{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/q52f768795/manifest","type":"Manifest","label":{"en":["Dr. Jennifer Brull"]},"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\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 (summary)"]}},{"label":{"en":["Date"]},"value":{"en":["2017-07-26 (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":["Jennifer L. Brull, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"summary":{"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"]},"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/162451/file/295880","type":"Canvas","label":{"en":["Media File 1 of 1 - BrullJennifer_01_Access.mp3"]},"duration":3270.6693,"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/162451/file/295880/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162451/file/295880/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/880/original/BrullJennifer_01_Access.mp3?1761147925","type":"Audio","format":"audio/mpeg","duration":3270.6693,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162451/file/295880","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162451/file/295880/transcript/85514","type":"AnnotationPage","label":{"en":["Dr. Jennifer Brull interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162451/file/295880/transcript/85514/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Side 1\n\nThis is side 1 of tape 1 of the oral history of Dr. Jen Brull recorded on July 26, 2017. I’m Dr. Herbert Young, a volunteer at the Center for the History of Family Medicine. The topic for this recording is Family Medicine for America’s Health.\n\nDr. Brull, do we have your permission to record this interview?\n\nYou do.\n\nWhy don’t we start out asking if you would give us your name in full.\n\nMy full name is Jennifer Lynne Brull.\n\nCould you tell us a bit about your present title and position?\n\nIn regards to Family Medicine for America’s Health, I am the practicing physician board member. In real life I am a family medicine physician who practices in Plainville, Kansas where I’ve been for fifteen years, and I have a full scope family medicine practice here. I practice currently at 60% time and the other 40% of my time is dedicated to being the medical director for an independently owned primary care accountable care organization in the state of Kansas.\n\nAnd where did you do your training?\n\nI went to medical school in Kansas City at the University of Kansas Medical Center and I completed my family medicine residency training in Topeka, Kansas at a residency program that is no longer open.\n\nInteresting, my training also is from a residency program that’s closed here in Kansas City. Can you talk a bit about the practice where you are now?\n\nI grew up in a very small town further west of here, about 250 or 300 people, and my early exposure was obviously to a pretty small place. When I went to medical school there was and still is a program called the Kansas Medical Student Loan Program that paid for my years of schooling, including stipends, in exchange for the promise that I would return to a rural area of Kansas to practice primary care. Since I was pretty sure I wanted to be some sort of primary care provider and I sure wasn’t scared of rural areas, at a minimum for four years, that sounded like a good deal, so I signed up. And chose to go into family medicine and started my practicing years, spent eight months, very briefly, in the town of Hays as an employed physician and then am self-employed here in Plainville and I’ve have been here fifteen years. So I long ago paid off my loan program but still enjoy being here.\n\nCan you share a little bit about your practice currently – size and organization? Patient size, et cetera?\n\nYes, I always say that our group is very atypical from the inside but from the outside it looks like a multi-physician primary care group. I am actually a solo family medicine practitioner. I own my own practice and I’m the only provider in that tax ID number, but I partner with similar other folks who have their own tax ID numbers and we practice together in an organization that’s called Post Rock Family Medicine. It’s an organized health care agreement, so it allows us to share confidential information about patients in a way that’s approved by all in the medical field. So there are five family medicine physicians in our group and we all largely practice in the 60% to 100% time. Two of my partners are married to each other and practice part-time because they have brand new twins. One of my partners has been here for twenty-three years, I think, and is still full time. And then one of my partners has been here for just over ten years and practices full time. And then we partner with our hospital who owns a clinic and employs a nurse practitioner. And the hospital also owns an urgent care clinic that we help staff and partner with. So it’s a large warren of lots of different practices but from the outside it looks like a single specialty group with an urgent care clinic.\n\nAnd roughly what size geographic area are you serving? \n\nWe take care of Rooks County. We’re the only physicians, providers in Rooks County, so it’s a typical Kansas county. And then we have a draw from slightly further out from that because several of the counties on either side of us are primary care poor in their resources. So we do have patients that come about a five-county distribution, but the largest pull is from within our county. Our county is just a little under 5,000 people.\n\nAnd then finally, what is the economics like in your area? Who are the major employers? How do people make a living? \n\nSo the largest employer is the hospital and we partner with them. They have a little bit over 100 employees. The large industries are farming and oil. So we have oil that tends to be a lot bigger when the price of gas is up, so right now it’s down. And then farming is a large industry in my area. \n\nLet’s turn to Family Medicine for America’s Health. How did you get involved?\n\nI was at the AAFP meeting when Glen Stream announced its formation and goals. And as I sat at the lunch where he described this, I really felt energized about what FMAHealth was trying to do and how they were trying to do it. And sometimes there are just moments when you think, oh, I want to be a part of that, and that’s what I felt when I heard Glen talk. He had said, during his speech, that there would be a call for applicants for various board seats. I knew that I would not be any of the organizational board seats because they had already been selected and I was not in leadership in any of those boards. But he mentioned that there would be a practicing physician seat on the board and so I watched for the opportunity to apply for that. And I was very excited when he called me one night when I was on vacation and asked me if I wanted the job. And I thought that was great, I was very excited.  \n\nSo have you been on the board from the beginning of its organization?\n\nMy understanding is that the eight families met several times prior to my joining, but I was the first practicing physician representative to the board. Lauren Hughes was the early career physician and she came onto the board before me, as did Vince Keenan, who was the first chapter executive member. And then Lauren Kennedy, who was the first patient representative, came after me. But we were all in the first year of the board.\n\nWhat was it that Glen said that excited you?\n\nWell, he talked a lot about how Family Medicine for America’s Health was working to improve the health of all Americans. I think it’s very exciting to be a part of a project that is so nationwide. He also talked about how they were going to do that, which is by strengthening the specialty of family medicine, by increasing the exposure of people all over the United States to family medicine and explaining to them what we were trying to do, and about the teamwork that they were building with the tactical teams that were going to involve all these different family physicians from across the United States in all these different disciplines and from different backgrounds. And it sounded exciting and I was very excited about the tech portion of it, which I’m the Tactic Team liaison to the Tech Team, because I thought that technology is a good way to solve some of the problems we have. And I think from the very beginning the whole project just really made me energized. \n\nGiven where you practice, is it a surprise to you in terms of how the family physician is viewed or maybe not viewed in other parts of the nation?\n\nI think that those family physicians who are boots on the ground, that it’s my job to be their voice. Definitely have a different experience across the nation. In my area, I think for the largest part we are well thought of by our colleagues. And although not compensated fairly for the work we do in regards to other specialties, I don’t feel like insurance companies deliberately trod on us. I am aware, in talking to my colleagues in other parts of the country, particularly east coast and northeast, that that’s not the case and that our specialist colleagues can be not very welcoming or collaborative and that insurance companies to really strong-arm the payment structure. And so it’s interesting because a lot of times what you hear as the voice of practicing physicians are those people who are most concerned and most frustrated. And hearing their voices helps me remember that not everyone finds as much joy in practice as I do – and that’s part of what we’re trying to fix. \n\nSo clearly the specialty faces some challenges. Would you put government, along with specialists and insurance companies and I might say (?) employers, in terms of valuing the specialty, what’s your perspective for those other two groups?         \n\nName the groups again?\n\nYou’d mentioned, particularly going east, that other specialists beyond family medicine may not hold the specialty in quite the same regard and that insurance companies, in terms of payment, may likely not value family medicine in the same. And I was just adding on to that the people who often pay for health care, which is employers and government.\n\nI would say I’m a lot more stressed about government now than I was a year ago. I think that the Obama administration voiced a lot of support for primary care and I think it’s really unclear what’s going to happen with the Trump administration. I certainly have not felt that they have a focus or a value on primary care. So I think the jury is out in so many states with this administration. And I think employers, maybe not regional but even more local than that…so you have pockets in places where employers are partnering with direct primary care providers in ways that are innovative and they make sense and they’re lowering costs for everyone and still making good lives for the primary care providers to succeed and you have places where employers have no interest in engaging in that conversation, but they could be right next to each other in the same city. \n\nAnd then ultimately, of course, it’s patients. How do you think family medicine, locally you mentioned a little bit, but say regionally or nationally, from your work with Family Medicine for America’s Health and the information they’ve gathered – where do you see patients viewing family medicine?\n\nI will tell you I think the work that our Marketing Research Team has done is amazing. And I was surprised to learn, at a baseline, how positively family medicine is viewed and to learn how much of an increase in recognition of the job we do that we have had based on the response to the campaign. So I think that has been very positive and that we’ve seen really good things come out of that. I heard this week that the Health Is Primary Twitter feed has 25,000 followers. That’s great. That’s wonderful that something that started with nobody a couple of years ago now has 25,000 people who are at least nominally paying attention to what we have to say.\n\nSo comment, if you would, a bit more then on how Family Medicine for America’s Health is responding to the initial reasons it was formed, but also any comments regarding the ever-changing health care environment that we all live in.\n\nI think that Family Medicine for America’s Health has learned a lot, moving from the idealistic stage in the first year to the realistic stage that’s here. I’ll give Tech Team as an example because I know those tactics the best. I remember reading through the tactics and goals for the project at the beginning and thinking, oh, yes, we’re going to do this thing and this is going to be great and sort of realizing, as we walked the path, that there were some things that we were not going to have the capacity to do or the time to do and there were some things that we didn’t envision in the beginning that we needed to take the time and build a capacity to do. One example was, one of the goals was to build a center that all of the eight families of family medicine would use to sort of align with electronic health records and make them perfect. And very early we recognized that there have been a lot of people trying to do that for a long time and we were probably not the people who were going to fix electronic health records. And so out of that really came a document that was published this year. It’s a written document in which the Tech Team spent time thinking about if we could leap forward in time to where technology around health made sense in an actionable way both at the individual and the population health level, what would that world look like and what would we be doing differently at one year, three years, five years, seven years, ten years, so that we would know we were on the path towards health technology that makes sense. And we wrote that visioning document and we published it and now the metrics that we are getting ready to hand off at the end of this year are all around what can we get accomplished in the next eighteen months towards that improved vision. And recognizing that by the time we get eighteen more months down the road or five years down the road the target may have changed again because technology will have changed and our vision of things will change and the payer system will change and we may not have been able to envision how far in that direction it’s going to go.\n\nAnd when you say technology, are you speaking of primarily information services records or broader than that? \n\nBroader, absolutely. So everything from how or why or does the Fit Bit that I’m wearing on my wrist interact with my primary care team and give them information that’s actionable and meaningful, right? So how does what I buy at the grocery store reflect on whether I’m going to get diabetes? How does my zip code determine my risk for future trauma or disease? So really, really broad. And trying to find a way where we can take all of the sources of information that we have available and not just flood some poor primary care provider with a thousand inbox messages but develop for them a sense of population health. So one of our pie in the sky goals is if you could provide every primary care provider with a list of three patients they should be worried about today based on all of this data that’s available, wouldn’t that be a wonderful thing? If every morning I log in and it says, hey, you’ve got to worry about Bill and Judy and Sam today because here’s all this data that tells us that something has changed for them and it’s not changing for the good. And then I could have my care management team reach out to those people and we can hopefully impact their lives in a positive way at the right moment in time. \n\nAs this group developed these ideas and vision, were they working with the rest of the health care system, so to speak, with the companies that have electronic health records and ancillary technology or is this you all speaking from your personal expertise and experience?\n\nWe did a visioning summit and invited some influential folks from across the technology spectrum and held it in Washington, DC and that was the seed that germinated the vision document. So that’s kind of where it started. We have two events planned this year, both are designed to really reach out to not so much electronic health record vendors because, again, we’ve decided that it’s not within our scope or ability or capacity to fix electronic health records and we really see that there’s going to be a leap and they may or may not come along on that journey. But to reach out to vendors who are looking into developing new things that will allow us to predict this how (?). So it’s FMX in San Antonio. At FMX we’re going to have a Shark Tank-like event and invite vendors to come and promo their health tech-related things and have a judging panel and an audience. And hopefully the interaction is a win for both groups, right? It’s a win for the vendors who get real, live feedback about where they’re on and where they’re off with their ideas and it’s a win for the primary care providers in the audience who get to see a vision of what might be and see forward into that future. The second event that we have is going to be at the STFM, I think it’s called CPI Conference, where we are going to work with conference participants around some particular conversations with that source and vendor. And the event is still not formed, so I hesitate to say because we’ve talked today and have three ideas about what we might do. But the idea being connecting physicians to people who are developing new ways, innovative ways, and having that be a mutually beneficial relationship. \n\nWas that STFM Conference on Practice Improvement? \n\nYes.\n\nI’m smiling because I was involved in the first of those when it was the Conference on Patient Education and the leader on it was Dr. John Renner who was very innovative - and I’m sure he’s smiling in heaven now as he hears about the direction that the conference has been able to go because he was early into computers and population health and so forth. \n\nBut let’s get back to you. You mentioned that you hadn’t been in leadership in any organizations, like some of the other board members were selected on that basis. But are you active in any organizations beyond the Academy or within the Academy, any particular areas?\n\nOh, sure. In Kansas I was in the leadership chain and I was the President in 2010-2011. I am currently the senior delegate to the AAFP from Kansas. I think I probably cut my teeth on leadership at what is now NCCL which was then NCSC and got involved as a new physician there and was a new physician delegate to Congress and really loved that. So I’ve done quite a bit with AAFP and with the Kansas Academy of Family Physicians. And I don’t know that you want a resume, but certainly have done other leadership within the field of medicine – just not in any of the other families of family medicine.\n\nBut with rural health organizations or other organizations?\n\nLocal things really. Not any of the national stuff. Probably the most germane is that I was on the board and then chaired the board for a couple of years of the Kansas Foundation for Medical Care, which is the quality improvement organization. So I got to work with a lot of primary care providers across the state in trying to help them improve their quality.\n\nCan you think of other knowledge or skills that you’ve brought to the board on this project?\n\nThere’s a couple of things that I was able to bring, one, I still practice medicine every week and I really love technology. So it’s very fun to get to bring that voice of “I don’t think that would work because of” or “I do think that would work because of” to the Tech Team, which is nice. On the board I think that I get to be that grounding voice about how is this going to sound to practicing physicians and what are they going to think if we do X, Y or Z. Because there aren’t a lot of folks – Mike Tuggy is practicing now, but there just aren’t a lot of folks who do that as their day job anymore. And then I think the other part of what I’ve been able to spin into the story is I was a very early adopter of practice-based quality improvement initiatives. Starting, I think 2004 is the earliest I can remember having done a quality initiative within my practice that was partnered with someone external to my practice and who does quality improvement. And really love the process of performance improvement as it applies to both the quality of care we take of our patients, but also the workflow and how we provide that care. And I think that has been a skill that I’ve been able to bring to the way we think about things on the board and the way that we think about things within the Tactic Team.\n\nYou’ve referenced your practice team previously. Can you talk a little bit about your vision of how a practice ideally works and maximizes the opportunities that are coming along?\n\nI think I’ve learned a lot over the years. So when I started I would have said that my practice team was my nurse and I, who I still have my original nurse after sixteen years. I think we’re going to play a game of chicken about who’s going to quit first. But I would have said that she was my practice team. And we used to carpool together from another town and we would, on the way to and from work, talk about nothing but how we could do things better the next day. We’re both perfectionists and are really particular and really want things to go well. And so we would talk a lot about how things could go better, more efficiently, higher quality, how we could get more things done. And then as we added to our team, as I got busier, she is now part-time, but I have a total of three nurses, one full-time, two part-time, so they’re part of my team. And when we did PCMH about four years ago, I think I recognized that there were people outside of nurses and doctors who could be part of that team and so we began adding our front office staff who are multi-taskers, how they could help us in the way that we deliver care to our patients. And then in the last couple of years becoming part of this Accountable Care Organization, we were asked very strongly by our partners to hire someone that’s called a care manager. We didn’t even know what that was or what they did.  But it was a wonderful case of happenstance that we knew a social worker who was transitioning, looking for a job. We had no idea how we were going to afford a full-time social worker, what we were going to do with this person in our practice. But we had some funds from the ACO partnership that we could take the risk and hire her. So she worked for us for a year before we decided we needed a second care manager. So we hired an RN who is our second care manager and they are an amazing team. And to be honest, we probably need a third, but I don’t know that we’re quite ready to go there. They have done a fabulous job of making us realize how well we can partner with our patients to improve their quality of care and their experience of care. And we have had some amazing breakthroughs of patients that have just been really frustrating and challenging in the past and now are some of our best success stories just because we’ve been able to invest more heavily in the social determinants of health. Our social worker knows how to get medications for less money, utilities for less money, transportation, housing, enrollment in Medicaid. I mean all of these things that nobody in our practice had the skills or the time to do, she is a phenom at doing. And our RN care manager turns out has this hidden skill around partnering with patients on goal setting and getting them to understanding what their goals are and helping align their goals with better health in ways that gets us increased outcomes. So our hemoglobin A1Cs when she starts talking to them about diabetes. So it’s just been amazing. So I would say that my care team, at this point, is pretty much everybody in the whole office because they’re all part of the vision that we are doing the right thing for the patient at the right time all of the time. And I think it just took this long to get there and understand that it was affordable to do this. And not only is it affordable but it’s probably going to wind up generating a really nice income if we generate shared savings as part of it.      \n\nIs this something that residents can learn in their training or something that you have to go out and be doing it like you have?\n\nOh, I think residents could absolutely learn. So as part of my residency training I learned that…and we had nurse practitioners and PAs who practiced alongside us. And to be honest, they were kind of the workhorses of the practice. Like they filled in all the gaps. When the resident wasn’t there, they saw the resident’s patients. Those sorts of things. And so I learned very early in my training that our allied health professionals as partners were really important parts of the team. I definitely think I got trained in residency that my nurse was part of my team. And if you had a good nurse who knew your patients, your care was going to be superior to the residents who did not have a good nurse or who didn’t partner well with their nurse. When you make your nurse angry, bad things happen. We had a psychiatrist in my practice and I definitely understood the value of having someone who you could walk down the hall and say I need help with this patient. And so I would say that I got that model in my program. It’s just no one envisioned care managers back in the late 1990s. Like I don’t think it was there. If someone did, they were way ahead of where we were. But I think seeing the care team in action in residency is the best place to learn it because when you’re ten years out in practice it’s really hard to change your habits and to believe that you can afford to change your habits and that it’s going to work out and it’s okay to let go of some of that degree of control. So I think strongly. I teach med students, they rotate with me on a pretty regular basis, and that is absolutely part of what I try to teach them - it is critical to have a team of people who help your patients because if you’re going to try to do it all yourself, you’re going to get way burned out way fast. \n\nCan you just clarify the nurse practitioners and others that you mentioned during your training were full-time employees? \n\nRight. \n\nOkay – as opposed to training at the same time with you? \n\nRight, they were full-time employees in the practice. I had a community-based residency program. Although in our practice here we have actually piloted, and still do, we train PAs and MD students side-by-side. So oftentimes one of my partners will be precepting an MD student and I’ll be precepting a PA student - and they are wonderful co-learners.   \n\nThinking again about this as a national project, how can you in Family Medicine for America’s Health help in terms of the physicians in practice who ideally are recognizing that they need to change their model of care? How is that addressed by the program either now and/or in the future?\n\nWell, I would absolutely defer that question to people on other tactic teams who know way more than I do. But I would point you toward the folks who are doing the translation to practice work and the calculator work that is really designed to help practicing physicians understand that they can do this, that this model works, and that it would work for them financially. Which I think is the hardest thing, right? When you earn your own money and you’re responsible for paying all these employees that you have, it’s really hard to just take a leap of faith into the void thinking that it will work out somehow. \n\nSo the business aspect of care for at least physicians in situations like yours is clearly still a major reality. And so the groups that are at work finding where it has worked and able to provide that as a model is very helpful?\n\nYes. And that is what the folks on the Practice and Payment Teams are doing.\n\nSo the real world is out there in the sense of a positive. The real world is out there, it’s being discovered, and then will be promulgated somehow?\n\nExactly. So they are looking at folks across the spectrum. So they’ve looked at people who are already doing it and doing well and how did they get there. They’re looking at people who are in the process of doing it and finding out what path they’re doing. They’re looking at people who are contemplative and people who are not even ready to think about it. And really trying to develop resources for each group so that no matter where you are in your stages of readiness, there is information available for you to be thoughtful about. And I think they’re calling it the Pathways to Transformation Project. And again, I apologize. I’m not on that Tactic Team so I only know the overarching things as a board member. But those are the folks who are doing just that.\n\nPart of our oral history project, we’ll be talking with the chairs of each of the core teams. So we’ll have an opportunity to learn more.\n\nYeah, Jason Marker and Tom Weida will be able to tell you lots about that. \n\nI’m sure they will!\n\nThink about where we are again as a nation and the directions, which may be more than one, that we seem to be heading. Are you optimistic, pessimistic, somewhere in-between?\n\nI am almost always a glass-half-full person, so I would say that I am very optimistic that Family Medicine for America’s Health has made a difference and has fulfilled many of the things that it set out to do in the beginning. I think that the world changes around so-and-so while we know what looks like a perfect plan at the beginning of five years, the climate changes and you have to be willing to modify and change and think through. And I think we’ve done a pretty good job of doing that. So I think that even though goals have changed, it’s been changes that make sense, given what has changed around us. I think that the only part of me that is pessimistic is around the current administration and the uncertainty of what the next thing will be that comes from that administration. And it’s not about any specific thing, just the concern that something will happen that we will not expect that will dramatically impact what we’re trying to do.\n\nAs you think of Family Medicine for America’s Health and the various groups that you all have either worked with, and that could be at the tactic team level, the core team level, or at the board level, are there any groups that you all thought you should embrace, bring into the project, whatever, or others that now downstream in the project are beginning to come to the fore and saying, oh, we really should have been working with them two years ago?\n\nI think that there has been a lot of debate about who’s in and who’s out and why they would be in or why they would be out of Family Medicine for America’s Health. And I think there is still tension among the primary care folks in the U.S. So I think it depends on who you talk to and when you talk to them. But certainly internal medicine, nurse practitioners, physician assistants are all people that I would have loved to have held hands and sung Kumbaya with, but I understand that there are politics that make that challenging. I think one of the biggest successes in this is working with our osteopathic colleagues who I think really felt like they were brought to the table fully. And I know that I have a better understanding of their path, their scope, their specialty, things that they can do that I can’t do and the ways that we can collaborate with each other. And I think that’s a success story. I would hope that Paul Martin would say the same thing. But I think that’s an area where we said we would really like to work with you and we really did work with them and still are.\n\nAnd how about others that have impact on the health care system but may not themselves be clinicians; for example, integrated healthcare systems?\n\nI think that there’s been good participation. The tactic teams have a pretty broad reach and a pretty diverse membership, so I think we’ve done pretty well about being intentional in including lots of folks from different groups. I think the group that I was most surprised by is our patient voice. And I know that when I started this, in general if you told me you should have a patient voice on your board X, and I have served on a number of boards…but if you said on any of those boards, you should have a patient voice on that board, I would have had a lot of hesitancy. And not so much because I didn’t want a patient to speak out but because I would have felt that it might have been awkward or that their focus may have been limited or that their understanding may have been. It might have been hard for them to understand what we were trying to do because they don’t speak the speak and live the life. And I think in my own understanding one of the biggest surprises that I’ve had is how important, critical, hearing the patient voice is for a board. And one of the Engagement Team’s mission is to get a patient on the board of all of the families of family medicine boards. And I have been watching as several boards have pushed back hard. Several boards have embraced the concept. And through my own experience with Lauren Birchfield Kennedy, who was our first patient voice, and Diane Stollenwerk, who is our second patient voice, and the ability for them to be so articulate about the patient’s perspective in what we are trying to do and helping us to be considerate of that perspective, I’m blown away and I am a true advocate for hearing the voice of the patient in organized medicine.\n\nIs that message also being carried to the practice level in any of the discussions?\n\nI do not think it is translated to the practice level. But I don’t know, we’ll see, it may start at grassroots and work its way up or it may start at the top and work its way down. You know, again, I think so many people are like I was which is sort of adverse to the idea but without being able to tell you why they were averse to the idea. So I think it’s going to take some time to work its way through and for people to see it’s happening and that it’s a good thing, that it is a worthwhile thing. I can tell you, my own hospital started a patient advisory board because they felt like it was important. And they said we don’t even know what we’re doing but we’re going to put this together and we’re going to see what we get out of it. And I think they’ve had some really nice things out of it as far as getting feedback about specific things that they’re trying to communicate to the community and trying to understand why people don’t understand what they’re trying to tell them. So I don’t know, I think it may go both directions. We may see some from the grassroots and some from leadership and hopefully we’ll meet in the middle.\n\nIt’s certainly a concept that has been around for a while. And I’m thinking of Milt Seifert in Minnesota. In his case, his salary was even set by his so-called advisory board. But at lower levels of intensity, the residency program in Madison, Wisconsin at the university had a patient advisory board that included physician and non-physician staff, residents. And patients were the most unique input that one could ever imagine. But it would sound like your patient voices, your two board members have operated at a fairly high level within the organizations?\n\nYes, absolutely. So Diane, one of the hats she wears is her business is actually teaching patients how to be good board members and how to take that broad view. So it’s very, very interesting. They are not physicians and it is really interesting to be thinking in one direction as a physician, to listen to their thoughts and feedback and comments about what we are discussing. And you just feel your paradigm change as you look at it from the perspective, from someone else’s eyes, and it has changed my mind on more than one occasion based on their feedback.\n\nLook to the future now. You mentioned that the core teams have been developing their various products and knowledge. What’s the handoff going to be like?\n\nSo about half the core teams are handing off at the end of this year and then about the other half at the end of next year and the board will continue through May of ’19. We’re starting with the ramp-up, then the maintain, and then we’re doing the deceleration. Handoffs are going to be really intentional because we do not want the work that people have done to get lost. So the Tech Team has developed three working agreements, is what they’re called. And the working agreements are an intentional handoff of a job or series of jobs with metrics to an organization. So we will have handoffs to AAFP, ABFM and STFM. And they’re very clear. They say by X date ABFM will meet X metrics and both the tactic teams have to agree that that’s the metrics we want set, the FMAHealth board has to approve it and the ABFM has to say, yes, we will do it. Then those metrics will get reported back to the FMAHealth board. So there’s a closed loop of expectations set and metrics met.\n\nSo is this commitment by these organizations of resources, including staff time?\n\nCorrect. And we tried to align them. So, for example, on the Tech Team there are a lot of things that ABFM and AAFP already have. It’s not necessarily absolute to do different things, but it might be asked for them to do them sooner or in a slightly different way and then to be held accountable for having done them. \n\nHow familiar are you with the prior Future of Family Medicine Project?\n\nI was, I think, in residency and so very, very little.\n\nAnd I ask it because some of the objective criticism in terms of how Future of Family Medicine Project worked after it terminated was the issues that you’ve identified, I think, for carrying forward with Family Medicine for America’s Health to assure that what people have said they would do will continue or that there is more definition to what it is that needs to be done and how it would continue. But was that one of the issues discussed by the board?\n\nYou know, not so much in comparison but that we wanted to make sure that work we had planned did not get left undone. And some of the tactic teams are phasing off a year sooner than expected and so I think those folks in particular felt that it was really important to have a plan.\n\nAnd why are they handing off earlier than originally expected?\n\nThere was a request from the Working Party to do so in an effort to direct funds in a different direction. So some of the money that had been allocated toward supporting the tactic teams would be reallocated towards priorities that they felt were more important.\n\nSo it wasn’t necessarily that the organizations that are going to continue as organizations to achieve the goals of the tactic teams were chomping at the bit and wanting to jump in right away?\n\nI think there was some of that though. I know, in particular, I was told that the Research Team being probably the most integrated team we have and I think that they were already in a semi-mode of – you know, it’s hard to tell whether it’s me as a tactic team doing this or me as a representative of my organization doing this. And so I think there was some recognition that we probably already were doing things like that and it made sense to look at what we could do. So some of the teams are not handing off and that was a direct evaluation by FMAHealth board saying who do we need the teams to stay together - because the work of the teams really can’t be handed off to any one organization and handing off to multiples is probably going to lead to some problems in getting the work accomplished - and which teams does it make sense that there’s one main organization or there are a couple of main organizations or the tasks are dividable. So it really became a sorting exercise to figure out how we could best accomplish what we wanted to and still meet the request for the fund check. \n\nWhat would you like to say as we come to the end of our time together?\n\nThe one note I made for myself is that I think one of the things that I was surprised at as someone who has not been a member of the board level or executive leadership at any of these organizations was that all eight family medicine organizations don’t hold hands and sing Kumbaya and that there are politics among the family of families that I didn’t anticipate. I also think that I didn’t even understand all of the wonderful faces of the organizations outside of the AAFP and ABFM who I was most familiar with. And so part of my most favorite experience of being on this board is having met and built relationships with and have a greater understanding of the world outside of AAFP, which is really my largest exposure and it’s a wonderful organization. But to have met people who think outside of those walls has been professionally very satisfying for me. And the folks who participate on this board just give of themselves endlessly and I’ve really loved building relationships with them. So I think that’s been one of my favorite things, really learning more about the structure of family medicine in the United States and a little bit in Canada (we have a little bit of those folks) and how it relates to each other and how I relate to all of those organizations. \n\nAnd you’ve been able to figure out how to fit this work in, in the middle of what sounds like a very, very busy clinical practice.\n\nI am so grateful for my life partner who hangs out with my kids when I am on the road and for my business partners who really take care of my patients when I’m not here. So it’s been a good fit. It does involve some crazy travel sometimes but it’s fun and it’s so worthwhile. I have never gone to a meeting and wondered why I was there.\n\nI have to ask - from where you live what airport do you use?         \n\nI use one of five airports depending on which direction I’m flying. So if I’m flying west now, with just a couple of hops I only have to drive twenty-five miles and I can usually fly out. Flying back is sometimes trouble. Otherwise it’s about three or four hours to either Kansas City, Wichita, Manhattan or Denver.\n\nWhat’s twenty-five miles away?\n\nHays, Kansas. There is a once-a-day flight from Hays to Denver, so if I can catch that flight, if the timing works out and I can catch it. Usually I can get one out. That’s usually not a problem. It’s coming back because the flights on the weekends are really challenging. So sometimes I could come back but I’d have to stay an extra day or something and so I’ll just go to Denver and drive after that. \n\nI appreciate that you’ve been able to take time from your busy practice to do this oral history and look forward to having another interview with you approximately five years from now. The way they’ve set this up is they wanted some while-it’s-happening interviews and then the usual oral history of looking back. \n\nGreat. Well, this has been fun.\n\n(End)","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162451/file/295880#t=0.0,3270.6693"}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162451/file/295880/transcript/85515","type":"AnnotationPage","label":{"en":["Dr. Brull information sheet [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162451/file/295880/transcript/85515/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Brull, Jennifer L. (19\n\nInterviewer: Dr. Herbert Young\n\nInterview Date: July 26th, 2017\n\nBiography\n\nDr. Brull grew up in a small town in Central Kansas. She attended the University of Kansas Medical Center for her medical degree. Under a, now dissolved, program called the Kansas Medical Student Loan Program she was able to go to medical school and have it all paid for. The only catch was that she had to return to the rural areas to practice. She knew she loved the rural areas from where she was raised so she headed to Plainville, KS after graduation. She currently practices in the Plainville area for a small population of folks. She owns her own practice and works alongside four other physicians, but she is the sole owner of the clinic. In her time away from the practice she became a part of the AAFP and then more recently the FMAH as a practicing physician on the board. She has won a few national awards for outstanding physician in a variety of areas. She says that she loves working with new physicians in her internship positions. \n\nOral History Summary\n\nIn her Oral History, Dr. Brull speaks about her time in rural medicine and how her childhood influenced her to move back to rural Kansas and practice. She expresses some concerns with the current politics of medicine and how the field as a whole is confused by current policies and stances. Additionally, she says that social media and Twitter specifically can be huge in marketing and getting information to people about the Family Medicine specialty. Also, she talks extensively about her commitment and activities in FMAH as well as the things that drive her to be a more complete physician.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162451/file/295880#t=0.0,3270.6693"}]}]}]}