The AAFP Attacks Burnout with Fluff

Thank goodness for the AAFP Leadership Conference (combined Annual Chapter Leader Forum and National Conference of Constituency Leaders) because they have offered answers on physician burnout and how to transform it into well-being.  One of the speakers there, Paul DeChant, who is former CEO of the Sutter Gould Medical Foundation — a 300-physician multispecialty medical group in California’s Central Valley — and co-author of Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine, states the solution “could lie in the concept of lean transformation”.

Ah, yes, the old “lean transformation” trick. There is more:

Although many associate lean transformation with manufacturing and productivity, DeChant said the concept’s principles actually focus on respecting people (including the clinical care team), maximizing value for customers (in this case, patients) and minimizing waste.

You see, it’s easy!  And it’s the doctors’ fault for not respecting the team or not maximizing value for patients or not minimizing waste.  Wait….what?

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Physician leaders, DeChant noted, can help if they “go where the work is being done and learn it.” This could mean anything from shadowing other physicians to learning how to schedule patient appointments by working with staff. By doing so, administrators can humbly learn how others do their jobs, what their challenges are and what those individuals think could be done to improve things. This “undercover boss” approach also builds trust with employees, he said.

Who wouldn’t want an administrator with them all day?

Not to be outdone, AAFP Senior Vice President for Education Clif Knight, M.D., presented a breakout session that highlighted the Academy’s long-term plan to dig deep, engage and help family physicians regain a sense of well-being, happiness and professional satisfaction.  Here is the plan:

An extensive initiative dubbed Physician Health First is set to launch in coming months. In fact, a number of resources related to the initiative already are in the works, including, but not limited to,

  • planning of the AAFP’s first health and well-being conference, scheduled for mid-April 2018;

  • work on a chapter workshop series in 2018;

  • expansion of related CME tracks and workshops at the 2017 Family Medicine Experience to be held Sept. 12-16 in San Antonio;

  • ongoing publication of timely and informative journal articles on topics related to physician well-being;

  • creation of an enhanced well-being portal on the Academy’s website;

  • development of a web-based well-being planning tool; and

  • offering access to the Maslach Burnout Inventory(

Does anyone believe that any of this will work?  It sure seems like the answer is changing the system and not the doctors but what do I know?

The only doctors that I see being happy are Direct Primary Care doctors.  They have removed the middlemen including administrators.  They do not code.  They see 8 patients a day.  Patients love it. Doctors love it.  Satisfaction for both parties is extremely high.

And no mention at all in this article of DPC by the AAFP.  That blindspot is so sad.

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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] 

  11 comments for “The AAFP Attacks Burnout with Fluff

  1. Frank Rubino MD
    May 17, 2017 at 2:06 pm

    When I see an MD administrator I see a burned out doctor. Why else would they leave the actual practice of medicine and become an “administrator”. FAPS.. I like that pneumonic. They no longer want to deal with real people with human problems. They no longer wish to deal with the paper bullshit, data gathering. Computer clicking nonsense. They make more money to boot!
    “Primary Care” will be managed by NP’s and PA’s because it has. Become a clerical job. Metrics is the name of the game and that can be managed by a secretary. There is no longer a need for a medical degree. I have been an FP for 39 years. This is the future of primary care. AAFP is on the way out.

  2. Mamadoc
    May 10, 2017 at 9:37 pm

    As my kids would say, WATF? These clowns have perpetrated a boat load of nonsense over the years but they have now exceeded themselves. “Lean transformation” my left foot.

  3. L. J. Sloss, M.D.
    May 10, 2017 at 8:21 pm

    Pretty typical response from co-creators of the problem, to which worthless and fecund fountains of humbug one might add the AMA and state medical societies. People who suffer from loss of autonomy need autonomy, not loss-of-autonomy-adverse-spiritual-response-tolerance facilitators. Yield and find peace, dear colleagues …
    Recall if you will the last sentences of the prescient novel 1984: “But it was all right, everything was all right, the struggle was finished. He had won the victory over himself. He loved Big Brother.”

    • Pat
      May 10, 2017 at 9:04 pm

      The AAFP is the industry leader in self-hatred.

  4. Kurt
    May 10, 2017 at 4:28 pm

    Make the Academic Bast***s and F’ing Morons drop MOC and be concerned with initial certification PERIOD. 50 hours CME a year is sufficient and if they want to offer optional courses fine. Most of us find a niche that may not include all facets of primary care. Me, I stay confined to
    geriatrics and don’t do peds or pap smears. Most my patients don’t have a uterus and those that do get sent out as I don’t have time to do them anymore with all the uncompentsateable EHR

  5. Randy
    May 10, 2017 at 1:33 pm

    I have a plan to help prevent burnout, it involves the AAFP not continually throwing working physicians under the bus.

  6. Pat
    May 10, 2017 at 8:13 am

    If the AAFP had been captain of the Titanic, they would have backed up and hit the iceberg again, repeatedly, in order to generate more data.

    • Doug Farrago
      May 10, 2017 at 9:24 am

      I LOOOOOOOVEEEE this line

    • Perry
      May 10, 2017 at 11:57 am

      Let’s see, how many times can we hit an iceberg and still stay afloat?

  7. John Parkin M.D.
    May 10, 2017 at 7:54 am

    “Physician Leaders” actually going where the work is done ?? What a novel concept ! This supports my personal theory that once a doc is sucked in by the “Dark Side of the Force” and becomes a PL in a health corporation or organization he or she has forgotten what actual medical practice is like. Unfortunately these are the people who have the time to meet with politicos and other PLs to take the time to develop the policies which are killing us

  8. Steve O'
    May 10, 2017 at 7:53 am

    The dawn of civilizations begins with individuals; individuals who gather to accomplish more and more ambitious and meaningful goals and achievements.
    The sun sets on collectives, when individuals mean nothing more than an element in the inventory of a collective. The individuals are like ants – they are ants, identical, interconvertable. Ant colonies do amazing things with organization. Humans, on the other hand, go into space and transplant hearts and write symphonies. Humans, when allowed to do what we do, far outdo ants.
    Direct primary care stands a chance of saving medicine by a new dawn. Individuals take care of individuals. There is nothing novel about it, other than to sweep away the cults of Chapter Leaders and their magic rituals; the National Conference of Constituency Leaders and their potions.
    There is an implicit intimidation to these cults. They can control individuals by force, not the honest force of cracking heads, but the implied threats particular to their domains – MOC’s and licensure/national board ties, and things that are incomprehensible to outsiders.

    “… lean transformation … principles actually focus on respecting people (including the clinical care team), maximizing value for customers (in this case, patients) and minimizing waste. Eliminating waste along entire value streams. It requires a complete transformation on how a company conducts business.”

    These are mystical words from a forgotten language that the acolytes murmur. They have nothing else that they can do. They are not useful for anything else. If they have MD degrees, they cannot be trusted to care for a patient independently. Any skills they might have once had are on the waste heap with the steps for the tango, or high school geometry.
    Hidden underneath “lean” and “six sigma” and “TQM” is the concept of EABeliminate all bullshit. The High Priests of Bullshit strongly support this concept – but up to a limit, let’s not be reckless. We cannot touch the dense regulatory/quality management/oversight guidance and morale encouragement departments which are necessary to deliver services. Business schools are now absolutely necessary in American Business. A hundred years ago, they didn’t exist – and look where America had brought itself by the start of the 20th Century! All running about like individuals, doing this or that!

    Look what medicine was like fifty years ago – given the scientific level of development medicine was at fifty years ago. I just chanced across an amazing anachronism. One of my patients was admitted to the hospital by elective admission! Of course, they never told me about it until he was done with his procedure, but all the same – an elective admission! Through something called an Admissions Department! Of course, the old Admissions Department is down by the Emergency Department – the old first floor offices are inhabited by the Quality Assemblage Tiger Team Division, or some such thing. I call them all FAPS – Fat Asses on Plush Seats. Emailing email. Videoconferencing. Poring over quarterly performance reports with tight faces. Touting the New Buzzword. Drinking the new Keurig coffee. What can we possibly do, they agonize over – to completely change the company and enact more production for less expense? I know – a monthly Nursing Award! with pins and laser-printed certificates! No, but we no longer hire nurses – we contract them out as perma-temps. Okay – so awards IN THEIR NATIVE LANGUAGE! That’s empowering, no? And sensitive. And forward-thinking.

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