{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/9s1kh0gt0x/manifest","type":"Manifest","label":{"en":["Dr. Robert Phillips"]},"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\u003eDr. Phillips has had a hand in many health care related projects, but being as the interview is focused around FMAH, he talks about his experiences with the pros and cons of that program. From inception, Dr. Phillips played a role in creating the FMAH initiative. However, a lack of vision, planning, and execution, as well as miscommunication, never made FMAH a huge success. Bureaucratic red tape is an issue that he thinks will hold back the profession from expanding. For the future, Dr. Phillips hopes to see a better representation in politics for Family Medicine. Additionally, he hopes that the current politics in Washington do not continue to have negative impacts on Family Medicine as a whole. \u003c/p\u003e (summary)"]}},{"label":{"en":["Date"]},"value":{"en":["2017-11-09 (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":["American Academy of Family Physicians","Family Medicine for America's Health","Family Physician","Family Medicine"]}},{"label":{"en":["Subject"]},"value":{"en":["Robert Phillips, MD, MsPH (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"summary":{"en":["\u003cp\u003eDr. Phillips has had a hand in many health care related projects, but being as the interview is focused around FMAH, he talks about his experiences with the pros and cons of that program. From inception, Dr. Phillips played a role in creating the FMAH initiative. However, a lack of vision, planning, and execution, as well as miscommunication, never made FMAH a huge success. Bureaucratic red tape is an issue that he thinks will hold back the profession from expanding. For the future, Dr. Phillips hopes to see a better representation in politics for Family Medicine. Additionally, he hopes that the current politics in Washington do not continue to have negative impacts on Family Medicine as a whole.\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: \u0026nbsp;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/162279/file/295070","type":"Canvas","label":{"en":["Media File 1 of 2 - PhillipsRobert_01_Access.mp3"]},"duration":2466.2151,"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/162279/file/295070/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162279/file/295070/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/070/original/PhillipsRobert_01_Access.mp3?1760561164","type":"Audio","format":"audio/mpeg","duration":2466.2151,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162279/file/295070","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162279/file/295070/transcript/85363","type":"AnnotationPage","label":{"en":["Dr. Robert Phillips Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162279/file/295070/transcript/85363/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Tape 1, side 1\n\nDr. Young: This is side 1 of tape 1 of the oral history of Dr. Robert Phillips, a member of the board of Family Medicine for America’s Health. We are recording this on November 9, 2017. I’m Dr. Herbert Young, a volunteer at the Center for the History of Family Medicine.\n\nDr. Phillips, do we have your permission to record this interview?\n\nDr. Phillips: You do.\n\nDr. Young: Wonderful. Could you please give us your name in full?\n\nDr. Phillips: Robert Leroy Phillips, Jr.\n\nDr. Young: And your present title and position?\n\nDr. Phillips: I’m the Vice-President for Research and Policy at the American Board of Family Medicine.\n\nDr. Young: Can you talk a little bit about your professional background, how you got to your current position?\n\nDr. Phillips: I trained in family medicine and health services research at the University of Missouri which included a two year fellowship after residency training and did some collaborations with the Robert Graham Center which was just opening at the time. I was invited to spend a month with them and then also invited to come to D.C. as Assistant Director of the Robert Graham Center. I spent four years there as assistant director and I was asked to stay on as the director of the Graham Center, which I did for another eight years. And in 2012 I moved over to the American Board of Family Medicine in the role that I’m in now.\n\nDr. Young: And just briefly, what does the Graham Center do?\n\nDr. Phillips: The Robert Graham Center is the Health Policy Research Center of the American Academy of Family Physicians. It’s the only specialty-based research center and operates with editorial (?) independence and has been a very productive research center for the specialty and for primary care generally.  \n\nDr. Young: And what sort of research does it conduct?\n\nDr. Phillips: It does a lot of health services and health policy research. It does economic research. And then it has a vital function of translating research for policy and public consumption. \n\nDr. Young: And the sort of research that you mentioned, funding for that?\n\nDr. Phillips: Some of it is funded by American Academy of Family Physicians. There are ongoing supporting contracts from the American Board of Family Medicine. And then it gets external funding from philanthropies and government. \n\nDr. Young: Excellent. How did you get involved with Family Medicine for America’s Health - or as some people call it, FMA?\n\nDr. Phillips: I was part of the very early planning group when the idea was conceived and then led the role definition of a family physician which we were asked to do as the prelude to creating\n\nFMA Health. After that three month role definition development, we ultimately published that role definition as well as a foyle definition. And I was part of the ninth month long planning group that led to the ultimate design for the strategic planning and the communications planning process but then was handed off to the FMA Health implementation team which then became the FMA Health board.   \n\nDr. Young: And it’s made up of a number of organizations, the board?\n\nDr. Phillips: It is. There are eight formal member organizations in the effort. It was initially intended to be open to a wider variety of primary care and patient organizations but that never really developed. \n\nDr. Young: Any thoughts on why it didn’t develop?\n\nDr. Phillips: I think a good deal of the strategic planning process may have been open to other organizations but the process I think seemed a little parochial for other groups to see it as really being open and welcoming to them. And the communication plan was almost entirely focused on family medicine. Even though it evolved into Health Is Primary, it still wasn’t seen as being very welcoming by other groups.\n\nDr. Young: And Health As Primary is the communications element?\n\nDr. Phillips: Health Is Primary, right. That’s the communication theme. \n\nDr. Young: And we might talk a little bit more about that later in the interview. Turning to you though particularly, what knowledge and skill sets do you feel that you bring to this project?\n\nDr. Phillips: Well, I was at the Robert Graham Center when Keystone 3 created the environment for Future of Family Medicine, FFM, back in early 2000. I wasn’t directly involved in either of those but was a very close witness to the process that led to FFM, then the six taskforces of that effort. A lot of the research we’ve done at the Graham Center or that we’ve done in collaboration with other groups have kept me very in touch with the implementation of the strategies from that effort and so I was fairly well-positioned to understand where it had arrived, where the gaps were and what the next iteration needed to achieve. \n\nDr. Young: So Future of Family Medicine or FFM, what was the outcome of that effort and how did that influence the formation and activities of the Future of Family Medicine?\n\nDr. Phillips: We published an initial article framing FMA Health and then a special issue of Family Medicine that laid out the focus of its tactic teams and the overarching mission again. And in both of those we talk about FFM as having achieved some very important goals but the financing of primary came very late to that effort with an add-on of the sixth taskforce. So it wasn’t very integrated with the strategies of the rest of the FFM effort, so we recognized that that needed to be an upfront lead for the next iteration that became Family Medicine for America’s Health. It also really lacked a communication strategy, so that became another primary focus for FMA Health. But there were a lot of the strategies that were implemented from that initial effort.\n\nDr. Young: And how was that achieved in terms of those different strategies?\n\nDr. Phillips: There was a systematic effort to hand those off to the different organizations and have them take a lead in supporting roles for those strategies. And I think that was the key to a lot of them having been achieved. But there was no kind of systematic review process that those handoffs, that they were held to account for those, and I think that was part of the reason why some of them didn’t happen. \n\nDr. Young: So are you saying that, in one sense, there wasn’t some overall organization that still tracked progress and success?\n\nDr. Phillips: Right, or a process that tracked it. You know, the Working Party brings those same eight organizations together twice a year and there was no process built into that that would monitor how things are being done.\n\nDr. Young: And at least one other person has commented that the Working Party has a fair amount of turnover in its membership.\n\nDr. Phillips: Right. So it’s hard to sustain a recurring agenda – that’s true.\n\nDr. Young: What, in your opinion, is the state of health care in America now? And I guess I would ask that both in terms of at the beginning of this project and where we are now. In fact, how far into the project are we?              \n\nDr. Phillips: Well, the state of health care, let me comment on that first. It’s very expensive, uncoordinated and inequitable. I think we’ve made some strides over the last two years to try and expand insurance coverage and access for many people, which is back under siege again, and so I feel it will slip back into inequity being the lead problem. But it does not embrace the real functions of primary care and health systems. Even though we’ve moved towards accountable\n\ncare organizations and other population-based funding, a lot of the leadership of the health system is still based out of hospitals and doesn’t understand the need to shift care to outpatient and preventive care and community-based care and so they still are hiring primary care and family medicine, in particular, to really be a feed-thru put for patients to more expensive services.  \n\nDr. Young: And in terms of the political changes that have occurred? \n\nDr. Phillips: Well, the political changes of the last year have not helped us in that regard. They purport to want to make sure everybody has access to health care, but the proposals they keep putting forward and the underlining of the Affordable Care Act put millions of people at risk of losing the coverage that they gained. And the focus on value-based care, while it should favor family medicine and primary care, the real impact is that it’s driving more and more family physicians to join health systems and become employed. And there’s growing evidence that the folks who do that, there’s a real -- drop in their full functioning as a primary care clinician.     \n\nDr. Young: So their scope of practice becomes narrowed?\n\nDr. Phillips: It does. Their scope of practice becomes narrowed. They stop seeing patients in the hospital. There’s been a rapid decline in OB provided by family physicians. It’s just becoming very hard to remain a solo or small practice physician. \n\nDr. Young: So given that track, what’s the future of the specialty?\n\nDr. Phillips: Well, I think our training program still … We’ve published articles recently showing that the folks coming out of training are looking for a much broader scope of practice than they’re able to find. So it’s still preparing people for a very viable and important model of care, but the workforce itself is not able to find it or do it. So I think we’re probably one generation of family physicians away from forgetting how to do that broad scope care.\n\nDr. Young: So training will change?\n\nDr. Phillips: I’m not sure how fast training will change. But the leadership, the role models who are outside of training programs … Not only will the people coming out of our training programs not be able to find what they’re looking for, they won’t have expectations of doing that and won’t be role models for students. So there’s going to be a mass forgetting, I’m afraid.\n\nDr. Young: Has the scope of practice in rural America changed?  \n\nDr. Phillips: It has because even a lot of those folks are joining health systems even though they’re functioning remotely. But their scope narrows even when they do that.  \n\nDr. Young: I know obstetrics certainly has lessened, but is that true of other aspects of family medicine in rural settings?\n\nDr. Phillips: It is.\n\nDr. Young: And who’s picking up that function?\n\nDr. Phillips: It’s not clear that anyone is. In fact a lot of it’s explained by the closure of rural hospitals which is happening very quickly. So it means the people who live in rural areas are having to go farther and farther for subspecialty and in-patient care.\n\nDr. Young: And does that have an impact on life … How can I put this? Do you think that the loss of medical services in rural America will mean that those populations will decrease?\n\nDr. Phillips: Oh, gosh, I don’t know. I know that that population is aging faster which implies the younger people are leaving. It means a loss of jobs since the hospitals are a big economic engine for rural areas, so that would have people shifting. But it may explain some of the inequities for people living in rural areas because if they have to travel farther they don’t have immediate urgent and trauma care, they don’t have close by OB services, so it does put them in more risk.\n\nDr. Young: Could you talk a bit about the process of FMA Health in terms of what does the board do, what do the tactic teams do? And I understand there have been some changes.\n\nDr. Phillips: The board has the responsibility of managing the work of the tactic teams and supporting them and negotiating for the funding streams that are needed to fulfill their activities. The board also has the responsibility of interfacing with the eight other organizations. Initially it was to update them and increasingly it’s about the handoff of the tactics coming out of the tactic teams and figuring out which, if any, of the organizations will take those on as assignments to carry out. Some of the changes that occurred recently is there was a lot of pressure in this last year with the new administration coming in, in Washington, D.C., to refocus some of the resources on communication efforts – and specifically within Washington, D.C. and a request from the eight organizations to speed up some of the handoff of the tactics. So four of the tactic teams, which are all made up of volunteers who have spent at least two years, some of them three, developing their tactics, will end at the end of this year and three will continue afterwards for another year. But the whole effort, which was planned to be a full five year effort, will ratchet down a little faster than that.            \n\nDr. Young: And is that because of the costs involved or the seeing of the change in government and so forth for the handoffs?\n\nDr. Phillips: Some of it is because some of the funding was shifted to the communication plan, so it’s getting a larger share of the funding than was initially planned. And that meant a reduction in support for the strategic planning process, so the outside consultant who has been serving as the coordinator and manager of the effort will be leaving us at the end of this year. It is also because \n\nof something you alluded to earlier - the turnover at the Working Party, the folks who made the initial investment and plan, have forgotten that it was a five year effort in what it was supposed to achieve. And I think they’re a little bit uncertain about the handoff of the tactics back to them and what’s being asked for them to take on. And with that uncertainty, they would prefer not to have more handed off. \n\nDr. Young: I believe that with the Future of Family Medicine there were, at least in the area of research, some challenges in terms of the handoff. Originally the Academy, for example, stepped forward because NAPCRG had not, as I understood it, to take on the Generation of New Knowledge recommendation. But then the North American Primary Care Research Group did step forward after ea bit. In terms of the handoffs here, are some of the things just so clearly in the domain of one organization that it’s a real clear handoff and in other cases are the issues crosscutting and are more than one organization going to work together on those?        \n\nDr. Phillips: Yes to both of those questions. Some of them are not only clearly within one group’s wheelhouse but a couple of them were part of the agreements at the beginning. So the Health Information Technology group, for instance, the Academy stipulated that the focus on creating a new center for HIT, although that’s not what it was ultimately called, the groups had to agree that the Academy would own that center. Payment was also one of the original tactic teams and the Academy made it very clear that advocacy generally, but particularly around payment and a lot of the effort around payment, would be the Academy’s to take on. So those were the early requirements for participation. Other areas, there’s a kind of clear alignment. The research tactic team, a lot of its focus moves over to NAPCRG. And, in fact, that was the tactic team that had an organizational staff member move in to participate in the tactic team early so that they could really facilitate the transfer of those tactics on research. \n\nDr. Young: And does he now assume the chairmanship for the tactic team?\n\nDr. Phillips: For research, yes, I believe he has. \n\nDr. Young: And other areas?\n\nDr. Phillips: Other areas, some of them are more that are more diffused … The Engagement tactic team, other than the specific request that each organization consider having a patient or a public member on their board was the question of all the organizations. Two already had that but the rest of them were requested to consider it. Engagement there means with patients? Right, with patients. As opposed to other … Well, it was also engagement with policymakers and with other provider groups that would logically fit within FMA Health.    \n\nDr. Young: So it sounds like compared to at least some aspects of Future of Family Medicine that in this case even at the beginning there was some requirements that organizations had to agree to for what would happen to the work of tactic teams after they phased out. I’m just curious, given that these are all family medicine groups and therefore there is interest, one would think, at least, in the breadth of what family medicine does, are you seeing that an outcome is going to be more organizational cooperation or will most organizations still end up focusing on their main mission of why they exist?\n\nDr. Phillips: I think what you mean, Herb, they’re taking on the tactics or the work of FMA Health, will it change the organization?\n\nDr. Young: Well, no. The point I was making is at least in the one area I had some knowledge of there was in research staff interaction that formed after Generation of New Knowledge. And while there wasn’t necessarily engagement at higher levels there was, at least, it was called FROG (?) – and I can’t remember when it stands for now … But there were regular meetings of staff from STFM and NAPCRG and the Academy and so forth to try and keep each other informed on what was happening within research within those organizations and major issues. But it wasn’t engagement at the highest levels but at least it was continued interaction. As it turned out, it didn’t go on for many years.\n\nDr. Phillips: I think some of that is shaping up already. You know, even though NAPCRG has taken a leave (?) on the research tactic team transfer, there is recognition there that other organizations like the Academy and the Graham Center specifically and ABFM, that there will be some joint work in that research space. The practice team which is really collaborating with the payment right now, there’s a focus on measure development and measure work that will involve the ABFM but also involve other organizations. So there has been an effort to try and say, hey, who’s going to be the lead on this? Who’s going to be accountable for seeing that it gets done? But who’s also going to be involved or consultant in seeing that this tactic is carried out? So I think there’s a potential for that same kind of staff level collaboration. \n\nDr. Young: What’s the plan for assessing success in the future of this project?\n\nDr. Phillips: That’s a good question. With the handoffs, there’s not only that role responsibility declaration, there’s also an effort to develop the metrics for how the eight organizations will know if that tactic was executed faithfully. \n\nDr. Young: Can you elaborate a bit in terms of how that will work?\n\nDr. Phillips: So as someone assumes accountability for an effort being successfully implemented, they also have to agree to how are you going to evaluate how this was done and whether it was successful or not. And while it hasn’t been declared how that’s going to be communicated back to the other organizations, it is set up an expectation. \n\nDr. Young: So details yet to be worked out within the board on that aspect?\n\nDr. Phillips: Right. There will be some work in the last year of the FMA Health board to track on those and see how they’re being executed, but it hasn’t been decided yet how the Working Party or other collaboration will continue to track past then. \n\nDr. Young: What has been the interest and efforts and success or not in terms of this project interfacing with other primary care physician groups and other members of the health care system?\n\nDr. Phillips: It’s been limited. We had early on stakeholders from other organizations. The AARP had a representative on the engagement team but she left after the first year. We had internal medicine and pediatrics attend some of our stakeholder meetings, but never fully integrated. Where it’s been most successful is there have been several conferences. In fact, there has been something called the Starfield Conference, named after Barbara Starfield, a health services researcher from Hopkins who was so essential to creating the evidence-base for primary care. So the Starfield Conference series, we’ve had three of them. Most of them have been associated with one of the tactic teams. And that’s where we’ve had the greatest engagement of other specialties or clinician groups because they see those as something that we all own and that will probably continue past the end of FMA Health. The only other major stakeholder in this effort, because it was designed to try and be inviting for other funders to get involved – and CVS, the pharmacy chain, really has been our only major external funding partner.\n\nDr. Young: And why do you think they’re particularly interested?\n\nDr. Phillips: Well, I think they saw an opportunity to partner with us about how to improve access and timely health care. I think it certainly also had to do with the fact that they have set up a series of urgent care centers across the country. And they had a campaign that they launched around the same time. The theme was Health Is … It’s not primary – but, gosh, it was so close to our P.R. campaign. And not just in theme but in color scheme and design. It was very almost odd how it paralleled and actually kind of overtook our messaging. I thought one helpful thing it that they created advertising for Health Is Primary and FMA Health in all of their pharmacies with the goal of trying to help patients who come into the pharmacy recognize the value of creating a relationship with a primary care clinician. So I think they saw it as a way to strengthen the message that they wanted to convey already and to partner with the branding of our effort to try to communicate that further than they could have alone.\n\nDr. Young: And any success dealing with other non-physician clinicians?\n\nDr. Phillips: Not very much other than early on. No.\n\nDr. Young: Why do you think these faded? Because of the direction of FMA Health and its emphasis on family medicine or other issues within those other organizations or what?\n\nDr. Phillips: I don’t know entirely. I think some of it was that they weren’t really involved in the planning of the tactic teams, of related role definitions, even though that was part of our design. I think they still saw this as too much parochialism for family medicine and not truly being open to a more collaborative effort. One thing I didn’t mention is that the Patient-Centered Primary Care Collaborative, the PCPCC, which is actually a product of FFM where you do have a much broader stakeholder group, they did partner with us fairly well. And, in fact, we wound up funding them to support some of the partnership. That was probably the best venue we had for engaging other non-family medicine - both clinical groups and payer groups, patient groups.\n\nDr. Young: How was the relationship among the family medicine organizations that make up the board? Was it smooth or were there challenges or differences of opinions? \n\nDr. Phillips: Well, the board representatives, we were counseled and agreed to not represent our organizational interest but to really take on ownership of the board and the effort – and I think that was very successful. The eight organizations, from the very beginning there was a strong schism almost that of the organizations, its full intention and its funding were on the communications and P.R. strategy. They were very clear in saying they didn’t think that we needed a strategic planning process even though the other organizations did. And that’s where most of the other organizations’ funding went, was to the strategic planning process. And I think that was an important problem to start with because it meant that that organization was never fully invested in the strategic planning process and it created some difficulties with us, particularly around the payment tactic team, when the strategy they were handed to develop tactics for around comprehensive payment, when that large organization shifted its thinking about comprehensive payment. So there was a real conflict over what the team was tasked with developing and where the larger organization was focused on payment.\n\nDr. Young: Is this something that’s inevitable in a multi-organizational activity?\n\nDr. Phillips: No, I don’t think it is inevitable. I mean there will always be conflicts and disagreements. But I think if you don’t have initial fundamental buy-in by the groups to the overall plan, if there is a named and recognized conflict from the beginning, it makes it very difficult to work together to achieve the real mission of the effort.\n\nDr. Young: Do you think that five years from now, looking back, there’s some areas that you think will have been real successes and some other areas that will still be ones the groups are struggling with? \n\nDr. Phillips: Yes. And they are? I think there are some really important things that are coming out of the Health Information Technology tactic team. They particularly influenced … They created the new center at the American Academy of Family Physicians and also strongly influenced the American Board of Family Medicine to launch as a primary care registry and taking on the measured development work for primary care. And the related Starfield Conference, Starfield 3 around measured developed was an important outcome of the practice team. In what way? Well, organizing that conference helped develop what is now called the Larry A. Green Center for … I don’t know the full title, but measured development basically. It’s going to be a four to ten year functioning center that will work closely with the American Board of Family Medicine and other groups to do the work around developing primary care measures that matter. So I think that’s going to be a really important outcome of FMA Health. I think the workforce team probably struggles to get its tactics to a point of enactment. And they had initially planned to have a conference as well. I think they’re still planning to have a small summit. But the tactics coming out of that, it largely falls into the advocacy arena where the Academy would take lead. But it’s just not clear that those are implementable or desirable at this point.\n\nDr. Young: And when you say advocacy, who are the targets of that advocacy?\n\nDr. Phillips: Well, it could be around reforming graduate medical education. It could be around other efforts to favor primary care training. Things that would be signals for the next generation  \n\nof physicians that primary care was going to be a good place to work. So I think some of those advocacy related tactics, it’s not clear whether there is real appetite for moving them.\n\nDr. Young: A different sort of thought here: You’ve mentioned that what family physicians do in practice today is not the same as some years ago. How about the students into residents? Have they changed? And also would be a point to ask if you’d share a bit about your clinical activity now. But do they come out with different life expectations as they enter the profession?\n\nDr. Phillips: They do. The American Board of Family Medicine does a lot of data collection as residents are leaving training and then again three years out from training. We published an article in JAMA last year showing that those folks coming out of training have much bigger expectations about what they will be doing than currently practicing family physicians do. For example, a full 25% of them want to do O.B. and currently only about 7% of family physicians do O.B. When we ask folks who are three years out of training, at least what they tell us is that about 40% of them couldn’t find the scope of practice that they wanted to practice. And about as many say that lifestyle was part of that equation too. So I think lifestyle is an important issue, but if you can’t find what you’re looking for then my concern is that there may not be a strong passion to push against that and force the issue of it being a part of the scope of practice. It fits in well with the lifestyle then. \n\nDr. Young: Can you clarify? Are you saying that there’s a certain expectation of lifestyle, being\n\nable to raise a family, work only a certain number of hours, but the reality is if you want the full scope of practice you may not be able to gain that? Or am I missing what you’re saying?\n\nDr. Phillips: No, I’m saying the reverse – that if you can’t find the scope of practice that you’re looking for, it becomes okay because I do want to spend more time with my family and it’s amenable to lifestyle. If you can’t find that, you may not have as much incentive to fight to get it. That’s my concern. It’s easy to give that up if it’s not an expectation coming, if it’s not available to you when you come out.\n\nDr. Young: And you’re currently doing clinical work?\n\nDr. Phillips: I am. I still see patients one day a week in a community-based residency training program. \n\nDr. Young: And are you seeing changes there in terms of what is being taught or how … I realize that there are particular requirements for training in family medicine, but I imagine that there are different interpretations sometimes of that. Have you seen any difference in what the residents are doing in training over your time there?\n\nDr. Phillips: I have. Malpractice insurance rates doubled for us one year, even though we’d never had any claims. And it effectively took all of our faculty who did O.B. out of doing O.B. And so the residents O.B. training was exclusively with obstetricians. The managed Medicaid became financially untenable for our practice, so we don’t see managed Medicaid patients either. And the combination of those things means that our patient population is down to 4% of our total population and our residents are getting most of their pediatrics training out of pediatrics. So I see our graduates coming out now with a lot of continuity care for children, without having done any function O.B. for any of their patients and they just don’t have any expectation and, in fact, have some fear about doing either one of those in practice later. \n\nDr. Young: We’ll pause now to turn over the tape.\n\nTape 1, side 2\n\nDr. Young: This is side 2 of tape 1 of the November 9th, 2017 interview with Dr. Bob Phillips.\n\nDr. Phillips, let me ask this: What was the mission, the goal of the Family Medicine for America’s Health and was it able to achieve that goal?\n\nDr. Phillips: Well, the vision for FMA Health was to transform the health of our country, not just its medical care. And we said very clearly that a robust family medicine foundation was necessary to that but not sufficient and that we really needed to focus on integrating primary care, mental health, public health. So the decision was that while family medicine was leading this and funding this effort, the hope was that we could recruit more people into this space to help us with that bigger vision. And I think we really struggle to make it inviting enough for other people to either embrace the vision or join the effort, was part of our initial struggle. And I think we quickly got focused on the tactic teams and the particulars. I think it also depended on who volunteers and come to the effort and whether they embrace that bigger vision or are focused on the parts. And as you suggested earlier, I think the elected organizational leadership, there’s enough of a change and turnover in a five year project that people kind of forget and get not just focused on the particulars but are already thinking about what is their organization going to have to do in response to this. So I think we’ve lost some of that bigger vision. We have some time to revisit it, but I think the next year and a half will really tell whether the eight organizations are willing to hang with that vision again.\n\nDr. Young: And was there early on in the process a specific goal in terms of health in the United States?\n\nDr. Phillips: Well, that was our vision statement. It was that we were focused on improving the health of the nation, not just health care. But like I mentioned before, this was this schism that        one group thought that was fundamentally a communication and P.R. effort and the rest of the family thought this was a strategic opportunity. And I think that was also at the heart of the problem of tackling that bigger vision, that we had a fundamental difference of opinion and of funding what we were willing to fund in order to achieve that vision. \n\nDr. Young: What elements do you see as really bright points in the effort to this point and in the future?\n\nDr. Phillips: I think the brightest point are the people. The folks who have been willing to volunteer and hang with it for years on each of the tactic teams are a bright spot. We started with six tactic teams and added a seventh on health equity that really brought some important folks to the process with that particular focus on health equity that added a lot of energy at a needed time in the effort. And that group will continue to the end of the project and not end early. But I think we have stimulated a lot of young leaders who will remain invested in the tactics of the project for years to come. And, frankly, that was one of the best things that came out of FFM also.\n\nDr. Young: You mentioned the Starfield Conference and the fact that other at least medical specialties participated. Was it the leaders of those organizations or the people who are active in the sort of work that Barbara Starfield’s research examined?\n\nDr. Phillips: It’s more the young leaders of those organizations. So I agree that the Starfield Conference concept, it’s really an important outcome of FMA Health because I think it’s going  to give us the forum going forward where the primary care specialties can come together around particular topics. It’s a brand that I think they can rally around.\n\nDr. Young: And is it for sure planned to continue as a conference?\n\nDr. Phillips: We are certainly working to work with Barbara’s family to secure that opportunity, yes.\n\nDr. Young: And I’ve lost track – have we just had this year’s conference or is that coming up?\n\nDr. Phillips: We did. Just last month, in fact, the Starfield 3 Conference happened.\n\nDr. Young: And were you able to attend?\n\nDr. Phillips: Yes, I’ve been to all three Starfield Conferences. \n\nDr. Young: What’s your take home from this last one?\n\nDr. Phillips: This last one is that there is an opportunity to create more meaningful measures for primary care than we have currently. We learned a lot of lessons from the UK about the dangers of focusing on disease-specific measures as what is valuable in primary care. And I think that gave us the ammunition we need to really focus on it. And, also, it brought a lot of people to the table to think about how to continue developing those. \n\nDr. Young: And what sort of  measures are they if they’re not disease-specific?\n\nDr. Phillips: Measure around continuity and comprehensiveness, care coordination. And a lot of emphasis on patient reported outcomes, what they find valuable or problematic about health care. \n\nDr. Young: Is the managed care empire interested in these?\n\nDr. Phillips: There is some interest. We certainly have payers and health systems folks there. They are interested in those because there’s a … In the policy arena there’s increased interest in these kinds of measures and so I think they want to be involved with us in helping shape those measures rather than leave it to government.\n\nDr. Young: And was government there?\n\nDr. Phillips: Yes.\n\nDr. Young: Which parts?\n\nDr. Phillips: A number of the agencies that are involved in endorsing measures. So they were very keen to hear what we were thinking. And hopefully taking back that knowledge to their process? Yes, and creating ways for us to introduce those in a way they could hear it. Can you elaborate? Well, the Center for Medicaid/Medicare Services, CMS, it’s in charge of the Quality Payment Program. And the Quality Payment Program measures are largely designed to differentiate physicians because in a budget neutral payment arena there has to be winners and losers. The goal is not to get everybody to the same level of high quality. So when we are talking with them about creating new measures around continuity and comprehensiveness, we can help shift that conversation saying these are measures that are not about differentiating winners and losers. These measures are about achieving high value care because we have the evidence that continuity is associated with lower costs and better outcomes. So if we shift your thinking about the purpose of these measures and how you achieve high value care, it’s not by winners and losers, it’s about improving the functioning of primary care. And that was very well heard.\n\nDr. Young: Were other non-physician clinicians involved in the Starfield Conference?\n\nDr. Phillips: They were. We had nurses there, we had AARP there. We thought they were essential to that conversation. \n\nDr. Young: This indeed sounds like one of the successes looking forward in terms of what the Family Medicine for America’s Health has generated. \n\nAre there any other areas that we have not covered that you want to comment on?\n\nDr. Phillips: The only one I would comment on is on payment. I think the payment tactic team has an opportunity to leave us with something very bright and important and that is a payment calculator. The payment calculator has assumptions in it. But whether you’re focused on comprehensive payment or fee-for-service or population-based payment, you can dial up and dial down how those payments come in and what they’re paid for and what they support in the practice. And I think that tool will give us a mechanism going forward to figure out when new policies come out about payment, they can help us figure out whether that’s going to be good for family medicine or not. \n\nDr. Young: And is that a tool available beyond the specialty?\n\nDr. Phillips: It sure can be, yes. \n\nDr. Young: And what form does it take?\n\nDr. Phillips: It’s an electronic tool where, like I said, you can make adjustments to the payment streams and look at how it impacts primary care and the functions that are available there. So it’s a tool, I think, that will outlive FMA Health.\n\nDr. Young: Would subspecialists be able to use it for the same purpose of determining how things would impact their work?\n\nDr. Phillips: No, it would have to be tweaked to do that. \n\nDr. Young: One other comment I’d be curious to hear from you: One of the tactic teams was reaching out to various practices, volunteers, to do data gathering and testing. Are you familiar with that?\n\nDr. Phillips: You mean the Bright Spots group from … Yes. Can you talk a bit about that? You know, I can’t talk a lot about it. I know that they’re doing key informer interviews with those and some visits to those practices that are doing novel work and having good outcomes to try and learn from them about how they changed their practices, whose present, payment streams that are necessary and supported. But the goal is to give some real life examples to what the practice and payment teams are trying to achieve.\n\nDr. Young: And this is going out into the real world, so-to-speak? It’s going beyond the expertise of individuals on the tactic teams or any of the other people who have been involved at the beginning onward. Do you see that having any impact on practices that have been part of those?\n\nDr. Phillips: On the practices that were interviewed? Yes. I think it will have some impact on them to know that they were recognized as being Bright Spots. I think the larger potential impact is to give other practices some confidence that it’s possible to become one of those kinds of practices and perhaps some real evidence about how to get there.\n\nDr. Young: And how will that knowledge be disseminated?\n\nDr. Phillips: I know they’re planning to publish some of that work. And there’s also hope that they can develop a summit also, perhaps a Starfield Summit. That would be one of the focuses. \n\nDr. Young: And do you know if they’re thinking about integration to any of the meetings that occur, the Academy’s Assembly or the STFM – I think they’re still leading the Practice Improvement Conference? \n\nDr. Phillips: I don’t know specifically. But the leader of the Bright Spots effort is very active in the Academy, so that could be a venue for them to bring it out. \n\nDr. Young: Any other thoughts before we end?\n\nDr. Phillips: No, I think we’ve covered it fairly well.\n\nDr. Young: Alright. Dr. Phillips, thank you so much for taking time to share your experience and knowledge regarding FMA Health and on other related issues.\n\nDr. Phillips: Dr. Young, thank you so much for your time.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162279/file/295070#t=0.0,2466.2151"}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162279/file/295070/transcript/85364","type":"AnnotationPage","label":{"en":["Dr. Phillips Robert Interview Summary and Biography [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162279/file/295070/transcript/85364/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Phillips, Robert\n\nInterviewer: Dr. Herbert Young\n\nInterview Date: November 9th, 2017\n\nBiography\n\nDr. Phillips trained in family medicine and health services research at the University of Missouri which included a two-year fellowship after residency training where he did collaborations with the Robert Graham Center. He was then invited to spend a month with them and then received an invite to go to Washington D.C. as Assistant Director of the Robert Graham Center. He then spent four years there as assistant director and was asked to stay on as the director of the Graham Center, which he did for another eight years. And in 2012 he was moved over to the American Board of Family Medicine in the role that he currently holds. Dr. Phillips was instrumental in the conception and creation of FMAH. From the beginning he was part of the test groups, development teams, and planning groups that helped kickstart the FMAH initiative. Although some of the aspects of FMAH never panned out correctly, Dr. Phillips still thinks that initiatives like this FMAH are crucial in Family Medicine and health care.\n\nOral History Summary\n\nDr. Phillips has had a hand in many health care related projects, but being as the interview is focused around FMAH, he talks about his experiences with the pros and cons of that program. From inception, Dr. Phillips played a role in creating the FMAH initiative. However, a lack of vision, planning, and execution, as well as miscommunication, never made FMAH a huge success. Bureaucratic red tape is an issue that he thinks will hold back the profession from expanding. For the future, Dr. Phillips hopes to see a better representation in politics for Family Medicine. Additionally, he hopes that the current politics in Washington do not continue to have negative impacts on Family Medicine as a whole.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162279/file/295070#t=0.0,2466.2151"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162279/file/295069","type":"Canvas","label":{"en":["Media File 2 of 2 - PhillipsRobert_02_Access.mp3"]},"duration":800.226,"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/162279/file/295069/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162279/file/295069/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/069/original/PhillipsRobert_02_Access.mp3?1760561162","type":"Audio","format":"audio/mpeg","duration":800.226,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162279/file/295069","metadata":[]}]}],"annotations":[]}]}