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. 

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 “The Four Pillars

  1. Randy
    February 5, 2014 at 1:51 pm

    Pretty unsurprising that a council of Academic Medicine supports an approach that probably works best in the academic setting, and ignores the difficulty in applying it to small offices and independent physicians. The academic physicians are the ones with enough time to come up with this stuff, while the rest of us are busy practicing medicine.

    With the evolving guidelines on EMR’s, meaningful use and PQRS it’s clear individual physicians and small groups are no longer valued or desirable. I’m just looking to make it through a few more years then get out.

  2. Jay
    February 2, 2014 at 11:27 am

    I couldn’t agree with you more, Doug. That’s why I joined the ranks of concierge medicine, in order to serve patients who value my service to them. I wish I could see another way to continue providing high quality, personal care to people that I care for, and care about; however, without financial backing from my patients, it can’t be done. With their support, I have been able to really focus on their needs, and provide unparalleled service. My hope is that the proven cost savings in being preventive and proactive will get the attention of insurance companies. Perhaps over time this will become a model for improved reimbursement for primary care.

  3. Pat
    February 1, 2014 at 11:30 pm

    These numbskulls remind me of the delusional “Bahgdad Bob” broadcasts from the bunker. And how many FP organizations are there??? Ken has it right, I too wish I could recover the enthusiasm and years I wasted on this self-immolating bunch.

    Direct Primary Care is now obviously the only hope, and a thin one at that, for a fast-dying discipline.

  4. Ken
    February 1, 2014 at 12:15 pm

    “The report is the outcome of a task force created by the Council of Academic Family Medicine (CAFM)”. A committee likely spent several weeks coming up with these 4 pillars, something that an average high school student could have thought up in 5 minutes. And of course, the Council of Academic Family Medicine, with their utter impotence, will have no impact on anything. Nativity or just stupidity?
    And yes, I am a family physician who has spent way too many hours (lunches and evenings of course) on ridiculous committees like this, thinking it was important work. Oh, to have all that time back…

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