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Tuesday Oct 27, 2015

Whack the 'WAC'

How many of you can relate to this statement? "I am self-employed, but I work for the government and insurance companies."

This is a common refrain from physicians in all specialties, but it is an especially frequent complaint among family physicians. The administrative burden on family physicians is mind boggling. A majority of family physicians have contractual relationships with seven or more payers. That means there are seven different prior authorization forms, seven different quality reporting systems, seven different prescribing formularies, seven different appropriate use programs, seven different … Well, you get the idea.  

Family physicians not only hate red tape, but there is growing evidence that it contributes to lower quality of care and is a major driver of physician burnout.

Have you ever experienced a sequence of events that crystalizes an issue for you? This happened to me earlier this month through a conversation with a family physician from rural North Carolina, a comment by an AAFP member from California, and a statement by a prominent author -- all driving home the same point -- the administrative burden on physicians is a HUGE problem.

This sequence of events started with a phone conversation I had with a family physician in North Carolina who is in a solo practice in a rural community. "You just have no idea how hard it is to take care of my patients," he told me. The thing that caught my attention was the fact that he wasn't complaining about the time, money, or the hassle on him or his staff; his concern was the red tape preventing him from taking care of his patients.  

That conversation was followed by a conversation with a member from California who, during a large meeting, stated that physicians are tired of the "WAC." I was not familiar with that term, so I did what any inquisitive person would do. I shouted out, "What is the WAC?"  He responded, "Work after clinic." This physician said that the volumes of administrative activity that require physicians to spend hours working after seeing patients was hurting patient care and destroying the love of practice among family physicians. He said that the AAFP needed to help physicians "whack the WAC."

The third and final event in this sequence was a paragraph in the closing chapter of Steven Brill's latest book, "America's Bitter Pill," which reads as follows:

"We should recognize that the quality of medical care is going to continue to be jeopardized by the broken economics of the marketplace, which provides rich incentives to everyone except those actually treating all of these newly covered patients. As doctors remain bogged down in paperwork and face mounting business pressures, the portion of our best and brightest who want to care for the sick instead of cashing in on the business of healthcare is likely to drop.”

Administrative simplification is something that has been a priority for the AAFP for many years. AAFP resources on administrative simplification say, in part, "The AAFP is determined to help family physicians reduce these roadblocks by identifying and eliminating regulations and processes that add cost while undermining the efficient and effective delivery of quality care."  

In addition, we have pursued extensive advocacy initiatives aimed at reducing the administrative burden associated with Medicare and Medicaid. These efforts include establishing a core set of primary care quality measures that would be used by all payers, including Medicare. We also continue to press CMS and commercial insurers to forgo the implementation of complex prior authorization and appropriate use programs that delay access to care for patients and add to the “WAC.”

The most meaningful and important work we are doing to "whack the WAC" is our aggressive efforts to delay and reform the flawed meaningful use program. Last week, CMS and the Office of the National Coordinator for Health Information Technology (ONC) advanced meaningful use (MU) stage three regulations despite widespread criticism from the AAFP and other physician organizations.  

In 2009, Congress passed the HITECH Act. This law instructed CMS and ONC to establish a program that would result in the adoption and implementation of electronic health records among physicians, hospitals, and other health care providers. It also instructed ONC to establish a standard for the interoperability of those EHR products. The legislation did not instruct CMS and ONC to create a complex, three-phase regulatory framework that would add layers of administrative complexity on physicians and throw cold water on any enthusiasm that existed among physicians to implement EHRs in their practices, yet this is exactly what has happened.

Only 10 percent of physicians have attested to MU stage two, and 43 percent of physicians face penalties in 2015. It is unacceptable and unreasonable to impose further punishments on physicians when more time and evaluation of the MU program is clearly needed. The AAFP strongly supports Congress' efforts to transition our health care system from paper-based to electronic health records, however, current MU regulations place unnecessary administrative and financial burdens on family physicians, favor software vendors over physicians and patients, and do little to improve the quality of care we provide.

Are you tired of inputting meaningless data into your patient records simply to comply with a regulation and avoid a financial penalty on your practice? Are you tired of your EHR working for vendors and failing to work for you and your patients? It is time to "whack the WAC," and let's start with the meaningful use stage 3 regulations. Use the AAFP's Speak Out resources and tell your representative and senators to pause the implementation of the stage 3 MU regulation. 


Patients trust is with their lives . Why can't the government and insurers trust us to practice good medicine without unqualified reviewers providing "oversight services."

Posted by Marc berger on October 27, 2015 at 11:23 AM CDT #

Great piece Shawn. As you know, a growing number of family physicians are just saying NO to all of the baloney associated with all of these hoops and getting back to taking care of patients through the Direct Primary Care Model. I have never heard a single physician that has converted to Direct Primary Care say that they were burned out or that they spent any time checking "meaningless use" boxes. I think all family physicians should go back and listen to an oldie but goody song from the 80's by Twisted Sister called "We're Not Going to Take It!" and see if the message does not resonate with them. When you sing the chorus just put Blue Cross, or Humana, or Cigna, or Meaningful Use Hoops at the end.....It could be our anthem.

Posted by Brian Forrest MD on October 27, 2015 at 11:51 AM CDT #

To return the joy back to medicine, I can only change in areas which I have control of. I'll share 2 office practices changes we have done with high provider quality of life improvements. These 2 changs have significantly "whacked the WAC":) 1--Shared Medical Appointments performed for the last 7 years. 2-We use virtual scribes for the last 4 years(Connecting SOAPware EMR and DOCS CPR).

Posted by Byron Haney, M.D. on October 27, 2015 at 12:17 PM CDT #

The "information highway" could have been such a good tool for collaboration. Instead it has been co-opted by the government, HIPPA regulations, and insurance companies. It is now at best an obstacle course, and at worst a minefield. In short, it is an instrument for control by forces larger and less interested inpatient care than money and political influence. This is captured very humorously and ironically in a video. http://letdoctorsbedoctors.com/ The progression of conversations in the doctors dining room at the hospital it's Kelly. The progression of conversations in the doctors dining room at the hospital is telling- 30 years ago, I used to hear doctors approaching 70 make comments like "I guess I'll have to hang it up in another year or two". Now I hear doctors in their 60s complain that they aren't able to retire yet. I serve as a preceptor for three medical school. It is getting more difficult to show my students how satisfying primary care can be. Not because we don't still love our patients or because medicine is not intellectually stimulating, but because there are so many obstacles continually being thrown in our way. I would like to see the secretary for Health and Human Services or CMS, or maybe the man in the White House have to do all of their work with this degree of encumbrance for just one week. Then the ice might break in Washington.

Posted by John Branch, DO on October 27, 2015 at 12:18 PM CDT #

It is good to verbalize what most of us are feeling in the fee for service world. I for one am not going to wait for our government to come up with some other model for healthcare. I echo Brian F.'s comments above and will be starting a DPC practice in the next year. I think that it is important to remember that all of the regulations and rules that must be followed to receive payment cause doctors to focus on these issues with little time or mental energy left to focus on what is more important, our patients' needs. I choose quality medicine, work-life balance. I choose Direct Primary Care!

Posted by Tim Mulder on October 27, 2015 at 12:35 PM CDT #

It's extremely unfortunate, this site, Medscape and other physician-oriented sites have numerous stories of physicians electing to get out of medicine altogether, get out of clinical medicine, or go in to direct care. All this brought on by a government and system that does not understand the concept of the physician-patient relationship and the importance of that relationship to the health of the patient and the community. Oh, it gives us lip service, but that's all it is. Until enough of us get together to put the train back on the right track, it's going right over the precipice, and an already ailing health care system will be seeing the grim reaper.

Posted by Perry Williams MD on October 27, 2015 at 01:18 PM CDT #

I don't care how much accountable care garbage is imposed as it is all doomed to failure. Until people/patients are held "accountable" for their lousy health behaviors nothing is going to change in this country by the time I retire. When one works in a rural or medically underserved area the only thing that can be hoped for is to stave off some disease complications as the success with diabetes/obesity/smoking/CAD can be very sparse due to the inability of the patient population to change their habits. When I tell students that primary care doctors are expected to be nursemaids, guardian angels, secretaries and health policemen they seriously consider another specialty. We do not have the time nor are we paid enough to be the first three vocations nor do we have the means to be "health policemen" as the patients are not held responsible for their crummy behaviors. Oh, let's hold the "Doctors" accountable for patients "indiscretions" as "they" aren't educating people enough. If I was a student and heard this, I'd go into something else. Notice all the fat "happy" diabetics in the drug ads on television? "Use our $600.00 a month drug and you'll be fine." It would go farther to tell them to lose their fat a--es as it would be more beneficial at getting their type II diabetes under control. No wonder they're predicting a shortage of 20,000 primary care practitioners. Maybe the NP's can step up. Maybe not once they discover all the baloney we have to deal with.

Posted by Kurt on October 27, 2015 at 01:37 PM CDT #

The EMR was never intended to help the physician or the patient. It was mandated to help government and carriers keep track of things more efficiently. The fabrication that it would help us was intended to sell the concepts to the gullible, which worked admirably. I still use a paper chart comfortably and count myself lucky to have had the fortitude to just say no! Financially, I am not suffering at all. There is still, regrettably, more paperwork to do, and in this the academy can hopefully have some impact. The hassles of the EMR , however, will remain a theoretical problem only until such time as I become convinced of its utility.

Posted by on October 27, 2015 at 01:57 PM CDT #

Thank you for this article and I couldn't agree more. I am excited to see the energy with which family medicine physicians are working to take back our profession, and protect the sincere, powerful, yet statistically unmeasurable relationships we develop with our patients.

Posted by on October 27, 2015 at 02:01 PM CDT #

Too little too late. We needed universal single payer health coverage all along, which would streamline the bureaucracy, and the single insurer would be less likely to deny care now that would save money in a few years. I did not see AAFP advocating for that.We needed to have a way to charge for the WAC, but instead docs are going to DPC which favors the rich over the poor. When I proposed at an AAFP conference years ago that we needed to be able to charge for phone call management of patient needs, that was shot down by your AAFP reps. It has been 6 +years that we all were supposed to be on EHR, yet the hospitals and corporations are not paying to integrate them, so we all redo the same data input over and over again, more WAC. DPC will lead to a 2 tiered system.And NO money is coming back to the PCPS who have set up ACOs, I read the news on that. The private insurers are laughing at us on their way to the bank. Meanwhile the quality of care is already suffering g, I have seen it with my 89 yo mother, her new PCP office could not get her meds entered correctly in their EHR, Sent the wrong med in , etc.

Posted by Cathy Zack MD on October 27, 2015 at 02:07 PM CDT #

Spare me the crocodile tears. The AAFP pushed not-ready-for-prime-time EHRs; the AAFP pushed MU when none of the standards had been written; the AAFP pushed MACRA with its crushing "value-based payments;" the AAFP pushed doomed-to-fail ACOs; and worst of all, the AAFP pushed the 100k/doctor/year certified PCMH. You're not part of the solution - you're a big part of the problem.

Posted by R Stuart on October 27, 2015 at 02:14 PM CDT #

I am optimistic. Maybe not in my time but in the near future there will be an abundance of Direct Pay type Practices to employ our physicians who are burning out with all of the insurance and governmental administrative burdens. Many of us believe in the Direct Pay Model but are not interested in starting a business and are just waiting for a practice in line with our patient - physician philosophies to come to town! I am excited to see doctors breaking away and I admire and am proud of the leaders like Brian Forest in this movement. Our business leaders and entrepreneurs who see the need and believe in the mission will help. We are smart and will find solutions!

Posted by Amanda Austin, MD on October 27, 2015 at 02:18 PM CDT #

If everyone stopped doing MU it might get their attention that something is wrong. But then, most MU is forced on employed docs by their administrators who also require doctors to sign over the payments. Fortunately that's not the case for me, so come January 1 I'm out. I can put up with 90 days but not 365. I prefer to provide the best educational handouts for my patients rather than the ones my EHR thinks are best. I also want to respect a client's choice to not sign up for the portal. And since I can talk face to face with my coworkers clicking boxes to do CPOE is an interference. #littleboxes #byebyeMU

Posted by Happy Solo Doc on October 27, 2015 at 02:59 PM CDT #

We agree the situation is bad. We can lay back and take it, quit, move, or go to direct patient care. Hoping we can cut a deal with an irrational power structure amounts to laying back and taking it because we are trying to negotiate from a position of weakness. Nothing short of a nationwide doctor's strike will get the attention of the power-crazed at CMS and ONC. I'm currently awaiting a provisional Canadian license. If that doesn't attract me as a permanent solution, when I come back I'll probably go to direct care (but not concierge). None of the EMRs are any good, and all of them get worse every time they get updated.

Posted by Steven F Gordon MD on October 27, 2015 at 04:09 PM CDT #

You doctors celebrating that you do DPC and so have successfully avoided all this EHR stuff, please stand with all of us, anyway. Because next step is not licensing physicians until they prove competency with an EHR, including doing their pt records on one. Massachusetts already requires it. The next step will be not licensing doctors unless they take 'Care & 'Caid. Now who's celebrating? And a doctor shortage? They don't care! They'll just flood the country with foreign doctors. No shortage, ergo no problem. I'm becoming more and more convinced that the only realistic docs among us have treated the problem definitively, by resigning from medicine -- or life -- altogether.l

Posted by RornDoone on October 27, 2015 at 04:14 PM CDT #

From the book, "Medical Leadership Lessons From History; Part 42 Title: “Medical Providers Are Being Stress Fractured” Authorhouse, 2015. In June, 1812, Napoleon invaded Russia along with an army of 600,000 men; fewer than 100,000 made it back. During their ignoble military withdraw, in the middle of a terrible winter, thousands of soldiers died of exposure to the intense cold. However, along the retreat route, in the little Lithuanian town of Vilnious, modern grave site forensic analysis of the soldier’s bones revealed an interesting fact: many of the soldiers had suffered from stress (marching) fractures of their feet. Because the journey into Russia would be so far, Napoleon and his officers meticulously planned every aspect of the invasion force, including detailing all the equipment each soldier would have to carry in order to accomplish their military mission. Each piece was confirmed as necessary. Each article was deemed vital to their overall success. Nonetheless, this meant that each man had to carry over 70 lbs of equipment on their backs. It was too much. Literally, their leaders broke their soldier’s feet! As the delivery of quality healthcare continues to move forward in this nation, whether or not it be through patient centered medical homes or accountable care organizations, peripheral items, such as demonstrating, in detail, meaningful EHR use, or perpetually dealing with subcontracted radiological and pharmacy management companies and their constant faxes for prior authorization information or their rotating substitutions for alternative prescribed drugs, and the patient paperwork involving durable medical equipment re-authorization -- in effect, questioning and changing every medical decision made -- are now so intrusive as to demand an ever increasing amount of the doctor’s time away from direct patient care; doctors are spending just as much time filling out the paper and computer work involved in the office visit as in taking to the patient. And this is just part of it. According to a 2009 analysis quoted by Medical Economics, in order to fulfill all the preventive care and chronic disease management guidelines, a typical primary care doctor would have to work 22 hours a day!* Is it any wonder that more physicians than ever are suffering from symptoms of burn-out? As it was in the past, there’s no doubt that, in the minds of Napoleon and his generals, each piece of equipment they asked their soldiers to carry on their journey into Russia was important and necessary. Their mistake was they forgot they were leading an army of men not mules! Unfortunately, History seems to be repeating itself, this time in patient care. Now is our “winter of our discontent.”

Posted by Calvin Maestro Jr. MD on October 27, 2015 at 06:33 PM CDT #

Like RStuart said, AAFP is one of the major architects of this problem. Sorry if I have less than no faith that AAFP can or will do anything helpful.

Posted by Nell Nestor MD on October 27, 2015 at 07:02 PM CDT #

If you want to cut down on WAC, then you should consider requiring appointments for most of it. You can charge for FMLA and disability forms, in addition to office E&M codes, when done at a visit. Most specialists do this. I got tired of the 10-20 new forms sitting on my desk at the end of each office day that required reviewing a chart, entering illness data, and taking a minimum of an hour a day to complete after hours. I now require visits for most paperwork. This has increased my visits and decreased my WAC.

Posted by solo doc on October 27, 2015 at 07:28 PM CDT #

It is ironic that I see the link to this in my inbox, just as I got done doing two hours worth of EMR charting, prescription refills, answering patient/staff messages, and going over lab results/typing lab result messages at home. I already spent an hour doing all of this stuff as well as looking through sheafs of DME paperwork, FMLA forms, prior auth forms, and outside records before clinic started in the office, did this over my "lunch hour," and then in any spare second we have in between patients, and after the last patient leaves but before the clinic manager leaves and turns the lights off on us and we have to go home at about 1730-1800. The common thread I see in all of this is it is all driven by the Democrat feds in their desire to continue to try to push the proven-false ideology of being able to provide socialized medicine in order to buy votes. The only waste, fraud, and abuse is what they push on us! The slow, extraordinarily expensive, and unreliable EMRs and their forest of meaningless use checkboxes come from Medicare. The innumerable "prove you provide quality" checkboxes come from Medicare. The $105k/doc/year PCMH is now a de facto Medicare unfunded mandate with the AAFP-celebrated MACRA. The giant inane intake questionnaires come from Medicare. The prior auths initially came from Medicare and still mainly come from Medicare. ICD-10 and its ridiculous codes including macaw- and orca-related injuries and being sucked into jet engines come from...you guessed it...Medicare! Yet the AAFP, which is the third largest lobbying group in the healthcare field according to OpenSecrets (just slightly behind the American College of Radiology) spent about 2/3 of their lobbying dollars supporting the Democrats that put us into this mess. The AAFP talks big but their largely non-practicing academic leadership is completely unwilling to take any steps to actually address these issues as it would conflict with their academic liberal elitist ideology. (I think the issue of AFP they published about 3 years ago about global warming proved the point they are academic liberal elistists.) If they actually wanted to fight the WAC, they would try to convince us to quit accepting Medicare, abandon PCMH, quit participating in PQRS, abandon meaningless use, stop MOC, sue the usually duopoly hospital systems that enforce anticompetitive clauses in our contracts, and spend their PAC money to get Democrats thrown out of office.

Posted by MO FM Doc on October 27, 2015 at 08:43 PM CDT #

The AAFP has been on the wrong side of health care policy for decades. They claim to be pro-physician and pro-patient but they have always sided with industry versus advocacy. The AAFP is part of the problem. NPs will take over primary care services over the next decade. New physicians will not want to do primary care and will see that the only way they can be rewarded for their sacrifice is to specialize. Why would any medical student choose primary care if they have other options given the way the AAFP pushes the industry's agenda while masquerading as an organization that gives a damn about primary care physicians?? They way I see it, the AAFP is a miserable organization that has shot itself in the foot and all of us in the heart because the leadership is completely incapable of achieving anything meaningful for its members. DIRECT PRIMARY CARE is NOT a solution to the family physician's problem. It is rather the response to a failed system that has been supported by the AAFP and it's truly incompetent vision in what family physicians need. If the AAFP actually wanted to do something right, then do what other groups do and call for activism. Get physicians and patients together and f***ing march into DC and demand change in the system, not this BS the AAFP calls advocacy. The AAFP is a joke in the eyes of the insurance companies and DC. The leaders are puppets of the system who are blinded by a mythical carrot in front of their noses while actual physicians have to deal with so much BS from rules and regs to the IDIOTIC MOC process which even the Internal Medicine board said was in need of an overhaul. Truthfully, I am going to be out primary care myself soon because it nauseates me what has happened to this field. I can make twice as much money, have a better lifestyle, and work half the month using my MD in other fields like ER and Urgent care and medical directorships. Why on EARTH would I practice family medicine anymore when the leadership of the AAFP is absolutely ineffective and down right clueless about the measures that need to be done to protect family physicians? When a NP can earn nearly what a FP can make and the FP takes huge liability on top of that, do you really think the system is meant to foster young minds to go into FP? If you think so, then you don't have a clue how the younger generation thinks. So I'm not impressed by words, and certainly not be the current state of affairs. You'll see. In ten years, FPs will be majority employed with some college grad with a business degree telling them how to treat patients based on numbers. The AAFP has failed utterly and completely and has blood on its hands for the demise of this field.

Posted by Jay Darji, MD on October 27, 2015 at 11:17 PM CDT #

Based upon the vast majority of responses I see to similar subjects there seems to be a huge disconnect between AAFP policy and the members. Thanks for the link to the elected representatives regarding stage 3 of MU. The problem with the letter that the link, "use the AAFP's Speak Out resources" takes you to is that the letter infers we're all good with the Meaningful Use program and we just need to give it more time. I used the link and in the blank field section where you can enter your own thoughts, stated the Meaningful Use program should abolished. I suspect if you polled the members of the AAFP and gave them 3 choices - abolish MU, slow down/modify MU, or continue in current form - most would chose abolish. 5 years into MU and it's turned out to be a real stinker. Another problem with the whole process of how we are represented and how we are treated was illuminated by my response to delaying stage 3 MU to my elected representatives. I did receive a single response from on of my senators thanking me for my response which exactly equals the number of responses I've received from approximately 50 other communications sent to elected representatives and governmental departments about MU. Just like our leadership the responses tell me they aren't listening and likely don't care. A year ago I told myself to care about this is just a waste of time and energy and to quit looking at AAFP New and similar items because it was irrelevant to be informed but here I am again. I really need to follow my own advice.

Posted by John on October 28, 2015 at 06:34 AM CDT #

All of this WAC is precisely why I left Primary Care 2 years ago and now work in an Urgent Care. I can work 12 hours shifts 3-4 days a week here instead of 5 and get 100% reimbursed for my time.

Posted by Elena Sutton, MD on October 28, 2015 at 09:38 AM CDT #

How sad, and especially since it's all true. I wish somebody from AAFP might read these comments and provide acknowledgement that we'be been heard, loud and clear, and actually provide a thoughtful response acknowledging the history of betrayal that we all feel. While it's true that it's hard to get physicians to agree on much of anything, it doesn't take a neurosurgeon to see the underlying thread in all of these responses: if the specialty of Family Medicine were a patient of mine presenting with such prevailing and profound sense of hopelessness and helplessness, I'd diagnose them with severe depression. The FM specialty is severely depressed! What's worse, carrying the analogy a bit further, the depression is based on ongoing domestic abuse. What we as physicians are saying is that we don't feel safe in our own "home!" We've gone to "shelters" before (ER, UC, DPC, etc.), with varying amounts of success, but we keep returning to our "partner" for the same basic reason that most real-life abuse victims: in a very real sense, we are dependent on the abuser! And just as in the patient setting, there's the whole cycle of abuse that happens over and over, with the honeymoon period, the empty promises, moments of reconciliation -- and then, inevitably as the change of the seasons, the abuse starts all over again. And quite honestly, there is a real potential for the abuser to harm us or even kill us, but we feel we have to stay in the relationship because of love or loyalty, or for the sake of those who are dependent on us. Besides, where else can we go without losing everything we've worked for all this time? And as a provider, I give victims a list of resources contacts for support and assistance, and as I was trained, say, "It's not right for you to be treated this way. You don't deserve to be abused. You have value and worth. Nobody has the right to treat you or anyone else this way." Who's gonna tell FM that? What shelters, supports, rescues, assistance, and advocacy remains if our own "partner" organization chooses to ignore our screams and pleadings as we take blow after blow? We're not even being heard. How many have to drop out or die before the system kills FM? And what's next? A restraining order? And what if the abuser violates that order? Who will enforce it? The analogy is limited but carries at least this far: there is need for just as radical a change as if we were assisting a victim to flee her (his) abuser. We are very mindful of the risks for our patients in these situations. Will AAFP come back to us, pleading for reconciliation, as the AMA has done, or will they become hostile and punitive? And in this case, FM has no legal recourse and divorce just doesn't exist. How many have to drop out or die before the abuse ends?

Posted by RornDoone on October 29, 2015 at 01:57 PM CDT #

I agree with another comment that continuing to tinker with MU is a waste of time. If EMRs really did what doctors need, you wouldn't have to force us to use them. Do you have to force us to use our stethoscopes? Of course not! We vastly prefer them to putting our ears to our patients' backs and chests. When EHR companies come up with a product that's better than paper charts, people will happily switch. Punishing doctors for not clicking meaningless boxes in badly designed EMRs is ridiculous. Eliminate Meaningless Use and focus attention on providing a high quality product we want to use.

Posted by Robin Dickinson MD on October 29, 2015 at 02:48 PM CDT #

I have loved and practiced family medicine now for almost 30 yrs.Started solo with EMR in 2005 , got rid of paper charts and did fine, till 5 yrs ago when the reimbursements got worse, equipment expensive, MU rules increasing the WAC , loss of work life balance. I have paid for AAFP membership every year for last 30 yrs, seen no improvement. I have done the MOC with no change or improvement in my practice.Paid a lot though! I have hired more staff to keep up with all the electronic paperwork , definitely not paperless! Now jumping through hoops to collect incentives by sending information that is in EMR but has to be documented as ICD9/ ICD 10 codes,ridiculous , and sent with claims. Getting tons of denials and PA for drugs and care for the patients, generics becoming more expensive, not sure some days why I still practice .Medicare dictating how medicine has to be practiced and other insurances using it as a gold standard and paying lesser than it.People pay for Medicare all their lives and get what in return? AAFP should be in our corner, but I do not see any help coming.MU 2 is a pain, not sure MU 3 is even feasible. I can always retire early and be free of all this hassle, but feels my patients will feel abandoned. I have been telling friends and their children not to go into medicine, if they are smart they will do well in any other field in shorter time and less loans.

Posted by A.Kohli on October 29, 2015 at 09:42 PM CDT #

Much anger, but much brilliance. The analogy to foot stress fractures of Napolean's troops, and the analogy to spousal abuse are colorful masterful prose. When I was dating my wife fifty years ago, my future father in law, a GP, advised me to not be a GP, a career he found severely disappointing in the abuse he suffered from his colleagues and patients. The rigor of our board and the advocacy of our academy made our specialty a respected career I have found rewarding. In my fortieth year I still experience joy in practice every day. If our academy has taken a stance we find offensive regarding any of our practice burdens, we should recognize that we are the academy. This academy is indeed a democracy. If you are disappointed with our current postures, vent your frustration more effectively by becoming active in the academy. Become a delegate to your state congress of delegates, join a state or national academy commission. Complaining is easy; advocacy is hard work.

Posted by philip kaplan on October 31, 2015 at 08:59 AM CDT #

I practice in a small town in Florida. My work day starts at 7AM and ends at 12PM. Ten hours are spent on direct patient care, the rest on paper work. I take a 4 hour brake on Sundays. Physicians in this small town were exited about electronic medical records. Several submitted Meaningful use reports.Many were audited and all but one had to return money to Medicare with interest. Most of them were accused of computer security issues. I think that being a primary care physician is a depressing nightmare. I do not make enough money to hire any help .I made sure that my child will have a normal life and work in different profession.

Posted by Irena Assefa on November 06, 2015 at 12:46 PM CST #

Fascinating comments. Phrases like "blood on hands," "domestic abuse," and "betrayal" may seem overly-dramatic, but I hear the exact same words from my fellow family physicians. They are not complainers (as one poster implies), but backbones of the medical community, respected and loved, who have worked with the AAFP in the past, and have now given up in disgust. When Mr. Martin makes the completely false claim that the AAFP is working to reduce the WAC we do, it is our duty to say, loudly and clearly, that no, rather the AAFP leadership has worked vigorously and consistently to INCREASE the administrative burden on its members. Dr. Doone says: "I wish somebody from AAFP might read these comments and provide acknowledgement that we've been heard, loud and clear, and actually provide a thoughtful response acknowledging the history of betrayal that we all feel." Well, don't hold your breath. As is discussed frequently and angrily elsewhere on the Web, the AAFP never responds to the questions and concerns of the little people. That might take some time away from the photo-ops.

Posted by R Stuart on November 17, 2015 at 04:01 PM CST #

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Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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