By BETSY TAYLOR
Dr. David Barbe, a family medicine physician who practices in his rural hometown of Mountain Grove, Mo., will be installed for a yearlong term as president of the Chicago-based American Medical Association this month.
Barbe, 63, is a vice president of regional operations for the Springfield, Mo., communities of Mercy health system of Chesterfield, Mo. He oversees five rural Mercy hospitals and 90 clinic practices in southwest Missouri and northwest Arkansas.
Dr. David Barbe confers with a patient at Mercy Clinic Family Medicine – Mountain Grove in Missouri.
Barbe has been on the AMA board since 2009 and the Missouri State Medical Association's board for over 25 years. He has chaired both groups.
Barbe left Mountain Grove for his medical education in Columbia, Mo., and residency in Wichita, Kan., before returning to the south central Missouri town of fewer than 5,000 residents to begin his practice. (He built a small group practice that he later merged with the Mercy Clinic in 1997.) His wife, Debbie, an obstetrics nurse, was his high school sweetheart.
He talked with Catholic Health World about becoming a physician leader and the challenges facing physicians.
You treat patients in a small Midwestern town and are a medical leader on the national stage. How do those experiences converge?
Debbie and I went back to Mountain Grove in the first place not just because it was our hometown, but because it was then, and continues to be, a chronically underserved area from a medical standpoint. And we felt that there was a great need and that we could fulfill that need.
I realized fairly soon that a lot was happening outside of the office that impacted the way I was able to deliver care for my patients. And so, that's what prompted me to get involved in state and national medical associations, and I've never regretted that.
It is also, to some extent, what prompted me to get involved with leadership in Mercy. If I see patients in the office only, then I can touch the lives of 2,000 or 3,000 people, maybe a few more. As a physician leader at Mercy, I'm hopefully helping shape care for tens of thousands of patients treated in our medical practices and hospitals.
And then, if you continue to extrapolate that to my involvement in the Missouri State Medical Association and now to the American Medical Association, I am hopefully impacting the quality of care and the availability of care and the affordability of care for literally millions of people, and that is very gratifying.
I see these roles as very complementary. I think it is remarkable how much the vision and mission of Mercy, the mission of Catholic health care in general, and the mission of the American Medical Association are aligned in that our goals are to provide access and affordable care to as many people in this country as possible.
What is the AMA hoping will happen with federal health care policy moving forward?
I believe through the public's voice, through the voice of hospital associations like CHA, the American Hospital Association and others, and the voice of physician professional organizations like the American Medical Association, we will have a moderating impact on the changes that will be the next iteration of health care reform. I am afraid that it will also include some cuts. I hope they can find ways to do that that won't gut safety net programs and that will make a path for low-income individuals to get subsidies that are adequate to purchase insurance.
What aspects of the AMA's work are you particularly passionate about?
My personal passion has to do with physician health and well-being. Physician morale is at an all-time low. Physician burnout is at an all-time high. If you accept that physicians are a very high-value part of the health care system, we can't afford to have physicians not performing at the top of their game, not being fully engaged and enjoying the practice of medicine.
Physicians who are stressed and burned out don't perform as well on quality metrics because they're sort of disengaged. They're trying to survive, and they're not able to fully attend to what the health care system and what patients need.
So, they give good care — don't get me wrong — but they don't give the best care. They don't give the care and the compassion that they could, and we have to work on relieving that.
What's contributing to burnout and how is the AMA addressing those root causes?
The AMA has devoted a lot of resources to that, in two dimensions. One is to improve the practice environment. Physicians are burning out because of the burdens of practice, the paperwork and electronic health records that many think work against physicians instead of for them.
The AMA did a study last year that shows that physicians spend about twice as much time doing clerical work, data entry and paperwork, as they do with direct face-to-face decision-making time with patients. The AMA's working on reducing the paperwork burden, reducing prior authorization hassles from health plans. We've already had some early wins. One of the large health plans in New York has discontinued the requirement for prior authorization for over 200 tests and treatments in their network. So, we are seeing a genuine impact that will make a difference in the practice environment for physicians in that area of New York. We're working on making the electronic health record more efficient and effective for physicians, which should improve the practice environment.
The other dimension of this is to work on the physicians' resilience, to just help them reconnect with why they became physicians in the first place. The vast majority of physicians want to stay in the practice of medicine.
Another recent survey we did showed that, in spite of the high burnout rates, very few physicians regret their choice of medicine as a profession. They want to see patients. They connect with that altruistically. We have to help them renew that joy in the practice of medicine.
What's involved in the AMA's efforts to build physician resilience?
We have online modules that are available right now to any physician. You don't have to be an AMA member. There's a program that we put together called Steps Forward at stepsforward.org. And it has almost 40 modules now that span everything from physician wellness to how to be more efficient with your electronic health record and how to better manage the paperwork burden.
We are also beginning to work with some of the integrated systems around the country around physician wellness. We'll help them assess the current state of their physician well-being through surveys and help them custom-design a program that they can then begin to use to address that. There's a lot of good work being done on this.
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