Walk Away From The Table

“The single most powerful tool for winning a negotiation is the ability to walk away from the table without a deal.”

Harvey Mackay in Swim With The Sharks Without Being Eaten

This is a very good book, by the way, and I was just reading it again recently.  What reminded me of this quote was an editorial in The Journal of Family Practice entitled “Orthopedist urges higher FP pay“.   Check it out.   He gets it and it is a good read.   My favorite part, though, was this:

A question I regularly ask my family medicine colleagues is whether it is best for them to remain members of the Relative Value Scale Update Committee (RUC). It is important to realize that the future of the RUC rests with family physicians. If the American Academy of Family Physicians (AAFP) dropped out of the RUC while noting that it was fundamentally unfair to primary care doctors, it is quite likely that the Centers for Medicare and Medicaid Services would find a more equitable solution. Alternatively, family doctors could demand greater representation on the committee and attempt to change it from within.

Now you know why I thought of Harvey.    I have said it before.  We need to walk away from the table and then they would come running.   But having wusses represent us at the AAFP does us no good.  Maybe we should walk away from the AAFP.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “Walk Away From The Table

  1. Kurt
    September 9, 2012 at 12:55 pm

    Ditto. American Academy of F-heads. Will need to change the name to AAFNP. AA of Family Nurse Practitioners. This will cease to be a viable M.D. specialty in 10 years. With 43% FMG’s filling the spots the handwriting is on the walls. Plenty of current practitioners are not recommending primary care to students.
    If there were financial incentives for the patient population to foster good health behavior, our jobs would be refreshingly easier with a more attentive audience. Primary care would be viable again. We’re losing it now because people don’t care. Just look at the obesity epidemic! I don’t think there is a shortage of docs reminding people to cut calories and exercise. The government is clueless. Punish the docs and the hospitals for re-admissions for behaviors they can’t control.
    Note well: Only problem with walking away from the AAFP is the loss
    of the infamous “Board Certification” and the prospect of being dropped by insurance and “preferred” provider organizations.

  2. Pat
    September 8, 2012 at 1:35 pm

    Amen, Doug.

    • Also fed up!
      September 13, 2012 at 2:16 pm

      As one of the “wusses” representing Family Physicians at the AAFP Congress and a family doc who agrees with the Authentic Medicine Gazette point of view most of the time, I have to respond to this posting. There are many of us at the Congress that agree with walking away from the RUC. This has been a hotly debated topic at the past 2 AAFP Congress meetings. The Board of Directors has thoughtfully deliberated about this after asking for changes from the RUC. The RUC committee gave a bit, but not what was asked for. At this time the Board believes it is best to stay in the RUC. (See http://www.aafp.org/online/en/home/publications/news/news-now/inside-aafp/20120313rucdecision.html for details of the letter and response.) The AAFP is working on the behalf of 100,000 + members, who do not all agree on anything, of course. It is a strong organization and the only way to keep it strong is for family physicians to stay in the organization. I struggle with recent changes and whether the organization truly represents me. There may be a day when I have to walk away from the AAFP–I hope not. For now, I choose to work from within. I beg family physicians across the nation to stay engaged. The AAFP has created many new ways to follow the Congress proceedings. Read the resolutions. Give your state Delegate your input. Become a Delegate! We need delegates who represent the common sense point of view that you advocate. Personally, I don’t believe walking away from the AAFP will do anything to help our cause. By the way, these are my thoughts and in no way are meant to reflect anyone’s opinions but my own.

      • Doug Farrago
        September 13, 2012 at 2:59 pm

        I appreciate the fact that you read my stuff. Here is my response to your response. I think more docs would be behind the AAFP and be more engaged if you walked from the RUC. Then you would have a mission, a platform and fire in your belly. Enough talk. The RUC does listen and we don’t need them. Actually, don’t walk. Run. We need to show them we mean business. Trust me, they will beg us to come back. And you will have all us minions in your pocket.

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