SAN ANTONIO -- Michael Munger, MD, the newly installed president of the American Academy of Family Physicians, took the reins from John Meigs, Jr., MD, and 乌鸦传媒 caught up with him at the group's annual meeting.
Munger, vice president of medical affairs for primary care and a practicing family physician at Saint Luke's Physicians Group in Overland Park, Kan., said payment reform and eliminating the regulatory and administrative hassles physicians face each day are among his top priorities.
"I believe that we have the ear of Secretary Price. I do believe he has heard us," Munger said of the new Secretary of Health and Human Services Tom Price, MD.
A member of the AAFP for more than 30 years, Munger served on the AAFP board for three years and in other local leadership positions, before being elected last September with a pledge to "fight the culture of single-specialty superiority."
In his community, Munger has been a spokesperson for the Clean Air Kansas City initiative, and a participant in the Overland Park Chamber of Commerce's Public Smoking Restriction task force. He also has volunteered at the Kansas City Free Health Clinic for almost a decade.
When he isn't practicing medicine or out lobbying for the Academy, he likes to cook, read, garden, and listen to jazz and blues.
This interview has been edited for brevity and clarity and includes responses from a follow-up email.
MPT: Why did you become a physician?
Munger: I actually was planning on becoming a journalist as I graduated high school. Because I had done well in science studies during high school, I applied to a fairly new medical school at the University of Missouri-Kansas City. It had a combined BA/MD program which was 6 years in length, and you start straight out of high school. I applied to it thinking that if I didn't get accepted I would obtain an undergraduate degree, again probably in journalism studies. I was accepted, made the decision to enter, and have never looked back.
MPT: What drew you to family medicine?
Munger: During my residency in the late 1980s, one of my mentors was . He was charismatic, dynamic. He was bigger than life and a great family doctor. The AAFP Center for the History of Family Medicine includes him as one of the 12 pioneers of family medicine.
He was not afraid to stand up. He was not afraid to ruffle feathers. If it was for the cause, he was out front and a spokesperson. And that really meant something to me. I'm not anybody who tries to speak out all the time, but you have to stand up for your specialty.
MPT: When did you feel compelled to stand up for family medicine?
Munger: When I was in my first year of practice, a local hospital had a policy that the only way I could admit a patient to the ICU was to have a mandatory cardiology or pulmonary consult regardless of the diagnosis or my training and experience. I had to stand up to the medical staff and protest this, and was able to have that policy rescinded.
MPT: The AAFP has also "ruffled feathers" -- for example, by pushing back against Republican repeal-and-replace efforts. If you had two minutes in an elevator with Senate leadership to discuss "saving" the Affordable Care Act, what would you say?
Munger: My "elevator speech" would focus on the need to ensure that all Americans have access to affordable, meaningful healthcare coverage regardless of their income, age, gender, or health status. The legislation should be a bipartisan effort that stabilizes the health insurance markets, that increases competition among insurance companies, and that lowers the costs of health.
Since the beginning of the year, the AAFP and our colleagues at five other medical organizations have consistently reached out to both the House and the Senate to let them know our position on what needs to be a part of any healthcare reform legislation.
We also just sent a outlining our thoughts on the Graham-Cassidy proposal. In it, we said the proposal would worsen the inequities in healthcare coverage and likely increase the risk of losing insurance for millions of Americans.
MPT: What are your top priorities for the year?
Munger: Payment reform and reducing the administrative and regulatory burdens on physicians are my top priorities.
With regard to the Quality Payment Program (the new way physicians are paid under the Medicare Access and CHIP Reauthorization Act) it's essential that we can get our members prepared. We also need meaningful changes to decrease the complexity of MACRA implementation.
As for the burden on physicians, let's really look at the whole concept of prior authorization, and ask what's reasonable and what's not reasonable.
If a patient is on an existing medication and it's controlling their disease process, they shouldn't have to go through another prior authorization to get on that exact same medication just because they change commercial plans.
MPT: The AAFP has proposed its . What are its goals?
Munger: We're looking at accurately reflecting the value of the care we deliver -- uncoupling it from the face-to-face interactions on an exam table. With this model, you would have resources to be able to hire additional staff and infrastructure to make sure you are managing transitions and better coordinating care.
MPT: What are the biggest challenges facing rural practitioners today and what are the most creative solutions you've heard?
Munger: As a nation, we need to address the maldistribution of physicians. The best way to solve that challenge is to get more doctors to practice in these areas, and the best programs to do that are the Teaching Health Center Graduate Medical Education program and the National Health Service Corps. Teaching health centers train primary care physicians, general surgeons, and dentists in the community – mostly in federally qualified community health centers that serve underserved communities.
MPT: What keeps you up at night?
Munger: The main patient issues that keep me up at night are around the cost of medications and high deductible plans that my patients face. I worry that they will be forced to choose to forgo treatment or care due to inability to pay.
MPT: Do you talk to your patients about politics?
Munger: I keep politics out of the exam room. If a patient will ask a question, I remain focused on being nonpartisan, but rather talk about principles that would improve the health of all people, such as affordable meaningful coverage for all and a decrease in the cost of medications.