Shutdown Threatens Food Benefits: Family Physicians Leader Urges Resolution

Mark (00:04)
Our guest is focused on strengthening family, physicians and the communities they care for, but their members
are navigating unprecedented and challenging issues coming out of Washington.

Shawn Martin (00:15)
Certainly, we are reaching a different tipping point and, the process and that process is going to ultimately start
to really, have an impact on a large number of, of American families. So we continue to push for them to get to
the negotiating table and open the government.

Margaret (00:33)
Our guest today is Sean Martin. He is the CEO of the American Academy of Family Physicians. This is one of
the largest national medical organizations with over 128,000 members in the US and around the world.

Shawn (00:46)
I would encourage them to think about the families that are, are being impacted, and certainly there are, issues
that are a part of the shutdown or a part of the negotiation that, are going to impact about 20 to 22 million
families.

Margaret (01:00)
This is conversations on Healthcare.

Mark (01:13)
Well, welcome Sean to Conversations on Healthcare.

Shawn (01:16)
Well, mark and Margaret, thank you so much for having me. I'm pleased to be with you today.

Mark (01:19)
Yeah, and, speaking of today, the government's shutdown continues, and yet on November 1st, about 25 states
are set to pause SNAP benefits due to the shutdown. Obviously this is gonna threaten food assistance for
millions of vulnerable families. What's the, AFP's position on the shutdown?

Shawn (01:42)
Well, I mean, I think we continue to encourage, house incentive members to find common ground to reopen the
government and then have meaningful debates on some key issues that we, and they all care about, including,
affordability of healthcare. But certainly are, we are reaching a, a different tipping point and, the process and
that process is going to ultimately start to really, have an impact on a large number of, of American families. So
we continue to push for them to get to the negotiating table and open the government and then, proceed with
their difficult conversations that, need to take place.

Mark (02:21)
It seems like there's a stalemate because the Democrats at this point, I think there's a lack of trust that's
happening down, in Washington. Really can't trust the decision, of closing first and, uh then have having, having
a vote on it. What, what's your advice to them in terms of how, how we can find, some common ground?

Shawn (02:44)
Well, I, I think first and foremost, I would encourage 'em to think about the families that are, are being
impacted. And certainly there are, issues that are a part of the shutdown or a part of the negotiation that, are
going to impact about 20 to 22 million families. There are issues that, need to be discussed and resolved that
impact affordability and access, to healthcare. But I think the message we continue to convey is that, those
discussions need to take place in a bipartisan way. but they also need to take the appropriate steps to make sure
American families are significantly hurt or impacted in food insecurity. Making food insecurity worse, is, is not
a means to, a better tomorrow for a lot of families.

Margaret (03:31)
And I'm sure your, hearings, I, I heard this weekend in a panel discussion mark that I was on, that the
emergency food shelters, and food banks are all feeling the same pressure. There's a downward pressure from all
of this, and that, of course affects patients in the exam room. So I'm sure your members are hearing a lot about
that. I know you're, asked to consider some very challenging issues. You recently called on President Trump to
reconsider secretary's Secretary Kennedy's ability to serve as the HHS secretary. can you share with us, I'm sure

there's a lot of discussion about that. What led to that decision and, and what do you say to your AAFP members
who might not think that was the wisest course of action?

Shawn (04:11)
Yeah. Well, I mean, of course, those, these are all very difficult, you know, conversations that take place over
weeks and months as we evaluate the, effectiveness of, of the federal government and state governments for that
matter. I think the thing really, had less to do with the policies that the secretary was pursuing, although that was
a critical factor in our thinking, and really more to do with the fact that the American public, through a variety of
polls over a very consistent period of time, dating back to the late spring, is expressing a, a real concern and
confidence with respect to the efficacy and messaging of the federal government. And the letter was very,
pointed in this space that the secretary, seems to have lost the trust of the American people. And steps should be
taken to either A, restore that trust, or B, find someone that can establish that trust in a new way. And, since the
secretary reports to the president, we felt it was most appropriate to ask the president to make that evaluation.

Mark (05:16)
Shawn, let's pull the thread in one of those hot button issues for Secretary Kennedy has been the claims of a link
between vaccines and autism. just wondering, is this one of the drivers for your members dealing with the
questions and concerns that they're hearing from their patients?

Shawn (05:33)
Yeah, so, I mean, I think there's a great deal of confusion in the exam room. There's certainly a great deal of
confusion in our communities around our kitchen tables at our school, PTA groups. I mean, the, sowing of doubt
around the efficacy of vaccines is, an issue that we're very concerned about. And, and the AAFP and other
physician organizations certainly understand and want to be alongside families that are impacted by autism and
finding and seeking information, that can help other families not have to deal with that in their children in the
future. But we can't assign blame or assign convenient blame, in our pursuit of those answers. So, one, we are
deeply, empathetic to the, the families that are searching for answers, but we also understand that vaccines have
been one of the most efficient public health strategies the country, has ever had. And many children over the
course of the past several decades are alive because of, so there's a balance there, and messaging matters, and
being honest and truthful, really matters when you're talking about issues that are, deeply personal to American
families.

Margaret (06:45)
Well, they're, it's hard to have a conversation with anybody in healthcare without talking about vaccines. right
now, both the time of the year that we're in and all these policy decisions. there's also been, concerns put out
there about MMRV, the measles, mumps, rubella, and chickenpox, or varicella, vaccines for children. I, I know
your organizations probably, or your members are asked to take stands on these various controversies. What,
what kind of advice do you give to members? Or do you rely on people to exercise their own discretion in how
they respond either to inquiries from the media, the public, and of course, in the exam room where it's more one-
to-one.

Shawn (07:22)
No, we, that's a great question. We, we, we are a resource to our members. We publish a vaccine schedule every
year for both children, adults and pregnant individuals. And, we do a review of literature and science and
recommendation from other organizations, and we assemble a, you know, front and back a vaccine
recommendation for our members to use in, in their practices. I think that MMR is an interesting space where
the AAFP for the past several years has recommended for children under the age of one that the, you know,
chickenpox vaccine be separated and administered, separately and independently from the MMR vaccine. So
we, you know, we're not, that far off of the recommendation that came out of, A CIP. Now, in the event that a
parent would seek to have one visit and one vaccine, then we think, the, the ability or the, or the importance of
the vaccine should be administered in one dose. if, if you run the risk of not being able to administer both doses,
we encourage our members, we try to resource our members, I guess is the way I would say it with information.
we ask them to enter those conversations with a tremendous amount of grace, work with their patients, answer
their questions. They're really on a journey with these families and patients over a period of time. I don't think
guilt is an effective public health strategy. And I say this all the time, guilt closes doors, grace keeps
conversations going, and, and I think we just continue to encourage our members, to be good advocates and be
on a, longitudinal healthcare journey with these, individuals and families.

Margaret (09:05)
Great way to say it. I like that.

Mark (09:06)
Yeah, it absolutely,

Margaret (09:07)
Grace opens doors.

Mark (09:07)
And let's, let's, let's talk a little bit about that journey they're on with their, patients. they're certainly having to
address the dramatic changes in HR one, which includes over 1 trillion in future cuts to healthcare programs.
And, the AAFP is developing strategies really to help those, physicians, adapt to the new policies and potential
effects on patients. Tell us a little more about, your strategy here and how you're advising, your members.

Shawn (09:41)
Yeah, I mean, Mark's strategy is a generous term right now. I think we are, still in the understanding phase. We,
you know, I think we're very much trying to comprehend and understand what happened in HR one, and,
obviously we understand the provisions of the bill. I don't think we've really developed sound positions on what
the impacts are gonna be and, and the sequencing of those impacts over the next couple years. There's, there's
going to be compounding effects, if you will, due to a variety of policies that were in that bill. I think the one
thing that we're, focused on right now, because it's the most timely issue, is really optimizing the impact of the
Rural Health Transformation Fund, making sure that states and family physicians and all the states and
territories are, are working with their state leaders to put together proposals that would benefit rural family
medicine and primary care practices, to the extent of possible given the needs of the state. But optimizing those
dollars to rural family medicine is really our priority, for the next few weeks until those applications are due
moving forward. Obviously, a lot of people are going to lose Medicaid coverage. Other people are going to, you
know, have transition periods between Medicaid and Medicare if they were dual eligibles. there's a lot of
impacts with the children's health, program, people moving off eligibility of Medicaid, particularly onto chip or
vice versa. lots and lots of reasons to be concerned. I think still lots of places that we need to better understand
the impact, but taking a trillion dollars out of the healthcare system, you know, goes without saying that. We're
deeply concerned about that.

Mark (11:24)
Well, and I, I would imagine you're gonna have practitioners where the issues around work requirements are
gonna have a lot, a lot of people coming, talking to whatever health condition they might have. to see, if, if,
there can be some assistance there and trying to articulate out their capability for doing work.

Shawn (11:44)
Well, that's right. I mean, you're gonna have an administrative task that didn't exist that's going to be put in
place. I think there is hope amongst federal and say, policy makers and regulators that maybe some technology
will help make that easier. But our physicians are going to be asked to, communicate on a variety of issues
related to eligibility and, and, you know, that's going to, you know, be another process on top of the processes
that already exist, as they try to help their patients and communities. That's a very good point.

Mark (12:16)
Well, we did have the deputy secretary for CMS on who said they were trying to make a app than makes it
friendly and easy. that's easier to say than, than to do. but that's what they're at least, hopeful that they'll be able
to roll something out, in the near, in the near future.

Margaret (12:39)
Yeah. Sean, I wonder if I could, go back a minute. You referenced the rural transformation, bill and, and that
opportunity, and, you know, family practice, has, a relatively short, and really wonderful history in the United
States, right? Am I remembering the certification is 60 years old? Maybe?

Shawn (12:59)
So we, we're, we're, roughly, we, we came in to be around 1969, 1970s when our board certification started.
Right. family practice was known as general practice, right. you know, for many decades, prior to that.

Margaret (13:14)
Right. And, again, a distinguished, history. And it's my sense, we live in a very family practice, strong area,
have one of the earliest family medicine, s programs right here, in Connecticut, one of the ones that really
emphasizes obstetrics and comprehensive care. But my understanding is that our family practice physicians in
the healthcare system really are the backbone of the rural areas. and, and disproportionately maybe located in
those rural areas. What are they hoping to see? What are you hoping to see with the Rural Transformation Fund
in terms of really advancing primary care and family practice access and delivery, in those areas?

Shawn (13:54)
Yeah. Well, that list is really long, so I'll give you the abbreviated version of it. So I think one is practice
stability. I think, family, family physicians and family medicine practices in rural communities, just due to the
demographics of the communities they serve, they're more reliant upon public health programs, being Medicare
and Medicaid. So, creating some type of economic stability for, those practices is, is really important. I think the
other thing which is often overlooked is the relationship between the family physician and the hospital, and the
pharmacy and the nursing home and hospice services in those communities. It's an ecosystem of a tiny
ecosystem that is really reliant upon each other. So family physicians need the local pharmacy to be vibrant.
They need the, you know, the, the community access hospital or the rural hospital to be functioning. That, that is
what helps that ecosystem, maintain some balance and some ability to provide comprehensive services. what we
are really, pointing towards is creating support for these rural practices beyond financial support. So, one of the
things, in states, particularly western states, is they're very isolated. I think a lot of us that spend time on the East
Coast forget how big these states are, and, you know, sending somebody, we are headquartered in Kansas City,
but if you're in western Kansas, you know, you're about five hours from Denver and about five or six hours from
Kansas City, they are really isolated. And creating the ability to provide healthcare services through technology,
or other types of means to help those communities provide the most comprehensive care, to other patients is
really important. And, those are some areas that, you know, we're trying to be creative and innovative around.

Mark (15:42)
Well, speaking about being vibrant and, financial, stability, I think, a FP and so many others have been focused
in on what the country's, primary care spend is. yeah. It's been too, too small for too long. but, and I wanna focus
in on how Medicare reimburses doctors, which may seem a little obscure when we're talking about primary care,
but it's incredibly important the Trump administration's proposed changes to the Medicare physicians fee
schedule, and you're encouraged by us, by that, those changes. Tell us a little more about your thinking.

Shawn (16:20)
Well, yeah, we, you know, we've been pretty honest. Washington's a weird town, right? There are things that we
don't like that are taking place inside HHS, and there are things that we do like, and this is an area where we
think, the administration is really continuing. some of its good policy that they pursued in the, in the first term.
And, and a lot of that is around, you know, enhancing, payments to primary care or primary care services
through the Medicare physician fee schedule. And they're, they're doing that in a couple of ways. One is really
taking a harder look and putting money behind longitudinal care through a, a program called Advanced Primary
Care Management code wonky term. But it basically means a payment to help physicians maintain a
longitudinal relationship with each Medicare, patient. That relationship and, and longitudinal nature of that
relationship is really advantageous to patients. Lots of data supports that. The other thing they're doing is really
taking a hard look about how physicians are paid globally. And, all physicians, every physician services
assigned a value. those values are impacted by each other through a relativity methodology. that pool of money
is impacted by what's called a budget neutrality provision. And, and I think to their credit, Dr. Oz and, and the
CMS team are saying, is this the right way? And if it's not the right way, how might we think about doing this
slightly different. They're not dumping the cart over, they're just looking at, on the margins. How might we do
this slightly differently to better reward the relational longitudinal care of primary care, in support of the
beneficiaries that we serve. And, look, it's highly controversial. 'cause anytime you move money around, it
doesn't matter if

Mark (18:06)
Moving Cheese, moving somebody’s cheese.

Shwan (18:08)
Yeah. I mean, you know, if it's in our own homes or if it's in a program as big as Medicare, you know, there's
gonna be a few conversations about that, and there's gonna be some opinions. So, we've been, you know, pretty
forthright that we think that this is a good, you know, a good policy pursuit on their part. And to the extent that
we can be helpful, we're gonna continue to be helpful.

Margaret (18:30)
Well, you know, another, interesting dimension that we've been following is the National Academy, report
towards implementing high quality primary care in the United States, which is led by, some of your wonderful
luminaries in the family practice, discipline, variety of other people. And one of the, final conclusions or
recommendations, was to really, and we've heard about this well, right, to really, pay teams to take care of
people. Right. Not, in individuals necessarily. I think you've taken a somewhat different position about maybe
pay some of the people on the team as part of a team, but not everybody in the same way, not a comprehensive
team approach. What's your, what's your thinking on that, about how payment might be changed to really
support team-based care and not any one group on the team?

Shawn (19:16)
Yeah. I, I think our, our position is probably somewhere in between, what you just said. Margaret, I think we
very much believe primary care is a team-based, endeavor. We certainly think that physicians are a very, very
important part of that, and particularly for the high acuity illness patients, you need physicians engaged in and
leading, much of that care. But that doesn't mean that the other members of the team are not contributing in
meaningful ways to the, the pursuit of health and disease management in those populations. We have a really
simple position, which is there should just be a prospective per patient payment to take care of the individual
and communities. And, you know, it's called a population-based payment. I'm old enough to just call it
capitation. I, you know, people get upset about that word, but, it's really just a capitated payment. I think, you
know, if, if we were a team of, a healthcare team, like we can figure out how to take care of our patients,
probably better than, some others. So just give us a capitated payment, give us a population to care for, and we'll
figure out if we need a pharmacist or if we need a nurse. And, and we'll figure out how to do that the best way
for our communities.

Mark (20:28)
That's great. Margaret, you were talking a little earlier about the family, practice, being a young disciplined, and
certainly one, that we, salute here. one of our, longest serving family physicians just retired after 45 years,
graduated from a great program. So we have a long history, but not everybody may know exactly what we mean
by family physicians. How do you define a family physician, and how does that differ from a primary care
doctor?

Shawn (21:02)
Well, yeah, I mean, what a great question. So, a family physician is trained comprehensively, to provide for,
patients across the, spectrum of age and, and across a, a comprehensive subset of organ systems and disease
states. Now, you know, all physicians in the United States are educated and trained to do procedures and
surgery, but really what you're talking about is, is often returned to, referred to as the biopsychosocial model of
healthcare. So the biological functions, the physiological functions and psychological functions, and sociology.
So a whole person, it's had lots of terms, whole person, comprehensive wholeness wellness, approach to
healthcare. But really, the way I summarize it, my father was a rural family physician. I just call it
comprehensive care for people of all ages. And, it's the ability to provide care, refer when the complexity or
acuity of care is beyond, their capabilities and really be on a healthcare journey. And both a physical and mental
perspective, with individuals and populations. And the, the beauty of, of family medicine, I, I give speeches on
this all the time. I call it the plasticity of family medicine. They can really do anything to meet the needs of their
population. So if that community needs them to do obstetrics, they can do obstetrics. If they need pediatric care,
they can do pediatric care. But it's really a unique skill that family physicians have as compared to other
physicians that tend to be age specific, disease specific, organ system specific. I don't know where you want me
to go with that, mark. I can go all day.

Mark (22:40)
Tell me, actually, tell me a little bit about where your dad practiced and a little bit about his practice.

Shawn (22:44)
Yeah. So my dad, practiced in rural northwest Oklahoma. So if you, were to draw a line between Wichita and
Oklahoma City, a straight line, and then you went west about way too far, about a hundred miles, he practiced
out in the northwest corner. Largely in a community called Oklahoma. But the, some, a number of surrounding,
towns, there were a few physicians out there. There, you know, it's, it's the typical story, right? There were a
couple of family physicians, a surgeon and anesthesiologist, and an obstetrician, and they just took care of, you
know, people in about six surrounding counties. And, you know, it was, it was not the best environment to grow
up in, to have people just showing up at your house all the time. 'cause, but as I got older and reflecting on it, it
was just a beautiful, way to take care of people and communities. And, you know, he's a wonderful guy. He

moved into academic medicine on the second half of his career, but for 20 years he was in service to, you know,
just an enormous group of people that were just, you know, they were mutually grateful for each other.

Margaret (23:51)
Well, we see in the community health center that the FQHC, that's under our Moses Weitzman health system.
We have patients who've been here pretty much, as long as the organization has been around three, three
generation care, I think we might have four generation care. In some ways, and that continuity, urban, rural, I
think, with a primary care practice is huge. But I wanna, ask you about something that has really caught, I think
the, imagination, the energy of many of our healthcare staff, physicians, nurse practitioners, dieticians, nurses,
everybody else, and that's really lifestyle medicine, food, is medicine. And I know you have a new partnership
with the Ardmore Institute of Health. I think that's to strengthen, the, the role of primary care, in addressing
chronic conditions, which is certainly a part of that whole movement. Tell me about the relationship. What are
you hoping to have happen and what the, what's the energy, for that within your association?

Shawn (24:48)
Hmm. Energy's high. I can, I can answer that quickly. Energy's pretty high. There's a lot of interest in this kind
of whole person health, effort that we're driving. One of the things that we're doing that's unique from maybe the
American College of Lifestyle Medicine and some others, is we were, Ardmore really asked us to work with
them to incorporate, lifestyle medicine, nutrition, food as medicine, some of these, emerging practice types or
practice interest areas, really thinking about how to merge them back into comprehensive primary care. So our,
our job and our research and kind of education is really designed to take these concepts and multiply 'em
through, you know, comprehensive or community-based primary care practices. How can just the average, you
know, primary care practice in Connecticut incorporate lifestyle medicine into their clinic so that it doesn't have
to be a specialty clinic or a full-time, effort for them. It's just part of what they do. And the irony is, is it really is
part of family medicine. I mean, family medicine was very much founded on these right principles, you know,
many, many years ago. And, you know, I, I love the energy behind it. So we're just kind of riding that wave,
right? And, and trying to help our members provide the best care they can to their patients.

Mark (26:06)
Well, Margaret, we know a conversation is incomplete unless I weave in AI somewhere along the lines. So let
me try to do that. No. So some younger doctors say traditional medical associations are really not doing enough
to engage social media and push back on misinformation. And for instance, we see Dr. Mike produces a very
popular, video and has criticized the AMA in his regards, and he is a family physician. So I'm wondering how is
the AAFP staying relevant in the year of TikTok and AI?

Shawn26:37)
Yeah, I, I, I love Dr. Mike. He's a good family doc. I, I'm always careful with my fellow travelers. I, I think, you
know, the AMA needs to be strong and needs to be vibrant. And I mean, we, you know, we work closely with
them trying to help them, on this journey that we're all on, together. But, so we are very much committed to, you
know, engaging content platforms that are relevant both to, you know, our members, but also more importantly
to the patients they care for. So we have public relations and media campaigns, but we are omnichannel. we
have influencers spread across all the social media channels, including the ones I don't know. And, you know,
we provide them with content that is relevant to various audiences. A lot of that content is designed for
physicians and healthcare professionals. A lot of it is designed for patients. But I think the most important thing
I would tell you is we have centralized a hub called family doctor.org, where all patients can come back and get
information, but they also can springboard out of family doctor.org back to all of our social media content
spread across, multiple platforms. So I'm really, in fact, we just won a couple of awards for our vaccine
campaigns. We were recognized, for the content and efficacy of those campaigns. I'm, I'm really proud of the
work we do in the space. I, I, it pains me to say I have reached the age where I can't speak, with any coolness or
confidence about, some of these social media platforms, but I can't speak confidently that we do it. So I'll just
leave it at that.

Mark (28:09)
Well, you said cool versus hip, so you're okay.

Shawn (28:11)
Yeah.

Margaret (28:13)
Well, Sean, thank you so much, for joining us today, for the work that you're doing and the work of your
members of the association. And thank you to our audience for being here. A reminder to be sure and subscribe
to our videos on YouTube, find us on Facebook and x, and please share your thoughts and your comments about
this program. Take care, and be well.

(28:36)
This copyrighted program is produced by conversations on healthcare and cannot be reproduced or remitted in
whole or in part without the express written consent from Community Health Center, Inc. The views expressed
by guests are their own, and they do not necessarily reflect the opinion of conversations on healthcare or its
affiliated entities.