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Wednesday Apr 17, 2019

Make Your Voice Heard; Take the Member Survey

In 1965, the Rolling Stones released the classic rock anthem "(I Can't Get No) Satisfaction." If you're over a certain age, you're probably now hearing the rhythm of that song in your head, but do you recall any of the lyrics other than the chorus?

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"When I'm drivin' in my car and the man come on the radio, he's tellin' me more and more about some useless information, supposed to fire my imagination. I can't get no, oh, no, no, no …"

Maybe you know the rest ... ?

The Stones may have been on to something, because 54 years later we're in the midst of a virtual explosion of information in the media, attempting to fire up our imaginations about how to rid our lives of stress. While flying home recently from the Arizona AFP's 70th anniversary meeting, I happened to browse the airline's magazine from the seatback pocket. It was full of advertisements and articles about health and tips on how to relieve social stress.

Stress is not unique to family medicine. However, while traveling to chapter meetings around the country, a common theme I hear from members is an expression of professional dissatisfaction with a health care system that is burying them under layer upon layer of competing clinical guidelines, unfunded mandates, burdensome documentation and quality reporting requirements, and meddlesome prior authorizations.

In other words …

"I try, and I try, and I try, and I try; I can't get no -- satisfaction."

As a dean of student affairs and admissions, I witness a distressing number of medical students arriving at the threshold of the House of Medicine with the preexisting condition of emotional burnout. This is exacerbated by a constant fear of academic failure, demands to actively retain a virtual library of medical facts, and the ever-present fear of not being able to match into their desired medical specialty.

These fears do not necessarily abate during residency training or with our transition to clinical practice. Every year I read numerous personal statements of individuals applying to medical school. A consistent element of each narrative is a desire to be leader of their respective medical team and to make a difference in the lives of those they will serve as a physician. Imagine the gut-wrenching disappointment of physicians who, at the midpoint of their medical careers, discover that those youthful ambitions have not become a reality. Some of our members may ask themselves, "Where is the meaning in medicine? Why can't I get any satisfaction doing what I do?"

Making a difference in a corporate entity's annual budget margin was not the "difference" we envisioned when most of us began our pursuit of becoming a physician. We must never doubt or diminish the reality that what we do is an invaluable service to society.

Of course, value is a relative term. I once took a nonscientific survey of each of the patients I saw for one week. At the end of each office visit, I asked the patient the following question: "If you had to pay out of pocket for your visit today, how much do you think the services we provided you today were worth?"

The average response was $20.

Ouch.

My followup question was, "How much would you expect to pay a plumber to unstop a drain in your house?"

The average response was $80.

Interesting.

My initial thought was that perhaps my patients valued clean pipes four times as much as they valued their own health and wellness. But it's more likely that insured patients with a predetermined copay didn't consider the money their employers contributed to their health plans or the money deducted from their own paychecks when pondering the actual value of care.

Although my initial conclusion about patients and perceived value was likely inaccurate, is it too farfetched to think that the agents pushing the levers of health care payment reform have an implicit bias regarding the social value of primary care services? If so, can we change that?

CMS recently asked all medical specialties to participate in a survey from the AMA/Specialty Society Relative Value Scale Update Committee (RUC) in an attempt to objectively revalue existing evaluation and management (E/M) physician payment codes for the various levels of patient encounters. This survey information will be taken into consideration as CMS revalues the anticipated collapsed E/M coding scheme set to be introduced in 2020. Members of the AAFP responded to our call to action by completing the RUC survey in high numbers compared with members of other medical specialties. Thank you to all who participated.

This month, the AAFP is asking our members to participate in another survey. Our annual AAFP Member Satisfaction Survey became available to all active members and residents on April 6. This crucial tool is used by the AAFP Board of Directors during its July strategic planning session to fine-tune objectives for the upcoming year by using "just-in-time" membership feedback. This is the AAFP's method of receiving an annual "personal statement" from you so we can more effectively direct our resources to best assist you with bringing meaning back into your practice of medicine.

For those of us who are feeling the heat of professional burnout, I acknowledge the distress and say, "It's OK to take care of yourself!" I encourage you to take action to stay well and stay strong by doing one or more of the following:

Simply being told you are valued is not equivalent to seeing it quantifiably demonstrated with tangible evidence. During each chapter visit, I continue to ask my nonscientific survey questions. For example, I often ask, "How can the AAFP assist you in bringing joy and meaning back into the practice of medicine?"

Note that I do not ask, "How can the AAFP bring you joy?" Each of us must find joy on an individual basis. Life satisfaction cannot be delivered by an individual or entity external to the person searching for it.

As I mentioned at the beginning, the sense of loss of life satisfaction is not something isolated to the 21st century, the profession of medicine or the specialty of family medicine. If we desire future generations of medical students to choose our specialty in numbers above all other medical specialties, we must commit ourselves to producing the secret sauce of professional support services our members can effectively use to make the practice of medicine all they dreamed it would be and more. Member participation is the key ingredient needed to fire up our imagination and lead to satisfaction.

"Hey, hey, hey, that's what I say."

Gary LeRoy, M.D., is president-elect of the AAFP.

Posted at 09:54AM Apr 17, 2019 by Gary LeRoy, M.D.

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