Another Strong Letter From the AAFP

The AAFP sent a letter to President Trump begging for a reduction in the amount of regulatory burdens that family doctors have to deal with.  Here are some highlights of the letter:

  • “There is not a single discipline of medicine that faces greater administrative and regulatory burden than family physicians and other primary care physicians.”
  • “In fact, research referenced in this letter shows that family physicians face a regulatory burden that is unmatched among the various medical disciplines.”
  • “For every hour a primary care physician spends in direct patient care, they spend two hours engaged in administrative functions”.

Let me ask the AAFP this.  Did you not know that jumping on the value-based pay and quality metric bandwagon of the last administration was going to make your members spend ridiculous amounts of time doing clerical work?  C’mon, AAFP,  I can see you smirking.  Of course you did and many of your members told you so.  I understand, though. You are just trying to cause a ruckus to distract from your incompetence.  I get it.  Good job.

Oh, and if you don’t believe me, here is one year ago from their website and the article AAFP Leads Move to Consistent, Meaningful Quality Measurement.  Here’s a snippet:

Measuring Primary Care

Of the seven core measures sets released today, it should be no surprise to family physicians that the set titled “ACO and PCMH/Primary Care Measures” is the most comprehensive.

The breadth of the core measures in this set illustrates the comprehensive scope of practice that is the hallmark of family medicine.

Core measures include activities associated with

  1. cardiovascular care, including control of high blood pressure, persistent beta blocker treatment after heart attack, and use of aspirin or another antithrombotic medication for treatment of ischemic vascular disease;
  2. diabetes care, including hemoglobin A1c testing and comprehensive eye and foot exams;
  3. care coordination and safety, including medication reconciliation; cervical, breast and colorectal cancer screening; and preventive care screening for tobacco use and body mass index;
  4. utilization and cost/overuse related to use of imaging studies for low back pain;
  5. patient experience, including timely appointments, physician communication with patients and access to specialists;
  6. behavioral health related to treatment of patients with newly diagnosed and existing depression; and
  7. pulmonary health, including medication management for patients with asthma and avoidance of antibiotic treatment in adults with acute bronchitis.

The collaborative also identified areas within this core set for which measures could be developed in the future. That list includes statin use guidelines, shared decision-making, preventive diabetes measures, palliative care measures, patient-reported outcomes, pain management measures, antibiotic stewardship, and substance use disorders and screening measures.

Yup, no one saw ANY regulatory burden or administrative time wasters here.


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 “Another Strong Letter From the AAFP

  1. John Kelly, MD, MPH
    February 18, 2017 at 6:25 pm

    Wow. Between fantasizing about Ayn and predicting the Fall of Rome, I have trouble remembering that Donald is going to drain the swamp, using every alligator he can find for his cabinet! What price meritocracy? Will patients begin to consider our costs as well as their own? Is “Atlas Shrugged” the answer to all our problems both personal and scientific? Will Little Nell lose the farm to the wealthy Snidely Whiplash, and be drafted to fight omnipresent terrorist threats in a bold new war? Tune in next week! Meanwhile, we have IT selling Big Data, ISP’s going down occasionally and paralyzing the whole damn office, politicians posing as budget solutions while lining their pockets any way they can, and family practitioners stuck with a national organization supposedly there to “have our backs,” but actually apologetic to the insurance companies and politicians that we cannot all be Med-Peds, and hoping the next PCMH gimmick will win ’em all over, so they both like us and pay us better! Now, Big Data is King, along with The Donald, and yet it’s not the same as Quality, and can be hand-molded to look like just about anything you might pay a consultant to conclude. What’s that you say? Family docs are so overpaid that we have to rein them it with reporting requirements that, big surprise, tell us they aren’t worth what they are being paid? We’ve got to punish them for not using the software that is still poorly written vaporware, because IT says it’s the ANSWER to budget savings? Huh. All the chiefs have got this problem down pat. All we need is another series of regulations! We have to get the front line soldiers seeing a patient every eight minutes! The hospital owns the practices, and they’re hungry ghosts, but that will make the soldiers more efficient! Yeah! That’s it!!!

  2. RSW
    February 14, 2017 at 10:44 am

    Shorter version: ” As leadership of the AAFP, we demand that President Trump, who has been in office for three weeks, supply our membership with immediate relief from the non-stop cluster fuck we have been giving them for the past two decades. Or else we’ll keep doing it.”

    The comments on the AAFP web site are priceless.

    • Doug Farrago
      February 14, 2017 at 2:08 pm

      OMG, yes, the comments were awesome. Wonder if they are Authentic Medicine people?

  3. HJR
    February 14, 2017 at 7:25 am

    “The great oak tree had stood on a hill over the Hudson, in a lonely spot of the Taggart estate. Eddie Willers, aged seven, liked to come and look at that tree. It had stood there for hundreds of years, and he thought it would always stand there. Its roots clutched the hill like a fist with fingers sunk into the soil, and he thought that if a giant were to seize it by the top, he would not be able to uproot it, but would swing the hill and the whole of the earth with it, like a ball at the end of a string. He felt safe in the oak tree’s presence; it was a thing that nothing could change or threaten; it was his greatest symbol of strength.

    One night, lightning struck the oak tree. Eddie saw it the next morning. It lay broken in half, and he looked into its trunk as into the mouth of a black tunnel. The trunk was only an empty shell; its heart had rotted away long ago; there was nothing inside – just a thing gray dust that was being dispersed by the whim of the faintest wind. The living power had gone, and the shape it left had not be able to stand without it. It was an immense betrayal – the more terrible because he could not grasp what it was that had been betrayed.”

    Atlas Shrugged – Ayn Rand

    • Steve O'
      February 14, 2017 at 8:12 am

      Elitist societies have fundamental contempt for those who can do things – and the work of the surgeon cleansing abscesses and the physician caring for the feverish patient is forever disgusting to the upper classes; not because of the nature of human illness and its unpleasant products, but moreso that it involves DOING things – the plumber who places the wax ring under the toilet, the sweating and fireman who drags canvas hose, the policeman who steps alone out of his secure vehicle. To be compelled to actually DO things is tantamount to slavery. Better to sit in a self-satisfied stupor and let the moneys roll in…from where? From our own brilliance, we guess – but we really do not know. One thing’s for certain – it’s not from effort – that’s best reserved for the tennis court and golf course, not the nasty effort needed to obtain food and shelter. That’s for beasts and machines.
      But the time inevitably comes when the culture cannot lavish riches upon those who cannot do. These times are called “collapse” and “downfall” and “dark ages.” But they are as predictable as the seasons.

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