Don’t Be This Guy by Pat Conrad MD

Thank you, Establishment Family Medicine, for once again making these posts so easy to write.  I realize readers expect, nay, demand witty jabs and original insight, but damn, you clowns do all the work for me.  This from the Anals (sic) of Family Medicine:  A SHARED AIM FOR STUDENT CHOICE OF FAMILY MEDICINE: AN UPDATE FROM ADFM AND FAMILY MEDICINE FOR AMERICA’S HEALTH.

“ADFM expanded on this to illustrate points where Departments of Family Medicine (DFMs) could engage along the “four pillars” continuum, and the ADFM Education Transformation Committee provided a worksheet further addressing where DFMs could engage locally.”

Not laughing yet?  Here’s the blueprint:

  1. Workforce Diversity

Because “diversity” is always the first thing that comes to mind when choosing a specialty.  And because students are beating down the doors to work toward “improving the health of underserved communities.”  That’s why orthopedics and ophthalmology can’t fill all of their residency slots.

-Student Factor Analysis –  “Virtual focus groups conducted with both M4 students who choose and do not choose family medicine [included] a need for high quality preceptors.” I did care about preceptor quality, but it determined my program, not my specialty.

-Impact of Organizational Programming

Through work with the AAFP, preliminary data analysis on family medicine Interest Groups (FMIGs) identified significant positive correlates to match rates…Attending the AAFP National Conference and AAFP student membership may also play an important role.”  Uh-huh.  Color me skeptical.

  1. Process of Medical Education

“A partnership between FMA-Health, AAFP, STFM, and ADFM created a Family Medicine Student Choice Learning and Action Network (SCLAN) to learn, test and measure the impact of interventions. ADFM’s work on the Best Practice Guidebook Project will provide a SLAN pilot tool.”  Well that sums it up nicely. This section calls for training future advocates and leadership development, but was too boring to repeat verbatim.  This section also worries about high quality primary care preceptors.  “The subsequent action plan identifies partnerships and initiatives to drive health system change.”  There is nothing sexier, or so efficacious.

  1. Practice Transformation

“Burnout prevention and wellness are major focus areas for physicians and trainees. Student and resident leaders implemented awareness-building strategies and assessed what has the biggest potential for change.”  Student and resident leaders???  Those powerless newbies can awareness build all they like, or they could all don propeller-beanies and dance in a circle in front of AAFP headquarters, while chanting the “Tayata Om Bekanze Bekanze Maha Bekanze Radza Samudgate Soha.”  The results will be the same.

4.  Payment Reform

Allllright, now we get to it!  This is where they advocate ignoring quality measures, PCMH’s, mandated EHR’s, and moving to DPC, where they …can…aw hell no they don’t.  They worry that “the payment gap between faculty and employed/private practice physicians should be a part of payment reform work.”  That was it.

“These programs highlight the collective impact of family medicine organizations on increasing student choice. Looking deeper into the evidence, collaborative opportunities within and outside family medicine, and innovative work around the four pillars will allow each of us to contribute to the shared aim.”  So are primary care apologists actively deceiving students, or are you just too stupid to see what has happened?  Does it matter?  Either way you are cruelly incestuous.  Are you telling your would-be charges about the true rewards of mainstream, establishment family medicine?  Are you really explaining how much fun they’re gonna have with CPT’s and ICD’s, and what a bowel-emptying joy it will be to comply with MACRA, MIPS, APM’s, and the rest of the value-based scam?  Are you promising them how much they will love becoming a transformative leader of community-centered health, while struggling to pay a simple mortgage and school bills, working at least 60 hours a week?  Do they know how angry their patients will be when they are routinely seen over an hour late?  Have you told them about MOC?

I trained in family medicine, was excited for it, was good at it, and bought the whole rotten package.  I would only go back to mainstream, establishment office FP now if it was the only way I could eat, and I would still get more personal satisfaction from the fresh air while picking up trash on the side of the road.  The only, ONLY way to go into family medicine now is DPC, and yet there is no mention of it in the Anals (sic) “shared aim.”  These people are liars and they are clowns.

(Theme song video here)

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