Americans Want Doctors In Charge


This from a recent AAFP report:

  • 72 percent of American adults prefer physicians to nonphysicians when it comes to health care,
  • 90 percent of adults would choose a physician to lead their “ideal medical team” when given the choice, and
  • By a greater than two-to-one margin, adults see physicians and family physicians as more knowledgeable, experienced, trusted and up-to-date on medical advances than nonphysicians.

Enough said.

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] 

  17 comments for “Americans Want Doctors In Charge

  1. Alice
    December 30, 2013 at 10:41 am

    As a physician assistant student in my second year, I find it discouraging to know that there are physicians out there that would rather not have us treat their patients.
    I respect physicians, and all of my preceptors have been physicians. Some of them may have noted that I am a LELT, and others have stated that I know more than 3 year residents.

    How are these LELT providers just supposed to go back to medical school? I have so many thousands in debt now, that it seems unfathomable for me to “just go back” when I am in a medical school right now. . . I would be taking all the same classes over, accumulating much more debt, so Americans could “want me in charge”.

    The PA profession was created by physicians, so that we could be an extension of the physician. Studies like this are demeaning to what is supposed to be a team based approach for the art of medicine. I really do like the Gazette and enjoyed the Placebo Journal (thanks to my preceptor). I am not offended by your comments, because I understand that you have paid many dues to get to your respected position. I just ask for consideration when I [we] have also worked very hard to get into my [our] position. You will ultimately be the leader, and the origin of the word doctor means teacher. . .

    • Doug Farrago
      December 30, 2013 at 12:31 pm

      Unfortunately, you dropped in on an ongoing debate. I work with PAs and NPs that are wonderful. That is not the issue. Every PA that I know who went back to med school and residency say the same thing, “I didn’t know how much I didn’t know”. That doesn’t make you bad or good it just means TRAINING and EDUCATION are important! Do you need more? Well, that depends on your role. If you make proclamations like others in your profession have on this site that you are as good as a doctor then you are clueless like they are. That does not mean we can’t work together collaboratively and, in fact, most PAs understand this and are not pushing to compete with doctors. The NPs are trying to compete and I am just pushing back. You see, unlike most of my pussy colleagues who only whine after the fact, I am standing up against this travesty.

      • Steven Gilles
        January 2, 2014 at 4:21 pm

        Thanks Doug.

        I thought this was a great comment/response to Alice.

        Alice is overall very correct in most everything she says.

        The problem Doug, is that on paper, I’m held to the same quality standards as the physicians are, I see the same types of patients and I fill out the same BS paperwork the physicians do. If you look at my schedule vs a physician’s schedule, there isn’t a difference. If you look at my diabetes and other quality numbers, they are on par with a physician’s. This is true in many primary care settings. Many PAs in primary care take call, some do pre-natal and I’ve known a few who do deliveries and assist in C-Sections. On paper, degree and training aside, many PAs are doing exactly the same job the physician is doing.

        So it is hard for many of us not to say “I can provide primary care as well as a physician.” because regardless of degree – many of us are doing the same job. That’s reality. I’m not making that up. Sure, certain systems really limit a PA’s role, but in primary care, many do not.

        So, I agree with you that I have less education and less training, but that hasn’t translated in most systems into less work than a physician, or less liability as a PA and it certainly hasn’t translated into a team based style of care or less stress/work for the physician. Systems just view us as a less expensive physician.

        If there is data suggesting PA outcomes are poorer than a physician’s, then the PA profession needs to hear about it. If there are glaring holes in our education resulting in poor patient outcomes – we shouldn’t be practicing medicine as PAs.

        So I will say it again. I can provide primary care services as well as a physician because the fact is, I’m doing that. Do I still talk to my physician colleagues and ask for help? Yes. Do I refer my complex patients to my physician colleagues who are specially skilled in certain areas? Yes. Can I and should I replace the role of the primary care physician? God no! Do I have a “supervising physician”? Yes I do, our interaction is a collaborative one that I am very appreciative of.

        I’m sorry to continue clogging up your blog site. You have every right as a physician to support only physicians and say whatever it is you want about non physician providers.

        Please however, consider not making PA providers your enemy by creating a diminutive nick name for us on here and using that as “proof” that our skills are inferior. I’ve said it before, most of us want to support you in your efforts and fight the EXACT same issues we all face a daily basis in medicine. We can be an ally to physicians and not seen as part of an ill or as an enemy . . . all PAs enter the profession with the sincere desire to provide/improve patient care and with a wish to learn from, collaborate with and be respected by physician colleagues.

        Mr. Sad LELT PA

        • Doug Farrago
          January 3, 2014 at 7:46 am

          Doing the same job is one thing, doing it as well is another. Just because you work hard, care a lot, work well with others, spend time with the patient does not mean you can rely on the same training or education as we do. That breadth of knowledge is important. I don’t care about what “systems” think because, you may realize, I hate those systems. And please stop bringing up the studies. They are bogus are driven by those same “systems” who want to replace us because you are cheaper. I agree about PAs having a role. I agree about collaboration and not competition. I cannot agree to stop pointing out the LELT differences when I or my profession is attacked. Sorry. Someone has to fight back (mostly against NPs) who want to get rid of me. I will end this argument there.

  2. Steven Gilles
    December 27, 2013 at 10:22 am

    This was a ridiculous survey.
    1300 people? 1300 people do not represent the entire will of the general population. The survey did nothing to ask if the patient’s had a basic understanding of the training and role of NP/PA providers. It is also biased and ridiculous in the way it is written.

    Example – I write a survey that asks:
    “You are in the ER for chest pain. Who should see you for chest pain?”
    -ER doctor?

    I personally would choose an ER physician to start the process for undifferentiated chest pain. However – the average American consumer would choose a cardiologist. Does that make the ER physician unqualified? Does it mean that all patients prefer cardiologists over ER physicians?

    Another example:
    You have a newborn. Would you like your newborn to see a specialist in pediatrics or a generalist? Patients are going to answer that survey as “I want to see the specialist in pediatrics.”

    You have an elderly mother. Would you like your elderly mother to see a specialist in adults or a generalist? Patients are going to answer that survey as “I want my mother to see the specialist in adults.”

    So – using the logic of this survey, the clearly biased approach in writing and a lack of any general understanding of how to write a reasonable survey – I could write a survey completely undermining family practice physicians.

    Most of you know this is ridiculous! Family practice physicians are excellent providers. So are PA and NP providers. The AAFP is going to play the AMA game? Trying to set up turf battles where one doesn’t need to exist?

    The survey was poorly written and goes against the actual data regarding NP/PA providers.

    Steven Gilles PA-C

    • Doug Farrago
      December 27, 2013 at 10:37 am

      Sorry, Mr. LELT, you lose.

      • Steven Gilles
        December 27, 2013 at 11:55 am

        What is a LELT?

      • Steven Gilles
        December 28, 2013 at 7:20 pm

        Ohhhh! Less Educated Less Trained! That is so clever.

        That makes great sense. Ok, I get that. So FPs are LELTS? I guess so based on your description. Compared to pediatricians and internists anyhow.

        Thanks Doug. Will make certain I do not send MY patients to a LELT like you, prefer that the adults see IM and the kids see Peds I guess.

        Doug do to refer your complex patients to IM?

        FP is the new red headed step child of medicine. You of all people should be able to see you play the same belittling judgment game the IMs do.

        So, no Doug. I don’t lose. Like it or not, agree with it or not ….. I can do your job as well as you. So Doug ….. you lose. You lose because you are a pompous, self serving, narcissistic, FP who isn’t willing to realize he is making himself irrelevant by choosing to disrespect hard working, well educated PAs who just want to provide patient care and want to be a productive team member.

        LELT. Ridiculous. Are we all 12?

        I’m sooooo fortunate I work with good FPs who respect my work, are willing to collaborate and don’t name call.

        From one LELT to another Doug, we both lose if you keep up your fear based untrue rhetoric.

        • Pat
          December 29, 2013 at 4:04 am

          You stated: “I can do your job as well as you.” So Stephen, you do realize you just devalued the “good FP’s” you work with? Why is accurately defining something considered “name calling?” This is whiny egalitarianism, demanding respect – and cash – for something you did not earn.

          • Steven Gilles
            December 29, 2013 at 10:47 am

            Good point Pat.
            So by your argument accurately defining something is NOT name calling.

            So I am accurately defining that as a PA in primary care I am providing great care regardless of my title or educational training. Based on your argument – that is not devaluing my amazing FP colleagues, but just defining what it is a I do in primary care and comparing it to what they are doing.

            Am I missing something?

        • Doug Farrago
          December 29, 2013 at 8:37 am

          Steven, the funny thing is that you still read everything on this site. Why? Go away if you don’t like it. And, by the way, there is no better way to describe you other than Less Educated and Less Trained. Do you deny it? To deny it, you would be lying. It must hurt. Sorry. Go to medical school. As far as doing the job as well as me….sorry…I am laughing as I type this….you would need to get some more training and better education. Case closed. Happy New Year, my little sad LELTer.

          • Steven Gilles
            December 29, 2013 at 11:01 am

            You flatter yourself Doug by assuming I read everything on your site.

            I do read pieces on here and I agree with a great deal of what you say, a lot in fact and I do like your site for whatever that is worth.

            Where we disagree is your approach and opinions about PA/NP providers. So I feel that it is important to stand up to the rare physician like yourself who feels obligated to create a battle where one need not exist.

            I don’t deny that I am less educated or have less training and that doesn’t hurt at all. It kind of feels good. Good to know that I can manage a diabetic as well as you can despite your incredible training that you keep hanging on to.

            Where you are wrong is where you state: “get some more training and better education”. I have a great education Doug. I got my masters degree at a medical school and took classes with MD students and did clinical rotations alongside medical students and my lectures were the same lectures the MD students had by the same lecturers. My colleagues are physicians who teach me every day (and lo and behold, I sometimes teach them something). So, I’m not going to go back to medical school to get an MD so that I can end up back in the exact same place doing exactly the same job . . that doesn’t make sense does it?

            You should be laughing as you type Doug. You could use a little humor in your life.

            So, I state again, I work with great FP physicians that I trust, respect and love working with who respect me and what I do. They choose to realize that we are all in the same battle. A battle against administrators, a battle against insurers, a battle against the ridiculous issues we face in primary care. Don’t keep making us out to be the bad guy. Stop creating turf battles where one need not exist. We don’t need to be your enemy Doug. We could very reasonably be an ally who will stand up with you and anyone else working the trenches of primary care . . . but clearly you don’t want that. Do you?

        • kurt
          December 29, 2013 at 9:49 am

          Lelt. It’s not rocket science to do office work. I’ve seen where they manage patient problems and do a pretty good job of it. If I can’t get a patient into the specialist they need. I don’t have a problem with the patient seeing the specialist’s NP. They have a line to the specialist’s ear. I suggest another tact. Just tell students to stay away from FP and straight IM period. They’re still will FMG’s who fill the slots but heck, if I wanted to get into the ‘ol U S of A, I’d go that route.
          Another revelation, I’ve seen NP’s manage chronic problems just fine, albeit with sometimes to many labs ordered. Nonetheless, once the patient kicks their ass about the cost, they do way I do and give careful thought as to what I actually need.
          Primary care will not be viable for anyone until there is the expectation of patient respo

  3. Kurt
    December 26, 2013 at 12:10 pm

    What people say and what they do are two different things. I’ve seen people viciously loyal to their NP and regret that they can’t be cared by them in the hospital. A good number of people like to see them because “they aren’t a Dr.”

    The NP’s can do the office work that an FP can do in a reasonably fine fashion. Once they are universally allowed to do this without physician supervision, FP will be a dead specialty. I do not recommend this for students anymore. The BS the med students are falling for is amazing. The vast amount of uncompensateable paperwork, a direct result of electronification increasing “online paperwork”, makes this specialty an anachronistic throwback.

    The movement towards hospitals only employing “board certified” ER docs will eliminate the prospect of moonlighting.

  4. Ken
    December 24, 2013 at 12:55 pm

    Wow, another AAFP survey. I wonder if they will do anything with the results or just use the data to plan for another survey. For now, I will keep my dues money for myself.

  5. Pat
    December 24, 2013 at 8:41 am

    AAFP Pres. Blackwelder summarized the findings this way: “Finally, we have a survey from patients that says they not only value primary care, they value you for your education, expertise and experience.”

    Neither he nor the study mentioned whether respondents (or their insurance companies) were willing to pay for what they claim to value.

    • Kurt
      December 26, 2013 at 4:50 pm

      Blackwelder is a nice, knowledgeable guy. I heard he went into academics because he was tired of seeing the same thing over and over. Well guess what? Common things are common and will continue to occur with full force until patients are held accountable for their habits that lead to chronic disease. I don’t care how many “Medical Home”
      gimmicks the ivory tower bastards start. Little is going to change.

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