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Wednesday Feb 26, 2014

Stories of Successful Underdogs Resonate With FPs

I read my first Malcolm Gladwell book more than 10 years ago when a fellow family physician gave me a copy of Tipping Point: How Little Things Can Make a Big Difference, at an AAFP commission meeting. Since then, I've read Gladwell's Outliers, Blink and What the Dog Saw.

I recently read the author's newest book, David and Goliath: Underdogs, Misfits and the Art of Battling Giants. In this book, Gladwell tests the reader's perception of what obstacles and disadvantages create apparent setbacks in life. His examples include the titular bible story, the dynamics of successful and unsuccessful classrooms and the thought processes of cancer researchers.

As I was reading, I kept thinking about family medicine, the apparent underdog in the playing field of medicine. David, who was skilled with a slingshot, faced Goliath, a man who clearly suffered from an endocrinopathy but who was big in stature and strong.

Family medicine has the right stuff. We are bright and strategic. But unlike the original story, there are many Goliaths on our battlefield, and this is distracting and time consuming, especially when we would rather focus on the things most important to us such as our patients, families and communities. How do we fight the many giant challenges -- dealing with payers, adapting to regulations, etc. -- that stand in our way?

In an interview with INC. magazine, Gladwell said, "Effort is the route available to the underdog. I may not be able to outspend you, but I can outwork you."

Gladwell's David and Goliath has a chapter about people who have been successful despite having dyslexia. Gladwell's theory is that if a task is made slightly harder, a person may learn better because he or she will be forced to concentrate more and is likely to read something multiple times instead of just once.

Family physicians certainly know about hard work. The amount of work required to become a family physician is significant -- 21,000 hours of standardized education and training, including exams overseen by a single certification body.

No one can truly replace us, although others are desperately trying to claim that they can. Gladwell makes a case for the proper number of students in a classroom to make learning optimal. Similarly, we are making a case for the number of hours of training required to provide primary care. Nurse practitioner (NP) training, in particular, ranges from 3,500 to 6,600 hours, and the clinical aspects of their education and training vary tremendously. Each of their three accrediting organizations has their own criteria for certification.

And yet, there are those who claim NPs and physicians are interchangeable. How can this be? Family physicians are the best medicine that the system has to offer.

But where is the best place to be standing in today's times? Should we position ourselves in the midst of the Goliaths who would prefer us to quietly do our work and not cause a fuss? Or do we steer clear of these challenges and let others decide our fate?

Gladwell observes that in many instances, underdogs can prevail with hard work and strong will. As modern day Davids, we, as family physicians, must strategically place ourselves where we can do the most good for the most people. Gladwell writes that while you are working on changing the game, you also have to make sure that you get the most out of the rules that already exist. That is exactly what the AAFP is trying to do. For example, the Academy continues to stay involved with the flawed AMA/Specialty Society Relative Value Scale Update Committee (RUC) rather than being absent from the table and having no voice at all. However, we also are advocating directly to CMS about payment issues.

And although it can be extremely frustrating, we continue to have regular meetings with the nation's largest private payers because it gives us an opportunity to work on common issues while promoting the value and importance of primary care.

We, the family physicians who are strong medicine for America, must emphasize our unique ability to listen, understand and help our patients, offering our valuable time and resources. We must be the brave David and use all our resources to stay in the game and win the fight.

You can learn about being an advocate for our specialty -- including a day of training and a day of lobbying on Capitol Hill -- at the Family Medicine Congressional Conference April 7-8 in Washington. I hope to see you there.

Rebecca Jaffe, M.D., M.P.H., is a member of the AAFP Board of Directors.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.