The Guilt Approach
I saw this article and was quite surprised at the approach they were using. Guilt. It seems the only residency program in the state of Alabama that trains primary care physicians to serve rural areas is in danger of shutting its doors. The reason, as this article states, is because Congress may repeal the Affordable Care Act. Well, that’s it dammit! They need to immediately withdraw the lawsuit because no one wants to lose Cahaba Family Medicine in Centreville, Alabama!!
I am a family doctor. I support programs that train more of us instead of giving the specialty away to midlevels. And I really believe these doctors have their hearts in the right place. That being said, it just amazes me when we, as humans, look at anything and only see how if affects us. I am as guilty as the next person. I know that. I try, though, to look at the big picture and that picture is bleak for family doctors. The reason is that no matter how well they train these doctors to work in rural areas those future docs still will be stuck with bogus quality metrics, worthless EMRs, ridiculous hoops to go through with Medicare and Medicaid, and still be paid the LOWEST of all doctors. This approach is broken. Repealing the ACA may do nothing to fix these issues either and I get that but the way the plan is set up now, I would never recommend ANYONE go into family medicine unless they did direct primary care.
If we all walk away from the insurers and Medicare and Medicaid and from the ACA then we could do a better job for patients at half the cost and finally get paid a reasonable rate. Or we can walk off the cliff like lemmings and beg people to keep one rural training site open.
Hey, don’t knock guilt – it’s the very basis for our entire U.S. health infrastructure. Guilt – as opposed to real analysis and reason – created Medicare and Medicaid.
Guilt was how the entire nation stood on a chair, bent over, stood on one foot, and snookered itself into this idiotic ACA.
I spend part of my time every month working in rural Alabama hospitals. It may be news to the folks at Cahaba Family Medicine, but I’ve talked with some of their colleagues in rural south Alabama and north Florida who have chucked primary care and all the onerous mandates and crappy pay for full-time hospitalist or ER work. All the ACA grants and new trainees that Cahaba could ever want will not make a damn bit of difference if the current problems are not reversed.
So guilt away. It’s a desperate, loser argument.
I walked away 3 months ago.
Frankly, I think all Primary Care would be better off without the ACA. The problem is coming up with another plan.