The Four Pillars


It sounds so magnificent.  Like the Four Horseman.   It turns out that all it takes to fix the primary care crisis is:

  • pipeline
  • process of medical education
  • practice transformation
  • payment reform

Brilliant!  So, we need a pipeline of family docs.  Got it.  Boy, that was hard so I am glad they figured that out for me.  It seems we need to improve medical education so that it “models positive primary care clinical experiences”.  What does that even mean?  Wow, these geniuses are on a roll. We also need to transform practices into “patient centered medical homes”, which is basically a made-up term to mean family medicine anyway.   Lastly, we need to “reduce the payment disparity between primary care physicians and subspecialists by appropriately valuing the comprehensive services provided by primary care physicians”.   And there it is.  When people say it’s not about money it is ALWAYS about money.  The first three pillars mean nothing without the last pillar.  In fact, this four pillar system is basically built on quicksand because no one wants to pay family docs more since we let the nurse practitioners get away with claiming they are as good as us.   And whose fault was that?  The same morons who proposed this four pillar system!

The report is the outcome of a task force created by the Council of Academic Family Medicine (CAFM) — which comprises the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the Society of Teachers of Family Medicine and the North American Primary Care Research Group — with support from the AAFP and the American Board of Family Medicine.”  

These are all teaching organizations with little real world experience.

The only pillar that would work to save family medicine is DIRECT PRIMARY CARE; a topic not even brought up in this report!  We need to walk away from the hospitals owning us.  We need to walk away from the insurance companies.   And then we can prove our value to the patients or they will walk away from us. 

47780cookie-checkThe Four Pillars