if I remember correctly, ten major areas of emphasis. And if I remember properly, single organizations sort of took on those various areas. I have the sense that in Family Medicine for America’s Health there may be more interplay of more than one organization, maybe one in the lead but not doing all the heavy lifting themselves. Is that correct? \n\nDr. Kruse: That is true. There certainly will be a responsible organization for a specific tactic. But many of the tactics will have several collaborating organizations that will lend their expertise is to the process. \n\nDr. Young: And is this an improvement in this cycle? I guess this is the third time the specialty has done this sort of major cross-discipline planning and action. \n\nDr. Kruse: I think it is. I wasn’t involved in the last two, so I certainly hope so.\n\nDr. Young: In doing an earlier interview several people had commented that they were hopeful that there would not be a loss of the organizations talking and working together. And part of that was that some of the people who are active now or early in Family Medicine for America’s Health would be able to have a continuing role, a continuity. Is that an issue that has crossed your mind at all?\n\nDr. Kruse: Yes.   The momentum at the Working Party will continue.  We might even select a new name to reflect that. Working Party hasn’t yet defined what new processes will occur between the meetings.  The idea of a committee for the Future of Family Medicine has been discussed.  Such a committee likely would have members of Working Party and people outside Working Party that might be longstanding members has also been discussed.  I’m hopeful that something like that will be developed to keep that momentum going.\n\nDr. Young: Because I’m assuming that the individuals who are representing organizations, who are individuals who at some point had been elected to office within the organization they represented and so that’s a way to be responsible to your members, but it also means change over time as terms in office change.\n\nDr. Kruse: That is true. That’s what happens with the Working Party.   There is significant turnover and that has been a significant disadvantage for the group that pulls all the family medicine organizations together.   Each of the Working Party organizations appointed one member to the Family Medicine for America’s Health Board of Directors.  After one early change after the first meeting, I believe that all of us from the Working Party organizations stayed the completed the entire five years.  There was turnover for the non-Working Party members, with one state chapter representative and one public member leaving the board.  But it was quite a stable board over the entire duration, and I think some mechanism for Working Party, or a committee or Working Party, with more continuity would be very important for Working Party going forward. \n\nDr. Young: Looking across everything, are there any areas that we have not touched on that you want to make sure get on the interview?\n\nDr. Kruse: No, I think we’ve covered it. \n\nDr. Young: I want to thank you very much, Dr. Kruse, for taking this time to share with us in this Oral History about Family Medicine for America’s Health from the board perspective. \n\nDr. Kruse: You are very welcome. My pleasure.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162443/file/295867#t=0.0,1780.8291"}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162443/file/295867/transcript/85503","type":"AnnotationPage","label":{"en":["Dr. Jerry Kruse Summary Sheet [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162443/file/295867/transcript/85503/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Kruse, Jerry\n\nInterviewer: Dr. Herbert Young\n\nInterview Date: February 12th, 2019\n\nBiography\n\nDr. Kruse was born and raised in rural Missouri and completed his academics at The University of Missouri and his fellowship in Family Medicine at Robert Woods Johnson center at MU as well. After that he went to the Southern Illinois University School of Medicine first as a faculty member at the residency training program of SIU in Quincy, Illinois. He then became residency program director there which he did for twelve years. Then he was the chair of the Department of Family and Community Medicine for the SIU School of Medicine for sixteen years. Dr. Kruse was also the president of the Society of Teachers of Family Medicine and is currently the chair of the board of the American Board of Family Medicine. During his time with the STFM was when he began to hear about the FMAH initiative in the early 2000’s. Currently, he is the dean and provost of the Southern Illinois University School of Medicine and the CEO of SIU Medicine which is the multi-specialty group practice of SIU. He is also a professor of family medicine and medical education.\n\nOral History Summary\n\nIn his Oral History segment, Dr. Kruse dives into his career in health care, academics, and his time with various organizations. Since the interview is based mostly around the FMAH initiative, he spends a lot of time addressing the challenge of informing the specialty, informing the government, and informing the payers of what needs to be done. As well as an in depth explanation of FMAH as an organization, a break down of The Working Party, and his views on the need for universal coverage for all Americans that goes further to address health care issues than the Affordable Care Act.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162443/file/295867#t=0.0,1780.8291"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162443/file/295866","type":"Canvas","label":{"en":["Media File 2 of 2 - KruseJerry_02_Access.mp3"]},"duration":1042.0947,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162443/file/295866/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162443/file/295866/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/866/original/KruseJerry_02_Access.mp3?1761142554","type":"Audio","format":"audio/mpeg","duration":1042.0947,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162443/file/295866","metadata":[]}]}],"annotations":[]}]}