The Guilt Approach


I saw this article and was quite surprised at the approach they were using. Guilt.  It seems the only residency program in the state of Alabama that trains primary care physicians to serve rural areas is in danger of shutting its doors.  The reason, as this article states, is because Congress may repeal the Affordable Care Act.  Well, that’s it dammit!  They need to immediately withdraw the lawsuit because no one wants to lose Cahaba Family Medicine in Centreville, Alabama!!

I am a family doctor.  I support programs that train more of us instead of giving the specialty away to midlevels.  And I really  believe these doctors have their hearts in the right place.  That being said, it just amazes me when we, as humans, look at anything and only see how if affects us.  I am as guilty as the next person.  I know that.  I try, though, to look at the big picture and that picture is bleak for family doctors.  The reason is that no matter how well they train these doctors to work in rural areas those future docs still will be stuck with bogus quality metrics, worthless EMRs, ridiculous hoops to go through with Medicare and Medicaid, and still be paid the LOWEST of all doctors.  This approach is broken.  Repealing the ACA may do nothing to fix these issues either and I get that but the way the plan is set up now, I would never recommend ANYONE go into family medicine unless they did direct primary care.

If we all walk away from the insurers and Medicare and Medicaid and from the ACA then we could do a better job for patients at half the cost and finally get paid a reasonable rate. Or we can walk off the cliff like lemmings and beg people to keep one rural training site open.



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] 

  3 comments for “The Guilt Approach

  1. Pat
    March 29, 2015 at 12:18 am

    Hey, don’t knock guilt – it’s the very basis for our entire U.S. health infrastructure. Guilt – as opposed to real analysis and reason – created Medicare and Medicaid.

    Guilt was how the entire nation stood on a chair, bent over, stood on one foot, and snookered itself into this idiotic ACA.

    I spend part of my time every month working in rural Alabama hospitals. It may be news to the folks at Cahaba Family Medicine, but I’ve talked with some of their colleagues in rural south Alabama and north Florida who have chucked primary care and all the onerous mandates and crappy pay for full-time hospitalist or ER work. All the ACA grants and new trainees that Cahaba could ever want will not make a damn bit of difference if the current problems are not reversed.

    So guilt away. It’s a desperate, loser argument.

  2. Earl Mahaffey
    March 28, 2015 at 9:40 pm

    I walked away 3 months ago.

  3. Perry
    March 28, 2015 at 3:03 pm

    Frankly, I think all Primary Care would be better off without the ACA. The problem is coming up with another plan.

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