Family Medicine Leaders During COVID

Describe what you/your faculty/department/program/clinic did that demonstrated that family physicians are leaders in health systems.
I am currently the program director for an urban underserved residency program in Milwaukee Wisconsin. We are located in a community that was most impacted by COVID illness, severity and mortality when compared to the rest of our state. I helped lead my program's response to the pandemic in conjunction with residency program and clinic leaders, staff, residents and faculty.

In the first week of the pandemic, our clinic made adjustments to our practice to keep people safe, we transitioned to virtual visits with ease and we provided support in our hospital setting. We saw patients who were at high risk of COVID outside of the clinic, did testing from their cars in the parking lot, and set up residents/faculty to assist in triage. We were ready within the first two weeks; it helped that my medical director also worked for the health department and kept us updated regularly with changes to recommendations, etc...

My experience working with physicians in leadership in the hospital setting was a little different, initially. I serve as the vice chief of staff for our sponsoring institution and was involved in all meetings pertaining to our hospital's response to the pandemic. It was evident in the first meeting that I would have to help many of my physician colleagues (from other specialties) to understand the concepts of community medicine and population health as we approached problem solving during the pandemic. I'll never forget how many people chuckled when I mentioned that we were seeing patients in our clinic parking lot or having to explain to surgeons why cases needed to cease. Did their patients matter? Yes of course, but one patient in the O.R. meant depleting resources that we might need to utilize when our hospital became flooded with COVID patients. I decided to educate my peers on these principles and volunteered to lead our surge staffing planning for our region and hospitals within the state.

Our program's reach within our hospital system stretched from testing patients, hospital system staff, and area corporate organizations (in our parking lot) to filling in gaps in the hospital, ICUs, newborn nursery, and labor and delivery. We had the skill set to do it all and this was quickly realized by our hospital system, I've never been more proud to have a seat at "the table."

How did you communicate with health systems leaders during the process?
As vice chief of staff, I worked with the hospital president, VPMA, and chief of staff, along with the various department chairs to help create a list of surge staffing providers to work in the ICUs and on hospitalist services when the surge hit our hospital.

I also met with the NICU leader, after the neonatology group reached out to our team, as they wanted to limit the number of community physicians entering our unit, and asked us to split newborn rounding in the nursery with their physician group (so we created a newborn rounding team to help there).

I had to meet with our hospital system's State Planning Committee to create access for our hospitals across the state, sharing our experiences with surge staff planning, and organizing and utilizing the list of volunteer physicians (some of whom were graduates of our program) that I helped create for our hospital's back up staffing model. I met with our hospital leaders daily and the State Committee daily, as well.

The hospitalist group leadership reached out to us to help them fill in gaps in the inpatient setting, and I met with them regularly to develop the training orientation protocols for bringing in our back up outpatient physicians to help in the hospital so that they would be prepared to step in right away when needed. We also provided a resident "assistant" to help those providers with EHR orders, progress notes, discharge summary documentation etc, on their first day working in the hospital.

The director of our hospital's respiratory clinic was a former residency graduate and he helped us get a COVID trailer stationed outside of our clinic (as our patients could not travel to the respiratory clinics on the other side of town, but were very high risk). By us getting a COVID trailer at our clinic, the hospital decided that we would be a great resource to have patients, hospital staff/family members get tested a mile up the road from the hospital in our clinic parking lot! The hospital even created a partnership with two large business organizations so that their employees could get tested in our parking lot, too!

What type of feedback have you received about your efforts?
Very positive. Our hospital was very grateful for how we were able to step into various roles to meet our patients', hospital staff, and community's needs. The hospital president bought plants for all of the residents, faculty and outpatient community physicians who helped on the extra inpatient teams as a thank you.

What type of impact do you think this will have on your health systems leaders’ perception of family medicine?
Very positive. Our hospital was very grateful for how we were able to step into various roles to meet our patients', hospital staff, and community's needs. The hospital president bought plants for all of the residents, faculty and outpatient community physicians who helped on the extra inpatient teams as a thank you.

What type of advice would you give to other family physicians or family medicine faculty about helping health systems leaders see the value of family medicine?
I think that family physicians should always be at "the table." I would encourage family physicians/faculty to be engaged in hospital leadership positions: various peer review committees, hospital and ambulatory quality and improvement committees, community engagement work, etc... We do this work within our residency programs and know how to lead these efforts already. It was obvious to me that the response to COVID 19 for our community had to be led by family physicians because of how we naturally think about patient care. Our philosophy of care allows us to think beyond patients as individuals, every day, in how we practice. We see how the things from our patients' surrounding community affects their health and livelihood, which is why we were able to think critically about how to adapt to caring for the community during a pandemic that affected the community in so many different ways. I truly believe that we are always needed at "the table".