"Our specialty is already dead; we just forgot to lie down," one Academy member wrote recently to AAFP News Now, reacting to a list of woes, including the rise of retail health clinics, cuts in family medicine training funds and inadequate payments for family physicians.
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From the President
The Collapse of Primary Care -- NOT!
But the fact is, as I meet with politicians, government officials, insurance companies and the like, I see an awareness and acceptance of the value of family docs and of the personal medical homes they provide for patients.
More importantly, there is a growing feeling of excitement and hope in our chapters and among the members of the AAFP.
It is hard to describe. Adults would probably use the term “cautious optimism,” but I prefer to think of it as something much more powerful -- like that feeling you get as a kid when you first see the tree on Christmas morning. It's a feeling deep in your heart that something is going to happen that is too good to be true.
More importantly, there is a growing feeling of excitement and hope in our chapters and among the members of the AAFP.
It is hard to describe. Adults would probably use the term “cautious optimism,” but I prefer to think of it as something much more powerful -- like that feeling you get as a kid when you first see the tree on Christmas morning. It's a feeling deep in your heart that something is going to happen that is too good to be true.
Right now I'm more optimistic than ever before about the future of family medicine, in large part because of a magnificent convergence of events in June brought about by the Academy's hard work over time. You may have read about these individually in AAFP News Now, but consider them together to get the full impact:
- CMS proposed changes that should significantly increase your Medicare payments for evaluation and management services beginning in 2007. In my opinion, this is the best news for family medicine since Medicare was created in 1965! Here's what it could mean for you: If you see 86 patients a week, code two-thirds of the visits 99213 and code the other third 99214, your income could rise about $30,000 a year. These proposed changes reflect recommendations made by the Relative Value Update Committee. The AAFP has a representative and an alternate representative on RUC, as well as an adviser to RUC. The committee's recommendations speak volumes about the Academy's influence through these individuals.
- The AMA House of Delegates called for an increase in the number of primary care physicians and a change in payment systems to "incentivize" such an increase. Having AMA policy on our side may not sound all that sexy to you, but it's hard to overemphasize how important it is. The Academy has intensified its efforts to influence the AMA through the AAFP delegation and other FPs active in the AMA house -- and it's paying off. As of now, there are FPs on every major AMA council and on several other groups within the AMA, and that includes the new chair-elect of the AMA board.
- The AMA house also decided that comprehensive health system reform should "be of the highest priority." Because of policies it now has in place, the AMA should be working in concert with AAFP for reform that has a primary care base, payment incentives to attract medical students to primary care, and liability system changes to preserve access and drive down the cost of defensive medicine. Changes in these three areas are imperative no matter what kind of system we end up with -- multiple-payer, single-payer or something in between.
- The Massachusetts Medical Society's annual physician workforce study shows that primary care physicians are in short supply in that state, including a "severe" shortage of family physicians. This acknowledges the strange paradox that the specialty most desired by people is in the shortest supply because academic health centers receive incentives to train and recruit subspecialists to get research dollars.
- The Institute of Medicine reported that emergency departments are overwhelmed, in part because of patients' lack of access to primary care services. We can hope that this will prompt the American College of Emergency Physicians to join the Massachusetts Medical Society, AAFP and AMA in calling for the training of more FPs, and to support FPs continuing to do a broad scope of practice, including working in the emergency room.
- Annals of Family Medicine published a study showing that liability reforms other than caps didn't make a dent in the cost of malpractice awards or premiums. It's gratifying to have an independent study confirm what my AAFP Strike Force on Liability Reform concluded last year -- and it's high time policy-makers stopped trying to blow smoke in the eyes of the American people with voodoo about solving the liability crisis. Instead, Congress should focus on legislating effective changes, such as caps on noneconomic damages and alternative dispute resolution, not on maintaining the earnings of trial lawyers. There currently is a Senate bill that would establish pilot projects for just such tort changes.
I believe these happenings in June raised the collective consciousness about the value of primary care, bolstered the prospects for family medicine and set the stage for real health care reform. We'll drive these points home Sept. 27, when thousands of FPs raise their voices at the AAFP's first-ever rally at the Capitol in Washington, D.C.
So keep the faith. We are not going to lie down, but rather we are going to keep the pressure on and continue the momentum toward a better health care system for us all.
See you in D.C.!
So keep the faith. We are not going to lie down, but rather we are going to keep the pressure on and continue the momentum toward a better health care system for us all.
See you in D.C.!
Related News Stories
Physician Fee Schedule Changes: CMS Targets Many E/M Services for Increases
(6/28/2006)
Primary Care Gaps Leave EDs in Crisis: Hospital EDs Make Poor Medical Homes
(6/28/2006)
'A Landmark Victory': AMA Sharpens Focus on Fostering Primary Care
(6/28/2006)
Academy Positions on Payment, Workforce Gain Steam at AMA Meeting
(6/27/2006)
Additional Resources
Massachusetts Medical Society Study Records Shortages of Primary Care Physicians for the First Time
The US Medical Liability System: Evidence for Legislative Reform
Physician Fee Schedule Changes: CMS Targets Many E/M Services for Increases
(6/28/2006)
Primary Care Gaps Leave EDs in Crisis: Hospital EDs Make Poor Medical Homes
(6/28/2006)
'A Landmark Victory': AMA Sharpens Focus on Fostering Primary Care
(6/28/2006)
Academy Positions on Payment, Workforce Gain Steam at AMA Meeting
(6/27/2006)
Additional Resources
Massachusetts Medical Society Study Records Shortages of Primary Care Physicians for the First Time
The US Medical Liability System: Evidence for Legislative Reform
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