The AAFP Propaganda Machine


We are in the field of science.  We should be able to look at studies and decipher what is utter bullshit and what is not.  When I look at the American Academy of Family Practice and see them put out an article with the title below, I get pissed:

FPs at Top of Recruitment List for Seventh Straight Year

Obviously, it was written to give some excitement to their audience/readers.  As one of the few family docs who reads their crap, I immediately saw through their hyperbole.  Here are the highlights from the piece:

  • The survey looked at medical specialties based on candidate population size and found that family medicine still is the “most requested and difficult search out there in terms of the sheer number of requests,” said Travis Singleton, senior vice president for Merritt Hawkins.
  •  “Family physicians are our No. 1 search request because of the demand, not just because of how big the specialty is.”
  • According to Merritt Hawkins, other factors also are driving the demand for family physicians. During the past decade, hospitals and health care systems have spent hundreds of millions of dollars building neuroscience labs, orthopedic centers, and heart and cancer centers. Increasingly, there is a realization among these hospitals and health centers that they need a primary care referral network to meet the needs of patients accessing the facilities, said Singleton.

Sounds great, right?  Then they drop the bombshell:

  • Despite the demand for family medicine, however, the average salary offered to FPs in the Merritt Hawkins search assignments dropped slightly……..

Yup, you got it.  Somehow the world of healthcare has turned the basic theory of economics on its head; higher demand, decreased supply resulting in LOWERING OF PAY?!?

Maybe the AAFP publication could have entitled the piece:

FPs Needed But No One Will Pay Them What They Are Worth (Find Another Career or Go The Direct Primary Care Route).

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] 

  8 comments for “The AAFP Propaganda Machine

  1. Kevin
    October 18, 2013 at 5:46 pm

    Doug, totally agree with your comments on this. By the way, AAFP stands for American Academy of Family “Physicians” and it is now the American Board of Family “Medicine”, and both have propaganda which has done nothing to further the cause for increased pay for family docs. Kevin

  2. tad hominem
    October 16, 2013 at 9:16 pm

    You don’t need to be a scientist to have a good “BS detector” and not even sure it helps, since much of the BS is generated by scientists. So what is the solution ? Bill your patients for the difference between what the insurance pays and what the “normal” charge for the service should be ? Insist on a credit card for payment at the time of the visit ? Cull the deadbeats off your patient list so you can spend more quality time with the patients who can afford you ! or who will follow your advice and can pay ! Shang-ri-la awaits.

    • Doug Farrago
      October 16, 2013 at 11:41 pm

      Direct Primary Care is the answer

  3. Kurt
    October 16, 2013 at 8:53 pm

    Lance and Doug have it correct. Still the ITB’s (Ivory Tower Bastards) convince the lambs to go to slaughter.
    That report says it all. “We want more but are going to pay less.” Oh, I do “supervise” an NP. She does too good a job of ordering insulin levels on folks not going for a pump and not asking folks if they’re going to be paying the bill. Nothing like pissing off somebody for superfluous labs they might be able to get away without
    for the time being. I have a business card with a blue heart on it with the words “Eat Shit and Die!” in the middle. I give it to the diet impaired and s/p M.I. people.

  4. October 13, 2013 at 3:21 pm

    just another example of how medicine defies the “laws” of economics. perhaps our leaders, administrators, the public, and our colleagues will learn eventually that you cannot shoehorn medicine into the conventional economic mold. in every other industry, when supply goes down and demand up, prices goes up. not in medicine. in every other industry, innovation and technology drive prices down, in medicine technology drives prices up. but, no worries. NP’s and PA’s will soon run the show, and we will get excellent by the book, automaton-like guideline based care, and we’ll all be happy as a clam….

  5. Pat
    October 13, 2013 at 2:19 pm

    Insightful as ever Lance – you make a great point that I’ve never considered: despite the popularized demand, the actual value of FP’s is dropping. Like many of us here, I too trained in FP and there is no way I would recommend it to anyone. It’s a sucker’s game, the house wins every spin, and the cute waitresses never ever show up with the free drinks.

  6. Ken
    October 13, 2013 at 11:19 am

    AAFP–the most flaccid group of them all. I gave up paying my yearly, expensive, fee a long time ago and the only change in my life is less junk mail.

  7. Sir Lance-a-lot
    October 13, 2013 at 11:17 am

    Nice one, Doug.

    I have tried to explain this phenomenon to non-medical family and friends, and they just don’t get it.

    Obviously, it can be explained partly by the inroads being made by PAs and NPs (whose cheaper labor will inevitably force all FPs out of business), but not entirely, as the demand indicated by the number of searches would also be down if employers were simply looking for fewer FPs.

    In fact, what we are seeing here is a situation where even though the demand (number of searches) is up, and the supply is constant, the price continues to drop, because the value of the product (FPs) is declining. Because of the directions taken by reimbursement schemes and quantities and the layering on of increased (time-consuming) requirements, the actual amount of money that an FP can generate in a given amount of time is decreasing. Add to this the perception of the average shortsighted hospital administrator, who can’t see any value to FPs beyond their actual hours worked and patients seen (“front door” to the hospital, referral source for more-lucrative specialists and procedures, good publicity from having schedule openings that actually allow patients to be seen by their doctors, etc.), then add the proliferation of NPs and PAs, who can bill the same as a Doc, but cost much less, thus decreasing the overall cost of a practice, and allowing the “line of profitability” to be lowered, and you have a situation where hospitals just aren’t willing to pay as much.

    Now add the general tendency of hospitals to try to force wages down as far as possible (without, of course, in any way colluding with one another to prevent any outliers from offering significantly more than the others), and you have a situation where there are a ton of searches, but relatively few actual job offers, because most of the people contacted, when they run the numbers, discover that there is no benefit to changing jobs, and so just stay where they are.

    Finally, of course, you have the FPs themselves, who again and again have proven themselves to be utterly incapable of standing up and demanding that they be treated with respect and paid in a way that reflects the services they provide.
    That’s us, folks.
    Do you see orthopedists saying, “Oh, well, I guess I just have to take their offer?”
    Do you see dentists saying, “That’s all the insurance will pay, so I won’t charge any more?”
    Do you see investment bankers saying, “I spent a lot of hours late at night working to get that deal finished, but I really can’t expect to be compensated for that?”
    Of course not.

    We’re our own worst enemy, but, not to worry, we’ll be extinct in a generation.

Comments are closed.