Community Centers

Here is the headline that was put out:

Survey: Community Health Centers Need Many More FPs

Now what does that do?  Is anyone going to take the job because there is a need for docs?  The simple of formula of demand and supply works pretty well here.  In fact the article says:

That’s the stark conclusion of a new report from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care titled “High Demand, Low Supply: Health Centers and the Recruitment of Family Physicians,” which was published in the Aug. 1 issue of American Family Physician.

Ok, we agree on that. They have a demand and the supply is short.  The question is what is the carrot to make docs work there?  They conveniently forget to mention this. But they do mention this:

“This highlights a need for policymakers to support federal programs that create incentives and provide community-based primary care training opportunities for medical students and residents to ensure an adequate supply of FPs to staff health centers and provide care to underserved populations.”

So would making it a training center for medical students and residents ensure doctors want to stay there.  No. I guess they are thinking that these groups would be enough for staffing?  Probably not.  The answer is paying family doctors a ton while also making the job tolerable.  Or, hear me out, how about encouraging more family doctors to go into direct primary care.  These offices are mostly community-based with doctors giving patients more time and attention.  Impossible?  Maybe you are thinking the patients can’t afford the $75 a month.  They can pay for other things but let’s assume for a moment that they won’t.  How about medical debit cards that they could use on DPC just like they do for food?  As long as DPC docs are not beholden to bogus government metrics than this could work. Just let the doctors worry about low overhead and the “caring for patient” part and the patient can just use the voucher monthly to pay.  There is the carrot.  It really can be that simple.

No other plan has worked.  Why not try?

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] 

  4 comments for “Community Centers

  1. Kurt
    September 8, 2018 at 4:01 pm

    In the U.S. , Primary Care is the bottom of the medical s**tpile. No wonder students don’t want to do it. I don’t blame them. Until patients are held accountable for their lousy health behaviors nothing ever is going to change in public health in the country. No amount of alphabet accountability that docs have to do is going to change that. At least with DPC as long as they pay their fees, they can pay lip service to the doc and the doc is not held accountable for the patient’s sins. Up until about 2007 that’s the way it was with everyone before all this crap ehr, p4p, accountable care was established. I do not recommend FP to any student at this time.
    I’m glad I was the last of a breed that could do hospital and office work at least for 24 years but
    now with having to piss on to much paperwork with little satisfaction am counting the months until I can retire and walk away from this mess.

  2. Tom
    September 3, 2018 at 3:25 pm

    Having just interviewed for an FP position at an FQHC, I can say the lack of respect for their physicians was palpable. It’s not that I care personally for respect, but rather i need to know that they respect the role I need to play as a physician, because without it patients’ safety may ultimately be compromised. And patients at FQHCs deserve that protection as much as anyone. They wanted me to see 22 patients/day and on top of that be site director for 4 NPs out of some instant NP programs. The pay was below anywhere else. No thank you. I said I’d consider if I had protected admin time to review every mid-level chart and maximum 18/day so I can give patients enough time, and even then I think that’s very tight. They wouldn’t budge. The clinic manager, instead of giving me a tour, brought me to her large private office and proceeded to try to interview me like she was hiring an MA. I don’t care about pay incentives, I won’t risk patient safety or my license or burnout. It’s just not worth it. I’d say the motivation of most physicians who got into primary care is to care, and we are just not as motivated by pay incentives. That they can’t perceive this demonstrates the lack of a voice primary care physicians have in discussing primary care policy issues and the lack of respect these policy and adminstrative people have for the people who do the actual work of primary care.

    • Steve O'
      September 4, 2018 at 10:24 am

      The presence of contempt in American society in general is both ubiquitous and unnoticed.
      Your lack of eagerness to shovel s_t shows your character blemish of laziness. Perhaps 10% of the trivial and senseless busywork put on your desk is there just to remind you that you are a field hand, and to keep your performance measures from looking too good.

  3. Terry Nugent
    September 3, 2018 at 10:19 am

    Brilliant idea. Much like the old HMO per member per month or the UK system for GPs. The key would be regulatory restraint which does strain credulity.

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