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Fam Pract Manag. 2002;9(3):15

To the Editor:

What an interesting letter from Dr. H. Jeffrey Wilkins [November/December 2001, page 12]. He extols leaving his practice due to many reasons – reasons I unfortunately experience daily. It is interesting, though, that just two-and-a-half years ago he lauded the virtues of his successful group practice model that was supposed to be the wave of the future [“Developing a Successful Medical Group,” June 1999, page 27]. Even then I was skeptical of any model in which capitation payments went from “5 percent to 50 percent of revenue.” Was this group model a failure and, if so, why did it ultimately not work? Perhaps there is more we can learn from Dr. Wilkins’ experience.

Author’s response:

The sentiments in the letter I wrote in response to the article “Is It Time to Re-examine Family Practice?” [September 2001, page 43] are in sharp contrast to the philosophy our group benefited from in the late 1990s. The group practice model was not a failure. In fact, it is still alive and independent. The model did ultimately contribute to my departure. I found the vision and construction of the group stimulating. It was the bureaucracy of the group that was frustrating. When maintaining the group began to take more energy than fulfilling its mission, I knew something was wrong.

Was going from 5 percent to 50 percent capitation a bad idea? To me, yes. The income per patient was generally very high, but we never got a handle on the overhead. Patients saw all the employees that cluttered my office solely for the benefit of managed care and constantly questioned the increased number of staff.

Meanwhile, managed care changed the attitudes of my patients. Patients cared less about what I had to say about their problems than about where I was going to send them. Was it because they felt they were being rushed? Were they annoyed my automated phone system kept them on hold on a Monday morning? Were they angry because triage nurses counseled them to not come into the office? Did I resent seeing someone who really didn’t need to be seen because I would be reimbursed only a $5 co-pay? The answers to these soul-searching questions helped me leave. When I announced I was leaving, the most common comment from colleagues was, “Wow, I’ve been thinking of leaving as well, but I didn’t know what to do.”

Rather than asking a group made up of salaried physicians who are shielded from malpractice insurance bills and health insurance premiums and have little visceral feel of a productivity-driven practice to address the problems facing the specialty, the AAFP should be talking to you or members of my group who thought we had a good idea when we got together six years ago. Family practice is drowning in a rough sea filled with sharks in the form of lawyers and health insurance companies. We deserve better. Our patients deserve better as well.


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