Facing extinction, our specialty is seeking renaissance in two forms. TransforMED, centrally planned and amply funded, is the AAFP's experiment (see “TransforMED Tries to Rebuild Family Medicine,” May 2007). Then there are the family practice equivalents of Edmund Burke's “little platoons”: decentralized, privately funded experiments in entrepreneurship exploring cash-only, ultra-low-overhead clinics, concierge practices and other models yet to be described (see “The Ideal Medical Practice Model: Improving Efficiency, Quality and the Doctor-Patient Relationship,” September 2007 and “Breaking Even on Four Visits Per Day,” June 2007).
These efforts are admirable and interesting. My concern is with scorekeeping. There are many ways to measure success, but only two seem to matter to medical students as they contemplate residencies: How much money will I make, and what kind of life will I live?
From personal correspondence with TransforMED administrators Terry McGeeney, MD, MBA, and James Arend, MBA, I understand there has been a problem with obtaining financial data from the participating practices, and they are attempting to address this issue. If this data is suspect, then it won't matter how dramatically the median A1C fell, how satisfied patients were with e-mail consults, or whether huddles produced happy campers.
I have been fascinated by the eccentric efforts of family physicians willing to practice outside the box. But what medical students and family practice residents have a right to know is this: What will my hourly income be if I adopt this practice model?
When our colleagues in medicine describe an experiment in progress, I would like to be assured that their numbers aren't funny. FPM has a responsibility to move beyond trust, and verify. In the case of individual authors describing their practices, this might involve the submission of federal income tax filings or financial statements to the editor for review.
This is neither insulting nor an invasion of privacy. I have to supply this data to a bank or a broker every time I apply for a loan. The future of the specialty is more important than a loan, and publishing an article is not a constitutional right.
In the case of TransforMED, the financial information should be published in a way that is beneficial to family physicians. It is not helpful to know that the average charge per patient went from $87 to $93 without knowing what influenced these rates. What's important for family physicians to know is how much income each physician received divided by the number of hours worked, including the extra time spent in huddles and conferences required by the new practice model.
Brian Forrest, MD, vacuums his own carpets and takes out his own trash to keep the overhead low in his cash-only practice (see the “Breaking Even” article referenced above). All is well and good as long as those hours are part of the denominator.
The game is afoot. I want assurance that the wardens are keeping score. I have developed a simple worksheet that makes it clear how financially successful a practice is, and I challenge authors who describe innovative models to submit it with supporting documentation for editorial review.
Editor's note: We thank Dr. Iliff for his suggestion. We will make a version of his worksheet available to authors where appropriate, encouraging them to complete it or supply other supporting financial documents. Click below to download a copy of the worksheet