Clueless Family Medicine Leaders


Now that the AAFP thinks they helped us in fixing the Medicare sustainable growth rate (SGR) formula, which really ends up handcuffing us to the government forever, they now are setting their sights on the primary care physician shortage.  Hooray! Unfortunately, there is not one creative idea in the whole group.  Instead, these are the same clueless leaders who keep saying the same thing.  They just don’t get it.  Here is a summary of their thoughts from the 2015 Family Medicine Congressional Conference (FMCC):

  • Several speakers focused on the lack of support in graduate medical education (GME) institutions for training the primary care workforce. As long as teaching hospitals dominate medical residency education, they said, there will be a continuing shortage of primary care physicians entering the field.
  • Overall, THCs (teaching health centers) are an important pipeline for training primary care residents. According to the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, in fact, more than 90 percent of residents who train in THCs enter primary care, compared to about 20 percent of all medical school graduates.
  • Two legislative aides at FMCC discussed the political obstacles that make it difficult to introduce changes in GME funding. Teaching hospitals receive an aggregate $10 billion annually from CMS for residency training, said Rodney Whitlock, Ph.D., M.A., health adviser to Sen. Chuck Grassley, R-Iowa, and some members of Congress believe the budget for GME should be cut. Whitlock said a better idea might be to identify ways to be more efficient with annual spending and allocate more for areas of need such as primary care.Training more primary care physicians is the first step to address many of the financial concerns about rising health costs.
  • But Klink said medical school graduates who enter family medicine residencies notice that the clinical settings where they train are often underfunded compared with those for subspecialties that are highly valued by teaching hospitals.

Sound familiar?  These people think that the answer to fixing the primary care shortage is to get more government money and make prettier training centers.  No one mentions the fact that the job sucks.  No one mentions the fact that unless you go out on your own and do DPC, you are a prisoner of your hospital employer, you are still getting the lowest pay for physicians, you are being replaced more and more by midlevels, and you are spending all your day doing unproven quality metrics.  But of course, you don’t want to fix these issues. No, you want to talk about the government helping us more.  How pitiful and embarrassing.


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] 

  5 comments for “Clueless Family Medicine Leaders

  1. MACF
    May 22, 2015 at 4:01 pm

    Maybe by having the THC initials they will attract some groovy providers…

  2. Diane
    May 21, 2015 at 10:30 pm

    Great comments about Famliy Docs being the underpaid workhorses of the system . What other profession would put up with this ?? It’s all MeaningLess Use to me!!

  3. Kurt
    May 20, 2015 at 2:41 pm

    As long as the system is moving towards punishing providers for patients lousy health habits
    I will not encourage any student to go into primary care. I’ve been at this for 27 years and the vast majority of people pay lip service to my suggestions and refuse to change. I still have trouble trying to get diabetics to bring a sugar diary in and attend free education sessions.
    The amount of uncompensatible paperwork has exponentially increased and anyone who suggests to students to consider FP should be condemned to hell. With the ABFM head being paid $740,000 dollars a year to figure out some new eductational B.S. to charge us for, this specialty should die.
    Too many PA’s and NP’s to do the job and I consider myself the last of a breed that still does hospital care. I used to have the philosophy to do the best I can with what I got. If the patient
    will take my advice, I rejoice in their positive benefits too. If they don’t, I did the best I could to treat the resulting complications and tried to continue to hammer away at them to change.
    If I’m am going to be dinged for this, I am no longer going to take on the difficult, “mal” compliant patients. In 6.5 years, I hopefully will be out (retired) from this BS and will never look back. Too bad. I envy Doug and hope his DPC practice works out well for him. Won’t work everywhere but good for him.
    The ivory tower bastards need to get off the backs of the rank and file and the social sciences should be dedicated in trying to get modalities, aversive or otherwise, to get people’s behavior to change.

  4. Randy
    May 20, 2015 at 9:46 am

    Theoretically it’s not that tough to encourage more young docs to go into primary care. The trouble is overcoming the special interests that currently dominate the current system.

    1. Bring pay for primary care more in line with specialists. This would mean a change in the RVU system currently devised by the AMA and its advisory committee, which is mainly made up mostly of specialists.

    2. Don’t treat primary care like a red-headed stepchild in medical school and residency. Since the bulk of clinical professors are specialists (and rightly so in my opinion) this will require a big change in perspective that will take decades.

    3. Don’t make primary care physicians do useless and expensive things while in practice, ie MU, PQRS, MOC, etc. These programs are currently supported by the organizations that claim to represent us.

    • Pat
      May 20, 2015 at 10:25 am

      Randy, all good points but I think the problem is much deeper than that now. Even beginning with wondering how to change the RVU system demonstrates that the collective psyche looks first to government for permission. This is exactly what Doug is addressing, and why primary care has become such a lousy job.

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