Friday, February 19, 2010

Belated Analysis

I realized that I never came back around to comment on the Twitter feed I typed up a couple of weeks ago. Just a brief comment:

I think that healthcare reform--critical and necessary as it is--will be focusing on primary care. Healthcare is more efficient and has better outcomes when primary care is the focus, not just a component of the healthcare system. However you feel about the current legislation in Washington, all players appear to agree that primary care will be the focus.

One of the knocks against family medicine and other primary care specialists is that we don't get paid enough for the paperwork and long hours and insurance hassles we have to face. The patient-centered medical home model, long endorsed by the AAFP, would remedy this and I think will be a component of restructuring the current broken system.

Making family medicine and other primary care careers more appealing to medical (and pre-medical students) will help bring qualified applicants into the fields. This change in the workforce will benefit patients and the system overall. This will involve restructuring and adjusting payment structures, and will probably end up with some unattractive doctor-vs-doctor arguments as those who currently hold the larger pieces of the pie are asked (or required) to give up a portion.

I think the AAFP has positioned the specialty well to make progress under healthcare reform. I hope that Congress can complete its work and allow the rest of us to get on with ours.

Listserve Exchange

As part of the American Academy of Family Physicians, I'm signed up to a handful of listserves. This message came across on one of them:

"I thought I had been purged from this listserve after I dropped my AAFP membership, but this discussion reminds me of why I quit the AAFP: it is a political organization with a leftist tilt that is happy to be used as a shill for the current administration's goals. The AAFP does not help me advance my career as a DOCTOR OF MEDICINE. I feel trapped in a "specialty" that, in spite of my years of training and experience, is the lowest paid of any and is very limiting in terms of career options. I could not do a fellowship in any medical subspecialty because the residency I completed is not regarded as equal to an internal medicine residency. A graduate of a 3 year internal medicine program could later decide to become a rheumatologist, an endocrinologist, a cardiologist, a gastroenterologist, a neurologist, etc, etc, but a family doctor probably would not be a candidate for a fellowship in any of those specialties. A family doctor is regarded as easily replaceable by a nurse practitioner, except that nurse practitioners probably have a wider choice of specialties and practice settings. Heck, a nurse can become an anesthetist and make more money than I can as a family doctor, but could I become an anesthetist? IMO, the AAFP should be focused on improving the training of and practice opportunities for its members, instead of being the ultimate politically correct machine."

Another person followed directly with an "Agreed" message endorsing the first.

It probably goes without saying, but I don't agree with them at all. I sent back the following reply (I've deleted the e-mail addresses involved):

"I can't make out the names of our 2 colleagues who just posted, so I'll frame my reply to your e-mails:

Dr.s X and Y:

I sympathize with your frustration re: the state of our current health care system, and agree that our specialty is undervalued (and we are underpaid relative to our interventionalist colleagues). I believe that the AAFP (and the state AFP chapters) are working to address these issues by addressing scope of practice issues and pushing for increased reimbursement and recognition of the specialty. Healthcare reform currently underway--whether you agree with the central proposals or no--recognizes the need for primary care and I believe that it will put family medicine in a strong position. The patient-centered medical home model promises to allow us to provide the type of care most of us wanted to (patient centered, focused and wellness and disease prevention), and has increasing support as a means to rebuild the system. The AAFP has been a strong proponent for this model.

Unlike you, I feel that our specialty allows us to do a large number of things that other physicians cannot: I can see a newborn, take care of a geriatric patient, work on heart failure, deal with sports injuries, inject a shoulder, diagnose a rash, and provide comprehensive caring for ALL of patients. None of our colleagues can claim the same.

As an organization, the AAFP focuses on the big picture, a holistic assessment of health. As such, political and social issues will impact our Academy to perhaps a greater extent than others. The Congress of Delegates and the NCSC allow all members to speak via their representatives and make their opinions known. If you do not like a policy or a position, there are mechanisms to address that.

You have chosen to step back from the organization because you do not think its values are yours, and because you do not perceive that it provides return for your membership. Many of us feel otherwise. I feel that the AAFP leadership has worked hard to position the specialty favorably during the health care debate. I feel that the Academy has a valid role in addressing social issues that affect health. If I felt otherwise, I could speak to my AFP and determine how to work on resolutions to address or change those positions.

This listserve might not be the ideal venue to discuss issues such as climate change. But, this issue could be brought up for discussion and debate as a resolution later. If the membership agrees that it is not an issue that merits a position statement, then the representatives will make that known.

If you stepped down from the AAFP, so be it. Your call, and your $. I hope you will still benefit from the actions of the AAFP in the future which (I believe) will result in a stronger specialty. I continue to encourage the medical students I work with to consider family medicine--many of us are still energized by our patients and, while upset and frustrated by the current healthcare system and reimbursement concerns, will continue to work to improve conditions for all."

I fell privileged to be in a position to help patients. I'm sorry that some of my colleagues don't.