Your physics metaphor of the unstoppable force of family medicine is apropos but are we really using the leverage of that force with those that make the rules and the course of medicine? I believe we have not been forceful enough with Congress and payors and CMS that the best hope for healthcare in the US is an increased workforce of family physicians. There is ample evidence that the more FP's in an area, the higher the quality and lower the cost. Yet how will we in academic medicine convince students to enter the field when it's a constant struggle to be paid adequately for the good work we do? Canada found that until the average income of an FP is about 0.8 the average for other specialties, they did not have enough students choosing family medicine. Instead of paying us to take the time needed to manage complex patients, the "system" makes it easier to send patients to the ED or to other specialists where more testing and treatment is performed, often without benefit to the patient, but with increased cost. If we had the funding to develop teams as in the patient centered medical home, we would have the team we require to adequately manage the complex patients with chronic diseases that take more time than we can afford now. It's time for the AAFP to be more hard nosed with Congress. We tend to be "nice folks" but our "niceness" is allowing the nation and our profession to sink into the abyss of increasing costs and reduced access to care. Maybe the message should be for FP's to withdraw from Medicare until payment improves. If Congress does not repeal the SGR, we should advise our members to pull out of Medicare. As long as most of us contract with Medicare, Congress thinks we like to be treated like slaves. Maybe we should stop accepting contracts with payors who want to save money by cutting our reimbursements. Let's start getting tough instead of just talking tough!!

Posted by John Messmer on September 17, 2011 at 02:26 AM CDT #

I agree with John Messmer completely. We can compassionately confront the inequity in our payor system(RUC) that is functionally disrupting and dismantling primary care. Excellent, high quality family medicine requires the best students to succeed. Unfortunately, I have watched that pipeline erode as the numbers decline. I am also watching the exodus of experienced FPs tired of the obstructions and difficulty finding younger grads to help care for our population. The time is now to address the AMA and congress as if our lives depend on it. RUC and payment reform is the elephant in the room; there are other issues but they pale in comparison. When there are half as many anesthesia interns as FP interns and we have been predicting a shortage of primary care for twenty years, it simply brings tears to my eyes. As our voice, please act strong, firm, and with strategic and honest compassion. Our society and our patients deserve no less.

Posted by Michael Lambke on September 23, 2011 at 04:32 AM CDT #