{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/rb6vx0844f/manifest","type":"Manifest","label":{"en":["Dr. Ted Epperly "]},"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. Epperly informs us about his back story to becoming a physician and the trauma as a child that led him on that path. From there he briefly talks about his education in Utah and then Medical school in Washington. A large portion of his interview is spent talking about his career history and FMAH. Through his career he was in the military for decades and upon leaving the service he realized the extent of the issues in the health care system. From there, he was dedicated to helping solve the problems in the health care realm so he moved to his various positions on the political side of medicine, one of those organizations was the AAFP and FMAH.  \u003c/p\u003e (summary)"]}},{"label":{"en":["Date"]},"value":{"en":["2018-11-21 (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":["Ted Epperly, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"summary":{"en":["\u003cp\u003eDr. Epperly informs us about his back story to becoming a physician and the trauma as a child that led him on that path. From there he briefly talks about his education in Utah and then Medical school in Washington. A large portion of his interview is spent talking about his career history and FMAH. Through his career he was in the military for decades and upon leaving the service he realized the extent of the issues in the health care system. From there, he was dedicated to helping solve the problems in the health care realm so he moved to his various positions on the political side of medicine, one of those organizations was the AAFP and FMAH. \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/160196/file/291685","type":"Canvas","label":{"en":["Media File 1 of 3 - EpperlyTed1_01_Access.mp3"]},"duration":1855.2402,"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/160196/file/291685/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/160196/file/291685/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/291/685/original/EpperlyTed1_01_Access.mp3?1758122881","type":"Audio","format":"audio/mpeg","duration":1855.2402,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/160196/file/291685","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/160196/file/291685/transcript/84351","type":"AnnotationPage","label":{"en":["Dr. Ted Epperly Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/160196/file/291685/transcript/84351/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Side 1, tape 1\n\nDr. Young: This is side 1 of tape 1 of the Oral History of Dr. Ted Epperly, the leader of the Engagement Core Team for Family Medicine for America’s Health. I’m Dr. Herbert Young, a volunteer at The Center for the History of Family Medicine. This recording is being made on November 21, 2018.\n\nDr. Epperly, welcome. Do we have your permission to record this interview?\n\nDr. Epperly: Yes, you have a full permission to record the interview.\n\nDr. Young: Could we start out, Ted, with your name in full and what your present title and position is?\n\nDr. Epperly: Yes. My name is Ted Epperly and I’m a family physician in Boise, Idaho. My title is and position is that I’m the president and CEO of the Family Medicine Residency of Idaho. That is a teaching health center which is a combination of both a family medicine residency program and a federally-qualified health center. So we have four family medicine residency programs here in southwestern Idaho and nine clinic sites of our federally-qualified health center. And we find that the combination of education and service are a wonderful mission mix in regards to training future family physicians and meeting the needs of the underserved.\n\nDr. Young: And you’ve been at this for quite a while?\n\nDr. Epperly: Right. I’ve been in family medicine education for thirty-eight years. And I was born and raised in Idaho, so it was great to get back to my home state. But I’ve been doing this particular job now for seventeen years.\n\nDr. Young: And what caused you to go into family medicine?\n\nDr. Epperly: Right. Really my journey into medicine began with the death of my sister. I was fifteen years old at the time, she was four. She was born in 1965 with congenital rubella and died four years later undergoing experimental heart surgery to try to correct transposition of the great vessels. And my father called me and told me to let my brothers and sisters know because I was the oldest of five. And I told my dad on that phone call, on the spot, Herb, that I wanted to be a physician. I never had given that a thought before that time. Nobody on either side of my family had ever become a physician. But with death my life opened, it started. Her door closed, my door opened and I was laser-focused into medicine. I got accepted to medicine at the University of Washington which was the regional medical school for my state. Idaho didn’t have a medical school back in 1976 when I started. And I initially wanted to be a surgeon because of my sister’s journey. But as I went through my rotations, I absolutely fell in love with family medicine. And, in fact, on my general surgical rotation I asked my preceptor, one of the general surgeons, I said, gee, is this all you do? And he looked at me and said, yeah, thyroidectomies, appendectomies, inguinal hernias and gallbladders, that’s kind of my day. And he said, gee, Ted, if you want to be a more broad scope physician, a real doctor, you ought to be a family doctor. And that had a lot of impact on me. And it was absolutely the right call for me. I’m a very open type of physician that recognizes that it’s the whole person and the whole family we’re caring for. It is relationships of trust built over time. It was the perfect model for the type of physician I wanted to be. Now, of interest in terms of kind of my professional background and how I got into the position of working with the Academy on this important project was my dad and I had a second conversation and he said, Ted, congratulations on getting into medical school and all of that, but how are we going to pay for this? And I said to my dad, don’t worry about it, I’ll figure out a way. And I had contacted the United States military about some scholarships they were offering and it was a competitive process. And lo and behold, I was given one of those scholarships which paid my way through medical school and gave me a stipend, which was great for a starving young medical student with a young wife. And for that payment through medical school at the University of Washington for four years, I needed to give three years in return to the U.S. military – and I did so happily. I did my residency training in the military at Madigan Army Medical Center in Tacoma, Washington. I had a tremendous experience there. Then right after my residency I got recruited to go into teaching. Somebody saw something in me about being an educator. And one thing led to another and I got promoted and given more and more teaching responsibilities and assignments and program director and department chair and ran hospitals and actually even got to serve as a family doctor on two U.S. presidents’ administrations, George H.W. Bush, the first George Bush, and Bill Clinton. And one thing led to another and twenty-one years later I had retired from the military and came back to my home state of Idaho where I became the program director and CEO and then later the president and CEO of my organization. And what that journey taught me and why it’s relevant, I think, to this discussion is that when I left the military and came back to Boise (it could have been Cincinnati or Tallahassee or Sacramento or anyplace else), I was blown away with how broken our healthcare system was. You see, I came from a single payer, twenty-one year system where our whole focus was on keeping people healthy and having quality in health be the parameters that we were working under and not making money. In fact, if anything we wanted to lower cost in the system and shift resources to prevention and good chronic disease management. So when I left the military and came back to Boise, I saw how broken it was. It wasn’t about health at all, it was about healthcare and about generating income and dollars. And I was unbelievably frustrated by this. My residency program was two blocks away from one of our Taj Mahal medical hospitals here in Boise that had fountains in the lobby and was doing robotic surgery and high cost procedures and pennies on the dollar were being spent for control of hypertension and diabetes and mental illness. So it was a moment in time for me. And I’ll never forget talking with my wife, Herb, and saying, geez, Lindy, I don’t know if I can take this. I’m not sure I can function in a system like this. And I’ll never forget her saying to me, Ted, what do you want to do about this? And I said, great question. I‘m going to run for the board position of the American Academy of Family Physicians. I’d been on the Commission on Education, I had been the chair of that. I had fallen in love with the Academy. I saw what it could do to help promote family medicine. I knew family medicine was the right answer for America. But by running for the board and getting elected to the board, I now felt I could do something around policy. I felt I could do something bigger than myself about changing a system. Well, that was a three year stint. And I ran for the president-elect position and got elected to that and became president of the Academy all at the same time Barack Obama because the president of the United States. So in my time of being president-elect, president and chairman of the board, I met with President Obama and his administrative staff six times and I testified to Congress eighteen times in those three years. And I actually again now saw how the system works, what its strengths and weaknesses were, what needed to be done at leverage points to really start to help change the system. So that’s how I got involved both in medicine, in family medicine, in leadership and then in leadership politics and policy at an Academy and national level that really helped me grow into the type of family doctor, advocate, educator, leader that I needed to be.        And then with Family Medicine for America’s Health, and I know we’ll talk more about this a little bit later, it was a perfect opportunity then to tap that experience and skill set to then be the Engagement Core Team leader around how do we bring a team together and focus in on helping unify the activities of family medicine and speaking in one voice for the good of the nation around what family medicine can do. So that is maybe longer than you wanted to hear about this, but I think it’s instructive to understand how an individual reacting in an environment that is both dysfunctional and changing can make a difference, can step up and can get engaged in a way that makes a difference.\n\nDr. Young: Obviously you feel that change can occur and that there’s a role particularly for family medicine. Can you elaborate a bit on what sort of role you see both in terms of Family Medicine for America’s Health but also within AAFP where your leadership experience has been?\n\nDr. Epperly: Absolutely. I think that family medicine is the epicenter of change. It is the change agent. It is the disruptive innovation that the system needs. What we don’t need more of is hospitals and subspecialists and expensive procedures. What we need is good primary care, timely access to care, good chronic disease management, good prevention, good end of life care. It’s all about relationships. And so if we’re going to change this system, which is basically more about wealth generation than health generation, family medicine and the bedrock of primary care is the place to do it. What I didn’t know at the time I’ve come to find out, at that is that I made exactly the right choice at exactly the right leverage point to start to then change this. And I recognize and am not naive about a $3 trillion industry is hard to change, especially when it’s so embedded in an old model. But it’s the new model that must happen. So family medicine is the place where that can happen. Family doctors of our country are the types of physicians because of their skill set and their relationships with people to do that. \n\nThe Academy and the eight organizations of family medicine are perfect places for young, growing family physicians to learn the skills and to learn the bigger system to start to make a systematic change happen. I’m thankful for the opportunities that these eight different organizations provide to our members. I’m very grateful for what the Academy was able to afford me to do that. And I would just end with the first part of that question you asked me, Herb, and that is that I absolutely believe change can happen. It needs to happen and will happen. The only constant in our life is that it will change and we might as well get it to change in the direction that we recognize is the right direction for the health of people in this nation. And I believe no other specialty both has the skill to do that but also the passion and the will to make that happen for the right reasons.\n\nDr. Young: Who are the other organizations or forces that are going to be amenable to the message of family medicine? And did you see any of that progress in terms of Family Medicine for America’s Health or through other groups in which you’re active?\n\nDr. Epperly: Yes. I think the brother and sister primary care organizations clearly this resonates with – internal medicine and the American College of Physicians as their group. The American Academy of Pediatrics - and the pediatricians are right at the bedrock of that as well. Those two  I’d say are the frontrunners. But both are conflicted, Herb, because both have substantial subspecialty membership in their organizations as well. Family physicians are absolutely pure when it comes to being primary care focused. So even though the pediatricians and general internists were onboard with a lot of this, they had their own internal dissention, if you will, about some of this from some of their members that then stood potentially to not feel as valued in a changing system that was going to refocus on the basics of medicine and professionalism around primary care. So it’s been an interesting journey, I think, for them. Other members that I would say I would include but maybe at a one step back in this are any of the professions and specialties of medicine that have generalism be an important part of this. For instance, general surgery is right at that level, that general comprehensive approach surgically to patients is important. Sadly they’re going through a transition time, too, where the last twenty years have seen way too many sub-specializations in the surgical field, away from the generalism of general surgery. I would say the same with psychiatry and general psychiatry, really an important ally as well for the basic comprehensive mental healthcare of people. Sadly, again, sub-specialization has happened to them a lot. I also see nurse practitioners and PAs as being important allies in this. One thing I know we’ll talk about a little bit later is the importance of team and teamwork. Nurse practitioners and PAs must be part of our team. We must embrace them as team members. We must work together around the things I’m talking about. And the reason I say so is that there is more work than just family physicians can do. And, in fact, an environment where burnout is prevalent, up to about 50% now of our members, of family physicians in practice, we must get to a solid team-based model. So those are some of the players that are in this journey, that are receptive to the message. \n\nThe other large groups that are receptive to this outside of medicine are employers because they want healthcare costs to come down, consumers because they want a better healthcare experience and more health and lower cost as well. So employers, consumers. We found that the insurers, the payment system, insurance companies are very much in line with this for all the same reasons. They want lower cost at the end of the day with better health for people and better quality for people. So we found them to be onboard. We also found that legislators and governors at our state level, congressmen and the President, at least of the Obama administration, were so at a national level, all for the same reasons: Let’s provide systems of care to people that provide health to them, better healthcare quality to them and lower costs to them. So it was a very receptive audience, I think, Herb. And that’s why the Engagement Core Team was the one I really wanted to get engaged with because the message around engagement was to unify people to speak with one voice on the importance of these issues.\n\nDr. Young: Perhaps this would be a good time to ask what was specifically the charge of your core team and did it change at all?\n\nDr. Epperly: The charge was to be able to galvanize the public at large, meaning both patients and people and all in the arena that would receive primary care to unify around a common set of messages and to be able then to speak about the importance and value of family medicine and primary care with one voice. What we didn’t want to have happen was to have this be fractured so that pediatricians were speaking with one voice, the internists were speaking with one voice, the subspecialists were speaking with another voice, payers with one voice, consumers with one voice. We wanted to advance the dialogue beyond physicians. Future of Family Medicine was really an important project but it was very physician-centric. What Family Medicine for America’s Health did and the engagement team in particular was to broaden the dialogue and the discussion to all those groups I just mentioned so that we could speak with one voice about the value, the power and the importance of primary care and family medicine in particular to help deliver on better health, better healthcare and lowering cost in this country. That was our charge and that did not deviate over the four years of our project.\n\nDr. Young: How do you accomplish that?\n\nDr. Epperly: We accomplished that by first getting a couple of things in place. A good team. We had several family physicians on that team. We had a consumer member on that team. We had some of our chapter execs, executive directors on that team. We reached outside of family medicine to other groups that were providing quality care in the nation. The PCORI Group           comes to mind in regards to that. The Family Medicine for America’s Health was wise in doing this. We also got a really good facilitator as an administrator to the project – and CFAR (?) was engaged with this group. I really want to call them out, and Mal O’Connor in particular, primarily because they helped provide the consistent infrastructure of administrative support for phone calls, for a lot of work, for writing, for agenda setting. I worked very closely with Mal, in particular, and his team as we set things up for success with our team. And I just that is a wise thing to do. Not only was the content of the teams important and the leadership of family physicians in this, but it was also the administrative infrastructure. And I just think that has to be noted here.          \n\nDr. Young: And how did you go about your work?\n\nDr. Epperly: We did that primarily with phone calls. We were distributed all across the nation from west to east, north to south. And so we had monthly phone calls. Sometimes even more frequently than monthly. Of course we had email exchanges. We used a platform called Basecamp in which there was also data that was being shared not only internal to our group but across groups. So there was quite an information flow and integration of work across the different teams and within our team. And then to build off of that, we put out two surveys to the nation-at-large around some of the topic areas. As we developed one of our projects on the Shared Principles of Primary Care, we did surveys nationally to multiple types of organizations – not only healthcare providers organization but, again, to payers, to employers, to consumer groups, et cetera. We also made use of a summit which brought over 100 different organizations together of all stripes. Again, if we’re talking about speaking with one voice and we were too physician-centric in the Future of Family Medicine, we wanted to be much more inclusive, much more engaging with a broader set of people and a broader set of principles for the shared principles, which was the primary of the three goals of the engagement team. The creation of a set of Shared Principles of Primary Care – again, back to inclusiveness, was our major work product. So if we’re going to develop that set, then you’ve got to develop it with all the people. You can’t develop it with just physicians.\n\nDr. Young: And you mentioned there were three goals?\n\nDr. Epperly: Yes. The three goals that we had were, No. 1, the Shared Principles of Primary Care. This was going to be for the nation-at-large, the public in general. The second was at a practice level. And that is how do we engage patients more in the running of the practice and the provision of their healthcare? So patient engagement was not only around shared decision-making at a one-on-one interface, but how could patients then be used in advisory groups to the practice or in ways that could help the practice be more person-centered to be more responsive to the community, to be more accessible to the community in ways that the community desired? That was our second goal. The third, we wanted the eight members of family medicine to walk the talk  and so one of our goals was to have a consumer representation on the boards of directors of all eight of the family medicine organizations. It was our opinion that if we wanted to truly be person centered then why would we exclude consumer members from our boards of directors? Why not have that voice at the table? Why not hear that voice? So one of our goals, Herb, the third one, was based around our organizations - and that was to have the consumer voice heard. So our three goals were at the practice organization and the public level. At the public level it was the shared principles. At the practice level it was that patient engagement. And at the organization level it was to have consumer members on the boards. \n\nDr. Young: This is taking me back, when you talk about at the practice level, to when I worked for Dr. John Renner at the University of Wisconsin-Madison, who after reading about the work of Dr. Milt Seifert in Minnesota, established a patient advisory board in the residency program for the clinic. I’m curious, are some of the things we’re working for through your Engagement Core Team things we’ve known about, even had experience in for a long time? And if the answer is yes, what’s preventing us from moving forward on these ideas that may have been around for a while?             \n\nDr. Epperly: That’s an excellent question. I would absolutely say this is not new information. This is something that’s been talked about for years and we’ve been slow to act on. Before I speak to why I think we’ve been slow to act on it, I just want to broaden it that the federally-qualified health center world has been doing this for over fifty years. The construct of Federally Qualified Health Centers or community health center boards of directors is that over 50% of the board members must be consumers and patients from the practice that is being served by the center. So from the get-go they established their boards of directors primarily by mandate. You couldn’t quality to be a Federally Qualified Health Center unless you had a membership that reflected a majority user board. So this is not a new concept. Why I think that we’ve been slow is that we still suffer from a lot of praternalism (?) in medicine of the doctor knows best. We didn’t want the input. We had more than enough work to do. We wanted others telling us how to do it and we thought we had all the answers. Patients would come in one at a time, we would treat them one at a time and the billing would occur and we’d move on to the next one. And I think there’s been a greater understanding that first started in many ways by the Future of Family Medicine around the concept of the Patient-Centered Medical Home. If this is going to be patient-centered, if we should put people at the center of the practice then we should be listening to them. Why wouldn’t we? And so I think ten years ago, Herb, we started to do it with the Patient-Centered Medical Home at an organizational level. We started to really pay attention to this and I’ve been very pleased with the Academy for doing that. What we saw as an opportunity now ten years later with Family Medicine for America’s Health project was to truly then try to hardwire that into the fabric of practices so that all practices would start to pay more attention to this and all organizational boards should pay more attention to this. It is still astounding to me conceptually that we can talk about person-centeredness and patient-centeredness, we can talk about having patients be on advisory groups and advisory boards and being the majority members in community health center boards and still have our own organizations not having members sitting on the boards. And I think in my reflection on this, it revolves around two things. No. 1 is what would these people have to tell us about what we should best do for our members. No. 2 is there can be some financial concerns about this:  Well, we’ve got to fly another board member or consumer member to our board meetings. We just don’t have enough margin for this. And then third, I’ve heard that what if they say something that we don’t want to do? And I reminded people always, this is one or two voices on a board. If it doesn’t pass the common sense test, the majority of the members are still the members of that board, it’s not going to fly. But why wouldn’t they want to listen to the insights or the inputs?      \n\n\nDr. Young: Let me stop. For some reason, one of my tapes has stopped prematurely. \n\nTape 1, side 2\n\nDr. Baker: This is side 2 of tape 1 of the November 21st, 2018 interview with Dr. Ted Epperly, team leader of the Engagement Core Team for Family Medicine for America’s Health. \n\nWe can pick up from where we were.\n\nDr. Epperly: We were talking about the importance of the consumer and patient voice both at the practice level, the national level, but in particular on the organizational level with our boards of directors of the eight organizations of family medicine. The one thing I wanted to mention that we were talking about as we flipped the tape was that the patient voice, the consumer voice is valuable. I found in my experience, because remember I mentioned earlier in the taping that I was the president CEO of the Federally Qualified Health Center, so I’ve worked with a consumer-oriented board for over a decade and I have found it to be unbelievably important because the conversations change. You start to recognize that physicians have one view of the world but people or patients or consumers have another. And it’s important, if you’re going to deliver person-centered care, if we’re truly going to walk that talk that we must listen then just as we would in the exam room to what the patient was saying, why wouldn’t we at the board level?      \n\nSo I found it to be extremely helpful both in my practice and important enough that then as the team leader of the Engagement Team, and my team agreed with me on this, that we would have this be fundamental to one of our three goals at an organizational level within our own Academy and the eight members of family medicine. It’s amazing to me, and as we talk about this in 2018, that we have four of the eight that do have patient members – and I applaud them for that. We have one more that’s on the verge of doing this. They have a pilot in place. So ideally that will be continued, would have five of the eight. But even in 2018, for those listeners that will be listening to this in the future and reflecting back on the day when this was even discussed and not even our organization had boards that reflected the very people that we serve, I think heads will shake in regards to how could we have been so physician-centric that we couldn’t see the bigger picture of that? \n\nDr. Young: In terms of parallels with other organizations that care about the consumer, are there any lessons that as your team went about its business we learned? Obviously you’ve mentioned that the community health center model has been here for fifty years, you say. Are there other non-medical settings where this approach of consumer inclusion of a voice has worked out well – or do we know?\n\nDr. Epperly: That’s a really good and insightful question. I don’t know. I don’t have enough knowledge to be able to answer that. My suspicion would be that any agency worth its salt listens to the voice of the very people it serves. As you were asking the question, Herb, I was thinking of the retailers – the Walmarts, the Amazons, the Googles, of banks, of grocers. I would think that at some level they would have to have some way other than filling out complaints and depositing it in some box in stores, there must be some proactive way they get input. I think medicine has been slow to this, quite frankly, without having good data on all those other types of agencies or industries – the airline industry, et cetera. I think medicine has been slow to this because of the highly technical nature of our work. Again, back to the doctor knows best, she’s had all the training and the experience to understand the nuances and the details of this that go beyond the standard patient. But instead of engaging them with the discussion and shared decision-making to inform them as a very person we’re serving, we’ve taken a different path in medicine for too many years – and that is these things are just made as decisions for the patient and about the patient, not with the patient. So I think we’re just catching up to probably what the rest of the world has already figured out in regards to how to best approach these situations.\n\nDr. Young: It seems that one of the ways that other organizations seek information on what consumers want is often highly structured where the consumer doesn’t really have that much freedom to open the door to other issues. But you’re pointing out that when you put someone on your board representing a consumer viewpoint they have free voice, in an ideal situation, and can bring ideas to the table. Deliver messages that aren’t in a highly structured survey form, for example. Was that part of your discussion at all, the mechanism and how important it is in terms of providing that consumer perspective, that patient perspective?\n\nDr. Epperly: Yes, it was. In fact, there are organizations across the United States (I learned this in the process of being on this team) that trains consumer members to be broad advocates not speaking on single item issues around them but to help bring the voice of the patient to discussions like this – and they’re trained to do that. And so one pushback I got from my colleagues on this topic, Herb, was, well, gee, they’ll sit like lumps on a log unless we talk about a certain disease process that they may have some familiarity with. No, that’s not the case. That’s not what we’re talking about. There are many members in our communities and across the nation that are specifically trained to be broad thinkers. In fact, at my practice level here in Boise, we selectively search out members that are well-educated community advocates that can sit on the board and represent the people of our community, not their single item health issues. That’s not what we’re talking about. We’re talking about having a thought partner at the table that has a different background. So, for instance, I’m going to channel some of my own personal board here now – a former chief-of-police, a former superintendent of the school district, a legislator, a former director of the Public Health Department, an business entrepreneur. We’ve got a banker. We’ve got different peoples’ perspectives that help inform us in ways that go beyond just what we would think as health professionals. And I think that’s the value of this. That should especially resonate with us in family medicine, having a broad scope of practice and realizing it’s about people and families. It’s not about an organ or a gender, it’s about a whole person. It’s about their family, their community. It’s just shocking to me that we would be a bit slow on this as opposed to just absolutely being upfront on this as a vanguard, if you will, of developing this type of  model. I mean we have in the Patient-Centered Medical Home, at least we speak to that. So why wouldn’t everything we do reflect that? \n\nDr. Young: One other thought in thinking back to Madison, Wisconsin and its Advisory Committee in the 1970’s, they found that by putting together in an advisory group a number of different patients, different ages, genders, et cetera, that messages would resonate within that group maybe brought by one person, but other patients would see wisdom in it or have their own take on maybe a different direction doing the same thing. So I’m interested in the Engagement Core Team’s thinking about various ways to get that consumer perspective. And obviously you can’t bring five people to a board of directors meeting several times a year, the same five people necessarily. But in a practice you have a more stable population to draw from, like you outlined for your counsel. Any thoughts on that?     \n\nDr. Epperly: I think that there’s a synergy that starts to happen when you do get a majority of consumer members on a board. It takes on a different flavor. I, again, can speak knowledgeably about this with a decade of experience on my own board here at our teaching health center. And I found it to be the best boards I’ve ever been on because there’s a balance between running the business, if you will, but then also serving the public. And I really like that. They remind me constantly not only about what this means to the poor in our community. But I’ve been very pleased with them absolutely paying a lot of attention to the residents and our learners in the sense of how will this impact our residents in training and being very mindful of the mission. I’ve been very pleased with this. And I think some of our family physician members that have never had the opportunity to have patients work on an advisory group or board with them or be a part of an organizational board would be very positively impressed with what they’re bringing to the table. \n\nI just wanted to make a quick comment that the Family Medicine for America’s Health board did walk the talk. I was very happy to see this – in that they have two members of the board that are consumer representatives – Lauren Kennedy and Diane Stolenbeck are both consumer representatives and I think that’s for the betterment of Family Medicine for America’s Health.  \n\nLike I say, we’re at four of eight, soon hopefully to be at five of eight of our own organization board of directors. But I’m shocked senseless, Herb, and I’ll go on record of saying this: In 2018, that it’s not all eight of eight. \n\nDr. Young: Let me come to the issue of carrying forward the work of Family Medicine for America’s Health and the Engagement Team, in particular, beyond getting a consumer voice on all the boards. There was discussion at the end of The Future of Family Medicine about the challenge of carrying forward the recommendations from the group, a variety of levels of success. And I understand that there was discussion with Family Medicine for America’s Health about how do we make sure that after the last meeting things don’t just disappear as politically processes take over and there may be new goals raised and so forth. How are the Engagement Core Team efforts carried forward? Or are some of them accomplished and not having the same thing as say the core team on research has sort of handed over certain tasks that have been taken up by other organizations and so there is an assumption of forward motion will still occur on those issues.    \n\nDr. Epperly: That’s a good question. Some of our goals have been accomplished, others have been handed over. Let me just speak to those just quickly. So the Shared Principles of Primary Care which became, I think, the shared centerpiece of our work which was to take a look at the old joint principles of the Patient-Centered Medical Home and advance them to be more inclusive to represent all people who work in the area of primary care. And when I say work in, I mean as patients, as consumers, as employers, as physicians, as nurses, as nurse practitioners, as PAs, as anybody. That work was finalized. We wrote a paper. That paper will be published in February in Family Medicine on the Shared Principles of Primary Care. So that work, we accomplished our goal. We came through a massive consensus process to seven Principles of Primary Care that will serve the public going forward so that we can speak with one voice about the value of primary care.  \n\nThat was our centerpiece. We accomplished it. It’s been published. It will be put in the literature. It will be referenced for years to come and hopefully a copy will end up in The Center for the History of Family Medicine as well. I would imagine.\n\nDr. Young: What plans are there to then take the principles and make them happen?\n\nDr. Epperly: We, in the process of this, had 300-plus organizations sign on to these principles. So from IBM to Exxon to the American Academy of Family Physicians to all the organizations of family medicine except the Association for Family Medicine Residency Directors – and that was a story unto itself as being the only outlier that didn’t sign on from family medicine. To having it signed on by the different health centers, medical schools, consumer groups, family and women groups, et cetera. It was a very broad sign-on. We partnered with this particular goal with the Patient-Centered Primary Care Collaborative, the PCPCC. And we handed this piece over to the PCPCC to continue in regards to its insertion. Not only did the family medicine organizations continue with this in terms of insertion into different lectures, workshops, et cetera, but the PCPCC we felt would even be the better organization because of it representing 1,000 different organizations in the PCPCC. So since inclusiveness and speaking with one voice and unity was important, then we felt it was important to get it outside of just a physician organization and getting it into one that then could do that. So that piece of work was accomplished, published and handed over to the PCPCC for continued integration of those principles in all of its work. Their CEO was on our Engagement Team, so she is a co-author of the Shared Principles and is absolutely the driver the continued effort to continue to have these inserted into all sorts of activities, including to the NCQA for usage in the definitions of the Patient-Centered Medical Home, in the creation of the standards around the Patient-Centered Medical Home, those sorts of activities, so that it starts to become foundational and definitional to agency accreditation, certification, et cetera. So it was important that we got that piece of work to the PCPCC. The second part, the patient engagement piece, at the practice level the STFM was very happy to pick that piece up. They felt it was part of what they were doing around patient-centeredness and practice development. We liked it as well because of the fact that it would become part of residency programs through the STFM, so we were pleased with that. There are ongoing efforts around toolkits to create for practices and for residencies and departments around patient engagement. We published a bunch of stories about how this could be done well from solo practice to large group practices to residency programs to departments. So there were examples in the toolkit as well as templates for how to stand up patient advisory groups, et cetera. I’m pleased that the AAFP’s National Research Network also picked up patient engagement and worked with PCORI and others around research projects on patient engagements. So we think that a lot of good work is being done in that space as well. And then the third one was more unique really to family medicine – and that was patients on our own boards of directors. And we handed that over to Family Medicine for America’s Health. We felt that that one should be owned by the board, the FMAH Board, and that they needed to continue to do that. The reason that we felt that that was the right home for this was that the FMA Health Board is made up of all those eight organizations. They each have representatives sitting on that board and would take ownership for this on the board. And so that is where that one was left, Herb. And do you know what action they’ve taken, if any? On this particular last one? Yes. The conversations continue. The pilot that the ADFM, the Association of Departments of Family Medicine, was the fifth one that was going to pilot it for two years. I think that they wanted to get the data, wanted to then show the data to the other four that had been doing it already. -- spoke very positive about board members. I think the other three that were waiting wanted to see what the data showed and the FMA Health Board will continue to drive that. Now, I know that they’re time limited as well. And at the last Congress of Delegates that happened in New Orleans in September of this year both Glen Stream and myself and Reid Blackwelder spoke about a potential model (and Glen Stream would be the right guy to talk to about this) for a continuation model of FMA Health going forward so that it didn’t sunset with FMA Health. And the rationale and reason for this and why I think it’s a good idea and an important one to continue is that one thing we learned from this process and one of the best things that came out of FMA Health, I think, was the fact that we got all eight family medicine organizations around the table talking to each other. Sometimes we can be our own worst enemies. And the best way to handle things is to sit and talk about them first and then to start to build things together second. And so I think one of the ongoing strengths of FMA Health and what needs to continue is a convener, if you will, of all eight different organizations in some way that gets us and keeps us working as a team. The reason I bring that up is that this is one of those items that was best handled by that ongoing, continuing effort to keep some degree of pressure and focus on this particular issue so it just doesn’t backslide into the next twenty years with no work being done on this.\n\nDr. Young: And this new concept would be something different from the Working Party, it sounds like.\n\nDr. Epperly: Yes. The Working Party was felt to be too limited in the sense that it was primarily academic and that we needed a broader representation as well. It would be kind of an outgrowth, if you will, of the concept of the Working Party, but I think it would be broader than that so that it would still carry over some of the uniqueness of what FMA Health has done more globally. And I’ll just use Engagement as the perfect example of that and that is that we weren’t thinking collaboratively outside of the profession of family medicine with the Working Party. It was primarily Working Party related things, internal to the house of family medicine. To get to the next level with what we’re doing with the value of family medicine is to engage the rest of the house of medicine and the rest of the nation in regards to what we’re doing. We can’t just keep internally preaching to the choir. This has to get beyond family medicine. It has to be to all the things that we tried to tackle with Engagement. It has to be speaking with one voice and unifying that message. Now, within that comes tradeoffs because we can’t get everything we want. But what we learned when we wrote the Shared Principles is that the Shared Principles as written by a family doctor were going to be different than Shared Principles written by 300 different organizations. And I’ll never forget, and this is a great place to put this for the Center for the History of Family Medicine, when we submitted our original article to Family Medicine and John Saultz, who is a good friend of mine, John is the editor of Family Medicine, he gave us feedback on the article and he said, oh, this is well written, the concepts are important, but I see that the new lion doesn’t roar like the old lion used to roar about the principles of family medicine. And I couldn’t help but write John back, in my letter back to him with modifications to the article to meet his specifications, that, John, this is a new world and that the old lion of family medicine roaring isn’t the model. That the new world has to have, if indeed, team-based care, collaboration and person-centeredness are a part of this.\n\nIt has to go beyond that. And it’s not that the new lion can’t roar like the old lion. It’s that the new lion roars in a different way. And that, Herb, is why I think the continuation of the effort outside of the Working Party, outside of a nominal attention to detail around the house of medicine and the house of family medicine needs to be broader and more inclusive. And that was one of the real strengths of FMA Health, I think.\n\nDr. Young: As you reflect on FMAH and also on the work of your core team, any other thoughts that you would like to make sure we capture?\n\nDr. Epperly: You know, one is that we’re still all dealing in a very broken healthcare system. One that needs to be totally revamped. I can’t think of a better model to revamp it on than family medicine and primary care because, one, we’re distributed to every part of the nation. Two is we take care of all people of this nation, of all socio economic groups, of all racial backgrounds. Three, it’s all about timely access in a way that you build a relationship as a usual source of care. So it’s a marvelous infrastructure to build on. One thing I’ve learned from all of this in my work with the Academy and studying other systems, international systems, countries healthcare systems, is all the successful ones are built on strong primary care. Sadly, America, being a nation where business was run on healthcare, not so much health was being run on healthcare, we’ve got the wrong team on the field. We have way too many subspecialists and proceduralists and way too few family doctors. So in our ongoing efforts, what I would say is family medicine is front and center in this model. We need to be proud of that. We need to own it. We need to step up to this. We need to be leaders on this. The way we’re going to lead on this is to be collaborative. It’s going to be that we’re listeners and team participants. I’m a very, very big fan of the Patient-Centered Medical Home and team-based care. And the reason I am, and we train this everyday in my residency programs here, our four residency programs with over sixty-five residents in training, is that if we’re going to provide population health and focus now not on individual health but the population’s health to keep as many people healthy as possible - we’ll still, of course, provide one each individual care, we’ll always do that. But we must have a team to do that. We must have nurses and nurse care managers, public health workers and community health workers, dieticians, social workers, psychologists all working at the team to keep the population as healthy as possible. And to work with that model, to use the quarterback of that team as the family doctor, needs a type of young man and woman that sees the value of both the broad scope of knowledge that we’re taught in family medicine, but then that interdisciplinary teamwork necessary to be able to run the team in a way that’s maximally taking care of the population. That is the model for better health going forward. Technology will enable that. Tele-health will enable that in ways in which we can reach into people’s homes. Our best advocates will be the moms of those families and the mothers to the children and the spouses of those recalcatrive (?) husbands. All of that will be a team-based approach, one right out family medicine. So we’ve got a marvelous opportunity, I think, in terms of the models we’re putting in place. We’ve got to be more inclusive. We’ve got to listen more to the patient. We’ve got to hear the patient. We’ve got to have a team that helps leverage that care in ways that we monitor and track and use data to make sure that we’re on track with people. I see it as clear as I’m talking to you right now, Herb, that this is all doable. And it’s all doable under the rubric of sound family doctors. And I’m excited about this. I wish I was going to live another …\n\n\n\n\n\nTape 2, side 1\n\nDr. Young: This is side 1 of tape 2 of the Oral History of Dr. Ted Epperly, the leader of the Engagement Core Team of Family Medicine for America’s Health. Proceed, sir.\n\nDr. Epperly: Thank you, Herb. I was just saying that I’d love to live another hundred years to see how this all starts to play out because family medicine will be the bedrock of how good integrated holistic healthcare happens in our country just like it has in every other industrialized nation. \n\nI’d like to maybe end with two thoughts for the future and for anybody that might be listening to this that speaks to the power of family medicine and the power of the things we’ve been talking about. The first is that the best definition of a family doctor that I’ve ever heard is the type of physician a community needs. And that speaks to the plurry (?) potency of a broadly trained family doctor, one that can utilize his or her skills inpatient, outpatient, emergency room, hospital, deliveries, whatever it might take. Each of our communities are going to be different. Each of those settings are going to be different. But the basic skills of good relationships, good communication, caring, thinking are going to need to happen. And there’s no type of doctor trained broadly enough to be able to be successful in all those settings. So I think that’s one thing that I would say, that we must value the broad training of family medicine because of the fact that we need to shape into so many different types of communities. The second thought that I want to leave the listeners of the future with, Herb, is around a quote from Charles Darwin. And Darwin, when he wrote his Evolution of Species back in the 1850’s, famously noted that “Survival isn’t going to go to the fastest or to the smartest or to the strongest. It goes to the most adaptable.” And we, as family doctors, are exactly that group. We’re adaptable and must be adaptable in changing environments and the changing healthcare system so that we provide the service that’s always going to be needed. And that is human touch, human kindness, someone you have a usual source of care from. Yes, technology will aid this. Yes, there will be different ways of communication, different ways of getting biometric data. But at a certain point it always is going to come back to a relationship with another human being and that family doctor is that type of person. So what we need to do as a specialty living the profession of medicine is to stay adaptable in a changing time. I think what Family Medicine for America’s Health did as a project was to take a look at how is healthcare happening now – and let’s project this forward for at least the next ten years in regards to what do we need to do to be able to be successful in this environment. I’ve been really happy to be a part of this. It’s been valuable. I want family doctors in different stages of training now and in the future to take up these challenges and this mantels and continue to drive this sort of needed healthcare downstream. It will be good for the health of the people of our nation if we do so. And with that, Herb, I’ll stop. And if there are other questions you have, I’ll be happy to handle them.\n\nDr. Young: Ted, I think that we have completed the list of questions that I had. Unless something else pops to mind at this moment, I think we will call it closed.\n\nDr. Epperly: No, I‘m very appreciative, Herb. It was great to catch up with you again and to talk with you. I wish you the best. 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