When you’re an “old country doc” — as Athens family physician Douglas Curran, MD, readily calls himself — relationships are key. Small-town physicians like him don’t enjoy the luxury of anonymity, whether they want it or not. You get to know your patients, and they get to know you.
Locals who aren’t your patients may get to know you, too — even if you don’t know them. As he often does with many things, the affable Dr. Curran has a story to illustrate that.
Years ago, Dr. Curran and his wife, Sandy, were having people over. She asked him to go pick up ice cream and some other less-than-nutritious eats for their guests. One of his practice partners at the time, family physician Kenneth Lemmon, MD, went to the same grocery store. After Dr. Curran got in line, he took stock of his groceries and scolded himself.
“I didn’t know the lady at all who was checking me out. And I said, ‘Oh gee, this is terrible. There’s nothing healthy here,’” he recalled. “And she said, ‘Oh, Dr. Curran, that’s nothing. You ought to see what Dr. Lemmon buys when he comes in here.’
“So she not only knew who I was, she knew who my partner was, and she knew what he bought. That’s kind of how a small town is.”
Once he becomes president of the Texas Medical Association at TexMed 2018 later this month (See “Why Come to TexMed?” page 27), Dr. Curran will try to convince his peers everywhere in the state that personable, small-town-style patient relationships — the kind he’s excelled at for more than 40 years — can make you a better doctor.
“I think when docs become a little more intimate with their patients and begin to feel their pain and their struggles, then you have a lot more empathy. It changes you from being their sort-of health care dictator to their health care partner,” he said. “Then you get things done — because they don’t want to disappoint you.”
Leadership in organized medicine is nothing new to Dr. Curran. He’s past chair of the TMA Board of Trustees, past president of the Texas Academy of Family Physicians (TAFP), and is now chairing a joint task force on Medicaid physician payments between TMA and the Texas Hospital Association. (See “Bio Box,” page 26.)
Dr. Curran has also been a leader in some of the most important legislative reforms for medicine in recent memory. Over the years, he’s advocated for the 2003 tort reforms, patients’ rights reforms, and legislation to improve Medicaid and the Children’s Health Insurance Program. He’s also spoken out against the push by other health care professionals to expand their scope of practice.
During his year at the helm of TMA, improving patient care is at the top of Dr. Curran’s agenda. Hand in hand with that is improving access to care. Dr. Curran, who practices at Lakeland Associates and at The University of Texas Health Athens, played a major role in creating a rural health clinic and an obstetrical care clinic for patients who don’t have the means to pay for such care. In his home county, Henderson, 26 percent of the population is uninsured, according to countyhealthrankings.org. Improving access to care will be his focus not just for the whole state, but specifically for the uninsured in places like Athens.
“They show up in our emergency room, and we still have to take care of them,” he said. “I don’t mind doing that, but I also run a business, have employees that want to be paid, and have health insurance to pay for myself, and light bills to pay and so forth. I run a business, so I’ve got to have enough money and enough resources to take care of that, as well.
“We’ve seen payment for physicians just continue to be static or shrink, and we survived for a while by just increasing volume. We can’t do that anymore. There’s just no place to … increase any more volume. So I’m hoping that we can shine a light on that enough to improve access for our people. If we can do that, we’ve helped the country doctor out there that I’ve been all these years.”
Payments in Medicaid have been a constant source of frustration for physicians. But Dr. Curran is optimistic about improvements. One big part of his solution: Eliminating onerous prior approval requirements “and all that garbage,” he said. (See “Taking Out the Garbage,” page 26.)
His emphasis on developing relationships extends to hospitals, too; Dr. Curran says he was determined to build a bridge to the hospitals upon becoming chair of the Board of Trustees.
“Building that relationship with our colleagues had to happen, because we have so much more in common than we have differences,” he said. “By being fairly open and transparent about, ‘OK, here are my interests, here’s what I need, here’s what needs to happen, here’s what’s been happening, and it can’t continue’ — I think that’s been fair [to have that dialogue]. It’s OK for us to push on them a little bit, and it’s OK for them to push back at us.”
Along with patient access and relationships, Dr. Curran plans to talk about civility. While plenty of people have noted the decline in civility in politics in recent years, he’s seen it in the medical realm, too — and says it’s time to remind everyone, “We can disagree without being disagreeable.
“Respect for the physician is not near what it once was,” he said. “You may be working with patients trying to educate them, trying to get them where they need to go — and there’s this attitude of, ‘There’s lots of other places to get information from than just the physician. I’ll go online, I’ll collect data from other things.’ And the data they may be getting is not very reliable. It’s not very scientific.
“This anti-scientific idea that’s out there is real. There are people that really have bought into this craziness about science being inappropriate, inaccurate, leveraged by people who have an agenda. It’s just not true. We really try to do the best we can to get good information and provide that to people, and you see people not listening to you when you tell them that.”
"It's in your blood"
One of Dr. Curran’s escapes from work is his ranch. The Arkansas native grew up with a grandfather who had a ranch, and his father ran a feed, seed, and fertilizer business. When Dr. Curran headed to medical school at the University of Arkansas for Medical Sciences, “I got rid of my jeans, and my boots, and my gloves, and everything, and I swore I was never going to punch another cow, never buck another bale of hay. I was done.”
He landed in Texas after he completed residency at The University of Texas Southwestern Medical School Family Medicine Residency Program at John Peter Smith Hospital in Fort Worth. But after ending up in Athens, one of his patients proposed to sell Dr. Curran his ranch about 12 miles outside of town. After driving back and forth from home to the ranch for a couple of years, Dr. Curran’s wife, Sandy, told him, “We’ve got to move to a ranch. You’re going to do this the rest of your life. It’s in your blood.” So they bought a ranch closer to town.
“I’m actually about three miles from the hospital,” he said. “I can be in the delivery room from my bed in about three to four minutes to deliver a baby. … The cattle business is just kind of part of me. I love it. I like to do it. I enjoy the animals, and it’s a nice release.”
Dr. Curran is also active in his church and helps with a water-drilling company in underdeveloped countries that one of his partners, Ted Mettetal, MD, started.
“You want to really change the world that we live in? Provide people clean water. There are so many kids running back and forth to the creek to get dirty water … rather than go to school,” Dr. Curran said. “It’s crazy what’s out there that’s easy to fix. Public health issues are enormous. We take a lot of that for granted in our country.”
Dr. Curran is just as caring of rural communities in Texas, having recently added to a long list of honors and leadership roles the Rural Health Champion Award from the Texas Rural Health Association.
Even with his accomplishments, Dr. Curran is still in awe about taking the office he’s about to assume.
“I just can’t imagine an old country doc who’s pretty much wore out is asked to participate at this level of leadership,” he said. “But I’m so excited about getting to do it, and I think I can do it and not disappoint anyone. I fully intend to be involved in change and be a part of that. I’ve been involved in that all my career, and I’m not going to stop now.”
Taking out the garbage
As chair of the joint Texas Medical Association/Texas Hospital Association Medicaid task force, Dr. Curran is optimistic about the prospects for improving physician payments in Medicaid and getting rid of needless red tape. Here’s his take:
“We’re going to [experiment] with Medicaid. We’ve seen work requirements talked about, we’ve seen other things talked about. I’m not saying any of those are any good. The fact we’re going to look at it and open up opportunities in Medicaid gives us a chance to weigh in on some things that might make a difference. If we can somehow increase payment and make it just a little more reasonable; and increase numbers and volume [of patients]; and increase access for our people by getting rid of some of the onerous stuff that we have to do, the prior approval stuff and all that garbage, that costs the state nothing. When we get rid of some of the burdens of the practice, hone things, become more efficient, and expand opportunities for other physicians, you may see docs begin to move back into Medicaid. If they do, I think that’ll be a real plus.
“We know from what went on in the early years of the Affordable Care Act, when [the federal government was] paying Medicare rates for Medicaid services for primary care, the cost of care went down because patients were being seen in the office and not in the emergency room. Those are opportunities for us to cash in.”
Douglas Curran, MD Incoming TMA President
Specialty: Family medicine
Medical school: University of Arkansas for Medical Sciences
Residency: The University of Texas Southwestern Medical School Family Medicine Residency Program at John Peter Smith Hospital
TMA leadership roles: Board of Trustees (chair); Select Committee on National Health System reform (chair); Primary Care Coalition, Committee on Professional Liability; Council on Member Services
Other leadership positions: Texas Academy of Family Physicians (TAFP) past president; TAFP Commission on Membership and Member Services (chair); TAFP Commission on Legislative and Public Affairs (chair); American Academy of Family Physicians Commission for Governmental Advocacy
Why Come to TexMed 2018
TexMed 2018 is your chance to meet up with fellow Texas physicians from a wide variety of specialties, to further your personal and continuing medical education (CME), and to be an active participant in the house of medicine.
But it’s not all business at our giant annual policymaking meeting, scheduled for May 18-19 at the JW Marriott San Antonio Hill Country Resort.
The TMA Alliance will celebrate 100 years as one of the state’s premier political, community, and service organizations with a Centennial Celebration on Thursday, May 17. Five-time Grammy winner Marcia Ball will be part of the festivities, which also will feature dinner and a welcome reception.
That’s not the only big party planned. The TMA Foundation will hold its 25th anniversary gala that same evening. More than 500 physicians and friends of medicine will enjoy cocktails, a seated dinner, auctions, and live music. Proceeds from the gala will support TMA’s charitable programs.
On Friday, May 18, don’t miss the TMA/TMA Alliance (TMAA) Presidents’ Reception from 6 to 7 p.m. for a chance to meet incoming TMA President Douglas Curran, MD, and incoming TMAA President Sunshine Moore.
On Friday and Saturday, the TMA House of Delegates meets to study and adopt new policy positions for the association, and on Saturday votes to elect new TMA leaders.
TexMed 2018 also offers more than 80 hours of free CME opportunities, including new sessions on “Population Health and Your Practice,” “Professional Development and Leadership,” and “Wound Care.”
More than 100 vendors will line the Expo Hall, including representatives from banks, practice management providers, insurance companies, and medical equipment providers.
For more information, go to www.texmed.org/TexMed/.
Tex Med. 2018;114(5):22-27
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