Air Force Consultant Report

Air Force Consultant’s Report

Antoine (Marcus) Alexander, MD
AFMOA, San Antonio, TX

Hello and Happy New Year to everyone,

The 30 degree San Antonio weather has been a friendly reminder that Winter is coming, and with it there are several things on the horizon: beginning of a 5 year Genesis EHR and Med-COI (Medical Community of Interest) network role out starting at Fairchild, completion of FY17 JGMESB and assignment planning for summer 2017 moves, implementation of non-enrolled medical officer (NEMO) initiative, projection of our P5 deployment taskings, and coordination for the USAFP annual meeting.

I had the opportunity to attend Cerner’s annual convention last month. As one that is traditionally cautious and even skeptical, I will admit to you that I was impressed. In trying to visit what seemed one hundred stations that were notably running quickly and smoothly off one Wi-Fi based server, I consistently felt like the system capability would be helpful to our patients and providers and that there was a profound focus on customer service. While there will still be some growing pains related to major change, there were a few notable takeaways. 1) This is not a small mom and pop shop. There were about 15,000 in attendance for the keynote presentations at the Sprint Center, with representatives from health systems such as Banner Health, University Health, Excela Health, and Children’s Hospital of Orange County. 2) These health systems had many positive things to say about their experience in rolling out Cerner’s EHR and with Cerner’s response when assistance was needed. 3) The MHS has significantly invested in training to accompany this roll out. 4) There are several options to improve efficiency for different provider styles – easy dragon incorporation, dynamic documentation vs power notes, and the ability to use and customize templates or scripts that include drop down style fill in the blanks. The combination of dynamic documentation and customized templates could truly produce a high quality and useful note in a short amount of time once a provider is comfortable and familiar with them. 5) The MHS is implementing Med-COI as an update to the infrastructure our EHR runs on, which may be as critical to functionality as the EHR itself.

We had an outstanding FY17 Joint GME Selection Board. We filled all 54 of our active duty FM residency positions (with Eglin and Nellis each growing 2 additional positions to improve our pipeline) plus six civilian sponsored selections. Additionally, we selected two FM-OB fellows and six Primary Care Sports Medicine fellows. The continued recruitment of quality Family Physicians is a testimony to what you all do every day and a must for the readiness and trusted care role the AFMS asks our FP’s to fill. AFPC reports that in FY16 91 FPs left Family Medicine clinical roles either for retirement, separation, GME, leadership positions, or transitioned to another AFSC. We are currently 97% manned for our clinical positions, and every vacancy (not assigned or not available) has a significant impact on the in garrison mission, readiness mission, and reliable quality care our patients receive. Our consultant partnered recruitment trip to three Kansas City residencies and medical schools in addition to the AAFP conference of Family Medicine Residents and Medical Students resulted in eight additional FPs this year and hopefully more to come in the future. Thus, our priority this assignment season will continue to be filling all of our anticipated vacant clinical authorizations. We are simultaneously reviewing your feedback regarding the top challenges for our physicians, including those that are likely to impact retention decisions. Thank you for your feedback and for our common goal of achieving our AFMS mission and delivering high quality care while also being the preferred place of employment with good work-life balance plus the bonus of our opportunity to meaningfully serve.

The AFMS leadership recognizes the somewhat steady state and predictable percent of primary care providers that are unavailable due to short-term absences. They have supported an initiative that placed 38 contract providers at 13 MTFs for one year in FY16 and that programs 23 GS providers (FM, IM, Peds, NP, PA) at 11 MTFs in the FY18 POM that are eligible to start the hiring process January 2017. If we are able to demonstrate the AFMS and patient value in this approach, we will request an additional 19 authorizations in the FY19 POM. While we have more than these 42 short term vacancies, once established this could potentially allow us to more consistently have the desired manpower to utilize our standardized processes and deliver Trusted Care. The initial 23 will likely primarily fill vacancies at their chosen “hub”MTFs, with a goal to eventually grow to be able to support vacancies at “spoke” facilities. This is a major shift in approach to this challenge, and we all must do our best to assure optimal utilization of these and all AFMH authorizations to the targeted clinical AFMH outcomes.

Family physicians will continue to play a key readiness role via our P5 deployment taskings (April 17 – Sep 17). With only 25 CONUS MTFs having 3 or more FPs, these MTFs must consistently provide available and ready 44Fs in order for us to have the capability to support 50 taskings per year. Any 44F at these locations that are not ready and available during their assigned band, will shift that tasking to another 44F at one of those 25 MTFs and likely negate our ability to maintain an average of one deployment every 4 years. We will continue to work on improving our readiness communication and transparency to allow your best possible life planning and assurance of your own personal readiness and availability. I think there is potential to also incorporate this into assignment planning as well as a more coordinated band assignment (P1, P3, P5) across the AFMS.

Last but not least, winter means planning to attend our USAFP Annual Meeting in Seattle, Washington 5-9 March 2017. Your attendance is secured via your routine local TDY request and is funded by your MTF. Please start this process now if you desire to attend. It is an amazing opportunity for clinical currency for readiness. There are multiple presentations with impact on both the clinical aspects of practice standards as well as the administrative and management aspects of professional practice in the military. It is an opportunity to network, learn, and understand our role in the AFMS, including an opportunity to hear from and discuss issues with our AF Surgeon General, General Ediger, during our service specific breakout.

Thank you again for all that you do and for the opportunity to serve as your consultant.


Antoin “Marcus” Alexander