{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/m32n58fn4s/manifest","type":"Manifest","label":{"en":["Dr. Rebecca Jaffe"]},"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":["Date"]},"value":{"en":["01-19-2023 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Crystal Bauer (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["video"]}},{"label":{"en":["Keyword"]},"value":{"en":["American Academy of Family Physicians","AAFP Foundation","family physician","family medicine"]}},{"label":{"en":["Subject"]},"value":{"en":["Rebecca Jaffe, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"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.\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/collection_resource_files/thumbnails/000/288/296/small/Jaffe_Rebecca_MD%281-24-23%29.mp4_1755698543.jpg?1755698544","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2376/collection_resources/158019/file/288296","type":"Canvas","label":{"en":["Media File 1 of 1 - Jaffe__Rebecca__MD_(1-24-23).mp4"]},"duration":2156.391,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/288/296/small/Jaffe_Rebecca_MD%281-24-23%29.mp4_1755698543.jpg?1755698544","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2376/collection_resources/158019/file/288296/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2376/collection_resources/158019/file/288296/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/288/296/original/Jaffe__Rebecca__MD_%281-24-23%29.mp4?1755698542","type":"Video","format":"video/mp4","duration":2156.391,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2376/collection_resources/158019/file/288296","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2376/collection_resources/158019/file/288296/transcript/83170","type":"AnnotationPage","label":{"en":["Dr. Rebecca Jaffe interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2376/collection_resources/158019/file/288296/transcript/83170/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Crystal Bauer: Good afternoon, I am here with AAFP Foundation past president Dr. Rebecca Jaffe. Dr. Jaffee, to confirm for the record, could you please state that you are aware that this is being recorded and you have signed a consent form from the Center for the History of Family Medicine and you're giving your permission to do this interview.\n\nRebecca Jaffe: I am aware that it is being recorded and I do give my permission for it to be recorded.\n\nCrystal Bauer: Wonderful. Well, let's get started. Becky, could you talk about your current work and what your present title is?\n\nRebecca Jaffe: Thanks, Crystal. Right now I am working for a national company called Aledade. Aledade is a company that supports independent practices in value-based contracts, starting with the Medicare Shared Savings Program and now layers in Medicare Advantage and other commercial contracts. I work for them as a Senior Medical Director, mentoring regional medical directors and conversations around value-based care with our clinician partners.\n\nCrystal Bauer: So that keeps you very busy, I'm sure.\n\nRebecca Jaffe: It has been an interesting ride after 30 years in private practice. Well, started at ACHC or a community health center, then went into private practice, and then to make a larger impact on supporting the safety net of health care, pivoted to a role with Aledade, hoping to continue to spread the joy of primary care and family medicine in a meaningful way. And Aledade allows me to still see patients so that I can maintain my authenticity. So a half day a week, actually, just before we started, I go and I see patients that I have served for many, many years.\n\nCrystal Bauer: That's wonderful. So going back before you were a physician and were considering medicine, could you tell me where you're from and where you grew up?\n\nRebecca Jaffe: Sure. I was born in New York City where my father was working on his PhD at the time. I did most of my formative years in a small town called Union, New Jersey, which is in North Jersey where I did grade school, elementary school, junior high school and high school. And then went on to Lehigh University in Bethlehem, Pennsylvania, who was participating in a six-year medical program, and so I spent two full years, summers included at Lehigh, and then went on to the Medical College of Pennsylvania to do my four full years of medical school.\n\nCrystal Bauer: Now, was that six-year program unusual for its time, or was that fairly common?\n\nRebecca Jaffe: It was the first of its kind back then. I don't know that they have six-year programs anymore. They have a few seven-year programs. It was a little too condensed to do it in six years, although I am grateful to have had that opportunity because I was very directed, as I will tell you later, to do medicine and primary care. So it seemed like the right fit for me.\n\nCrystal Bauer: Oh, good. So you went on to residency. Can you tell me a little bit about your residency experience?\n\nRebecca Jaffe: Sure. I was lucky enough to go to Wilmington, Delaware, where what was formally the Wilmington Medical Center, then it became the medical center of Delaware, and now it is called ChristianaCare. It wasn't the original 10, but it was in that second block of 10 residency programs across the country led by Dene Walters, who was just a wonderful mentor and really embraced family medicine in its scope and its depth in such a meaningful way making at least me want to do that depth and breadth of family medicine as well. So, so fortunate to have been exposed.\n\nBack then we had embedded behavioral health, something we're talking about again. I like to think of my medical experience as a pendulum that swings from side to side and sometimes amuse myself when I think that we had an embedded PhD clinical psychologist in our family medicine program back in the day, and now it has come back into vogue to embed clinical behavioral health back into that primary care setting where the patient can get the breadth of the care they need.\n\nCrystal Bauer: Wonderful. So it sounds like you were really inspired in med school and residency to go with family medicine. Are there particular individuals who inspired you in that time?\n\nRebecca Jaffe: My family medicine inspiration was actually my general practitioner growing up. He was in our town. He lived in a duplex. He lived in half of the duplex and his office was the other half of the duplex. And the door opened at","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2376/collection_resources/158019/file/288296#t=0.0,600.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2376/collection_resources/158019/file/288296/transcript/83170/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"AM and 1:00 PM and it was a first-come, first-served kind of situation. He had an X-ray machine, so when I fell and I thought I broke my arm, my mother could take me there and he could X-ray it and say, \"It's just a sprain. We'll do this.\" Or he could say, \"Yes, indeed, it's broken,\" and cast me right there at the office. In addition, he not only took care of me, he took care of my aunt, my mother, my grandmother. I distinctly remember him asking me questions once when I came to see him about my grandmother, asking about swelling in her legs and her arms.\n\nOf course it wasn't until I was in high school and college that I understood that he was asking me about heart failure symptoms and I didn't even know that she had had breast cancer and a mastectomy. And he was seeing if her lymphedema was worsening by asking me questions because she didn't necessarily come in as regularly as he would've liked. And putting those puzzle pieces together and solving them was just so intriguing to me, and I loved a lot of different things.\n\nI was planning to be an art major, a little bit of this, a little bit of that, and that's what family medicine provides. With my artistic bend, I thought, \"Well, maybe plastic surgery,\" and that was a fleeting thought because it's just one small sliver and really taking care of the breadth, it's been such a honor to take care of three, four, five generations of families and serve them in meaningful ways and support them during tough times and celebrate with them during happier times, and really understanding the dynamic to really help them navigate through the health care system with as few bumps as we possibly have to endure.\n\nCrystal Bauer: Well, it sounds like you had the perfect role model to get you interested in family medicine. So after residency, talk to me a little bit about what you wanted to do right after residency. What were you interested in?\n\nRebecca Jaffe: I wasn't quite sure, although I knew originally that I had to pay back my National Health Service core obligation. My father spaced children out so that he'd only have to pay for one education at a time. However, that did not account for graduate school. So in order to help with what now seems like a minimal financial burden, I decided to apply to the National Health Service Corps to help them pay for medical school and in return worked at a community health center in inner city Wilmington, where I did my residency to serve a population that I observed a little bit in residency, but really, until I was in that location, had no idea about some of the, what we now call, social determinants of health, and how affecting they can be on people's health.\n\nBut that education came quickly with that experience and with that my volunteerism. We created programs while I was at that CHC where some of the federally subsidized high rises where people really had difficulty just going two blocks down the road to come see us, we created a clinic. They gave us a room, and we created a clinic in the buildings so that we could provide care in a meaningful way for people who really had transportation as a barrier. And we got through the city a social worker who would come and work alongside us so that if there were people with food insecurities and other obstacles to getting care, we had partners to help us help the patients navigate what already was a complex system and now has evolved into an even more complex system.\n\nCrystal Bauer: Do you feel like your training to be a family physician perhaps prepared you more to deal with that population as opposed to maybe other paths to medicine or specialties?\n\nRebecca Jaffe: Of course I don't know what anyone else's experience is or was. However, I felt really prepared and supported in taking on that role right out of residency because we had preceptors in the residency program who were local docs. So if I encountered something that I had never seen before, they were kind enough to pick up the phone when I called and helped me navigate possible ways of helping these patients in meaningful ways using their years of experience and just my eyes and ears with not so much experience behind it. And so was never alone. I felt like there was a team behind me helping support the good work that the community health center was really trying to do.\n\nCrystal Bauer: That's great. So how long did you stay in that role? How long were you there for?\n\nRebecca Jaffe: I was there a little bit over two years. My obligation had expired and I don't know if it's a funny story, but I and the new head of that community health center butted heads a little bit. I had put in a request for $50 to get what back then were called Dextrostix because we didn't have glucometers. The only way we could get an idea of what someone's blood sugar was to stick their finger and put a drop of blood on the stick, and it gave us parameters as to what their blood sugar might be. And so I didn't think that to be an unreasonable request, although this person gave me much pushback and said that I should purchase it out of my own personal funds, that he didn't have it in the budget.\n\nAnd then ironically, a few weeks later, thousands of dollars worth of paneling got delivered to our office instead of his. And when that happened, being me, I called and challenged him because the invoice came along with the paneling. And so I said, \"You had thousands of dollars of paneling that the organization is paying for, yet for direct patient care you could not come up with $50. You asked me to pay for it.\" I brought it even to the newspaper and they ran an article on it and-\n\nCrystal Bauer: Wow.\n\nRebecca Jaffe: ... he told me at that point that I was easily replaceable and he was going to do that, and that I needed to find a different path than staying at the community health center. I then drew a circle because I wasn't supposed to practice within five miles of that community health center and found a place to establish my practice. And he went through three physicians. None of them stayed more than two months, and then he had to close down that site because nobody wanted to practice in this very compromised neighborhood.\n\nCrystal Bauer: Wow.\n\nRebecca Jaffe: Yeah. It was quite sad, and so many of those patients then had to take public transportation, which required two buses for them to come see me five plus miles away to get care.\n\nCrystal Bauer: Did you see a lot of your clients come to you, though, afterwards? They wanted to continue care with you so they made those sacrifices if they could to come see you, if possible.\n\nRebecca Jaffe: Yes. It was very disheartening because I knew how little they had, and it still costs money to take the bus, even though it is somewhat cost-effective. Filled out lots of paperwork for special transportation needs for so many of them and still did the best we could, but it was-\n\nCrystal Bauer: It was challenging.\n\nRebecca Jaffe: ... it was sad because without support and care, some of them lost their battles.\n\nCrystal Bauer: So what prompted you to open up your own practice? Is that something that you had been thinking about for a while, or was it that story and that pushback with that boss that prompted that?\n\nRebecca Jaffe: Yeah, I love practicing family medicine and holistic care, and if I could do it in the CHC, that was a population that really needed me. And if I couldn't do it there, then I needed to find some way to continue to see those people because there were people... Actually today I saw someone who I saw as a resident. They followed me to that CHC. They followed me into private practice, and even though my job only lets me see patients one half day a week, there are some people that have known me a very long time. So that continuity that Barbara Starfield talks about, continuous caring, really is meaningful for me and I think for my patients as well.\n\nCrystal Bauer: Absolutely. So you've been in private practice for the majority of your career as a family doctor. You've had some interesting experiences along the way. I understand that you were an Olympic volunteer physician. Could you tell me how that came about and that experience?\n\nRebecca Jaffe: Yeah, that was an exciting little offshoot for me. I did athletics in high school and a little bit in college, and it's family medicine, right? Part of the prevention is in exercise, and one of my preceptors was heavily into doing this, what was then called soft orthopedics, now called primary care sports medicine, before there were even fellowships available. And so took a number of my electives as a third year resident with orthopedic surgeons who took care of the Flyers and the Eagles and the Phillies, and went down and spent time in Virginia with the national shoulder expert, and went up to upstate New York to spend some time with a famous knee person and sort of put together a sports medicine profile.\n\nAnd the United States Olympic Committee was looking for volunteers to work in the training centers. So when one of our local physicians did it successfully, I was emboldened to apply myself and was fortunate enough to be chosen, and then chosen again. It's an evaluation project that goes forth. Then I got invited to what then was called National Festivals, where athletes from around the country came and participated in athletics with physicians like myself being there. Then after that, I think was the World University Games every so often. I think it's every four years, athletes from around the world compete, but only from the collegiate level.\n\nSo had the opportunity to go there, and then went to the Pan Am games, which was an unusual and really... I don't know if it was life-changing, but it was inspiring for me to go to Cuba and meet Fidel Castro in his palace, and to travel with the likes of George Steinbrenner, who was our field team leader for that trip. And then got the opportunity to travel with USA Basketball to Taiwan and hockey to Switzerland. And my last volunteer set was to the Olympic Games in Atlanta.\n\nCrystal Bauer: Wow, wonderful. So family medicine can take you anywhere, essentially.\n\nRebecca Jaffe: It can take you everywhere. What do you mean, anywhere? Everywhere.\n\nCrystal Bauer: Yes, exactly. Exactly. Well, I want to shift gears and talk about your involvement at the board level at different organizations. So I understand prior to serving on the AFP Foundation Board, you served on the American Academy of Family Physicians Board in 2012. Could you talk a little bit about your desire to join that board and your motivation for that?\n\nRebecca Jaffe: Sure. Well, family medicine obviously is something that is near and dear to me, and ensuring that family medicine and its value in the health care system is top of mind motivated me to seek leadership positions so that I could have a voice at the table. Especially as we saw more and more physicians going into academic medicine or health system medicine, I felt like the voice of the independent physician needed to be heard around the table as well. And so decided that I would see if those who have the ability to elect might give me the opportunity to serve.\n\nCrystal Bauer: Wonderful. Could you talk about your time serving on that board? Any key takeaways that you remember or recall?\n\nRebecca Jaffe: What an education. Well, so, the saying is, what happens in the boardroom stays in the boardroom. So therefore-\n\nCrystal Bauer: Understood.\n\nRebecca Jaffe: ... there are many a story I wish I could tell and am not able to tell because that is the credo. It gave me opportunities to learn and understand many points of view. And, like family medicine in general, there are so many different kinds of family physicians, those that just work in urgent care, those that just work in academia research. And everyone, rightfully so, wants the AAFP to support them in a meaningful way and understanding that all stakeholders should have a voice. And then the resources are finite and we have to make good decisions to use those resources in ways that are going to be meaningful, not only for family medicine, but for the communities where family medicine serves.\n\nCrystal Bauer: I understand you also served, and currently serve, on the Transfer Med board of directors. Could you talk about that?\n\nRebecca Jaffe: So Transfer Med is no longer. Transfer Med was a subsidiary of the AFP attempting to help primary care practices literally transform in this value-based care space early on. They had the right idea. It's just, primary care wasn't being reimbursed yet for all the effort it would take to transform the practices to do the right things. And so the AFP, after I was already off the board, made the decision to close it down, perhaps prematurely.\n\nAgain, I was not in the room, and so it gave opportunities for other businesses, including the company I work for, to recreate some of the work that Transfer Med started to help primary care reshift their thinking from sick care to well care, and really promote doing prevention, which is what I learned in residency and promoted from the beginning of my career. However, not all residencies were as foresighted as Dene Walters was with regard to that education, so others needed to catch up as the pay for performance, doing the right thing and making sure that follow-through happens, might occur.\n\nCrystal Bauer: Could you tell me a little bit about how you became familiar with the Foundation and your decision to run for a board position on the Foundation?\n\nRebecca Jaffe: Serving others feels like it is something that I watched my mother do throughout my life, and being of service to is something that I really value. And understanding that some of the political prominence of the AFP board was not necessarily the best direction for me, that supporting the good work in a meaningful way would be a better use of my time and talent, led me to decide that I wasn't even going to run for additional board hierarchy. That I was going to see if the Foundation might be a better place for me to spend time and energy bolstering the work of, I call them the seedlings, our students and residents, those that are going to be the family medicine leaders of the future, and support some of the great work of these free clinics that we have across the country. Again, really meaningful work for those. I mean, the cost of care is just ginormous, and if we can help in subsidizing that in any way, shape or form, it's so helpful to those that get that relief.\n\nCrystal Bauer: Well, and it sounds like at the beginning of your career you were involved in a similar clinic, so that it sounds like that has impacted you and followed you, in a way, to your Foundation time with that program.\n\nRebecca Jaffe: Yeah. Sure. There are certainly threads where being of service to and practicing holistic care in a meaningful way is a thread throughout my entire career. You are absolutely correct.\n\nCrystal Bauer: So why did you decide you wanted to be interested in the officer's track for the Foundation that would lead to your presidency?\n\nRebecca Jaffe: Well, I really feel like the Foundation, although some of our members are aware and understand, not all of them are. I was hoping to be able to leverage the opportunity to get out there and meet and inform and sort of rally the troops to support the Foundation in a meaningful way. Unfortunately, COVID got in the way and made for a less dramatic, impactful presidency year, and we can't look back. We did the best we could under the circumstances, and perhaps it might have been different and we'll never know because COVID came and COVID usurped all the time that I was serving.\n\nCrystal Bauer: So, yes, that obviously is the low point in that year of your presidency. Are there some high points that you can recall as far as the work of the Foundation in that year?\n\nRebecca Jaffe: Well, we did the best that we could. We didn't slow down. We just didn't accelerate the way I had hoped to. I think most of the work got done and people were still generous throughout the pandemic, even though primary care definitely got affected financially by the shift in visits and the fee for service world. So, highlights, I don't know. COVID these last three years has been a bit of a blur. All I know is that at least it didn't take us two steps backward. We were able to tread water and stay where we were and not have to recover like other organizations did during the time of the pandemic.\n\nCrystal Bauer: As a past president and somebody who served on multiple boards, could you talk about how these physicians have shaped you as a family physician and leader?\n\nRebecca Jaffe: Getting to meet family doctors across the country, whether it was through the AAFP or the AFP Foundation, or my current role at Aledade has been nothing but inspiring. We don't look alike. We don't talk alike and are caring for our communities and our patients are a thread that you could create this wonderful quilt of what family medicine is because of the meaningful work that is done for individuals, for families and communities across this country, and I guess with WONCA across the world. I think that really doing this kind of meaningful work and advocating that it still be front and center, we continue to live the consequences of a health care system that is still quite broken.\n\nAnd to have an advocate, a strong advocate for your care is a huge benefit in navigating the complexities and trying to raise as many people up as we can without pushing anyone down. I think that all too often, as a consequence of the pandemic, we see too much negativity, and I am hoping that the leadership roles that I have been able and lucky enough to embrace, have helped me understand that negativity doesn't help. It's being positive and always looking for solutions where everybody has something to give, something to gain, something to meaningfully contribute, ties that leadership experience and family medicine together for me in a wonderful way.\n\nCrystal Bauer: Well, Becky, you have led a very active and accomplished career so far and have contributed so much to the specialty of family medicine. Before we conclude this interview, is there anything that you would like to add that we didn't cover today?\n\nRebecca Jaffe: Wow. So if people hear this and are thinking, \"Should I do family medicine or something else?\" I think, and I don't know how it's all going to evolve, but doing great work as a family medicine doctor fills one with much positivity and joy. And to be smart about it. There are contracts and ways so that you can get reimbursed and compensated for what you do in a meaningful way and still be of service to people and communities and families. So spend time with an independent family doc and see what they do and how meaningful the work is and can be before you discount family medicine because it is a truly rewarding field in so many different ways.\n\nCrystal Bauer: Well, thank you so much, Becky, for taking the time to do this interview, and thank you for all the work you've done as a family doc and especially your work with the Foundation.\n\nRebecca Jaffe: Well, I thank you and the Center for the History of Family Medicine, another key component into learning from the past and making a really positive impact on our future.\n\nCrystal Bauer: Thank you.\n\nRebecca Jaffe: Thank you.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2376/collection_resources/158019/file/288296#t=600.0,2156.391"}]}]}]}