Monday, October 27, 2014

This I believe, Family Medicine-style!

I was honored to be recognized for the following piece at the FMEC annual meeting this past weekend. The FMEC encourages members to submit pieces similar to the NPR "This I Believe" campaign but focused on elucidating the core beliefs within Family Medicine.

I thought I would share it here as my first step back into regular blogging (now that I've finished moving and getting settled in my new position), hopefully to further stoke the fires of the #FMRevolution...

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I believe that Family Medicine is the solution to American health care, but only if we stand united against the threats to our specialty and our patients.

I believe that family doctors give high quality, cost efficient care. US Counties with the right proportion of primary care to specialty care have populations who live longer and health care that costs less. (In 2014, with fewer and fewer general internists and pediatricians, primary care in the US is Family Medicine.) Too many specialists and not enough family physicians lead to unnecessarily expensive care and shorter life expectancy.

I believe that family doctors provide something intangible to our patients and our communities. We value relationships. We tailor the care we give to our patients’ values and preferences as much as possible. We care for every age at every stage, and we provide continuity of care to individuals and generations.

I believe, though, that Family Medicine has an image problem that is largely our own fault. The average American does not know what a “family doctor” is. Many family physicians are fatigued from wading through our fragmented health care system, and too few of us feel we have the time and/or the skills to share who we are and what we do with the public. 

I believe that we let the insurance companies dictate too much of what we do.  We let fear of inadequate reimbursements change the tenor and flow of our office visits. We order tests to fulfill insurance company mandates.

I believe that we allow trial lawyers and the fear of litigation to interfere with how we practice.  Gone are the days when someone might present with abdominal pain and walk out without a CT scan.  We order expensive lab tests “just to cover the bases” and prescribe unnecessary antibiotics to keep our patient satisfaction scores up.

I believe that Family Medicine is under attack. The Relative Value Scale Update Committee, or “RUC,” devalues what we do. Out of 31 physicians on the RUC, only 1 is a family physician. My office is paid more for snipping off a skin tag than for a thirty-minute patient visit treating multiple chronic diseases. 

Perhaps worst of all, I believe that we resist self-scrutiny.  “I’m not the problem – that’s not me,” I can hear you all thinking.

It is you, and it is me.

We must advocate for our specialty if we are to advocate for our patients. We must resist fear and fatigue. We must stop practicing medicine as if our nation’s health care dollars are infinite.

If we don’t, then the insurance companies and the trial lawyers and the RUC will win – and our patients will lose.

I believe that Family Medicine will overcome these challenges. The 21st century demands a strong Family Medicine infrastructure based on equity and compassion. Even now, thousands of us fight tirelessly for our patients. We volunteer for leadership roles and organized medicine societies. We innovate new models of patient care without waiting around for insurers and the government to do it.

I believe that I have seen the future of our specialty in the applicants to our residency programs and the students who attend our meetings. They are intelligent, dedicated, and optimistic. They believe in Family Medicine and are not shy about sharing it. Their courage and energy will fuel our future, and that future is bright.

Family Medicine is the solution to American health care, but only if we stand united against the threats to our specialty and our patients. This I believe.