A delegation from the American Academy of Family Physicians came calling at Modern Physician. They were proud of the strategic plan they'd come to ballyhoo and solicited the magazine's help in spreading the word about it.
Its 32-page "The Future of Family Medicine" is a good plan, worthy of membership support and worth reading by physician leaders in all branches of primary care. The AAFP is to be applauded for taking an unflinching look at the problems of its 97,000 members and devising what appears to be an ambitious yet credible approach to them.
Primary-care docs make up the backbone of our community healthcare system, but the AAFP?s leaders have seen troubling signs. In the 2004 residency match, compared with 2000, there were 11% fewer positions open in family practice, 13% fewer matches made into those programs, and 35% fewer U.S. allopathic medical school grads taking the available placements.
AAFP President Michael Fleming, M.D., walked gingerly around the topic of declining U.S. allopathic medical school placements.
"The folks we are getting, particularly from the D.O. schools and the international students, are quality people," Fleming said. "I think the concern is on the other side, that there is a decrease in U.S. (allopathic) medical students. That's an area we have to work on."
While most physicians are being squeezed these days, the pressure is greatest in primary care, and family practice is no exception.
In 1999, the median compensation for a family physician was $141,560, ranking only above pediatrics among 29 specialties surveyed by the American Medical Group Association. By 2002, the average pay for a family practitioner had inched up just 5.3%, to $148,992, according to a followup AMGA survey, while inflation jumped 13.7%, according to the consumer price index for urban areas kept by the U.S. Census Bureau.
Doing the math, family physicians lost $11,962 in buying power those three years.
The AAFP's plan talks about a grass-roots campaign by local family practitioners to meet with and begin attracting young people to the specialty. The campaign aims to reach as far down as the grade-school level.
At the core of the plan is the notion that family medicine still has tremendous value and a bright future because people still want a relationship with a family doctor who knows them well. But family physicians must change to secure their future.
For example, family physicians are uniquely positioned to dominate as providers of disease-management services, except for one serious shortcoming: Most family doctors lack the requisite healthcare information systems to run an effective disease-management program.
The penetration of electronic medical records systems within the ranks of family physicians is 10% or less, says IT guru David Kibbe, M.D., director of the AAFP's Center for Health Information Technology.
Nevertheless, the AAFP plan calls for all family physicians to adopt a standardized, electronic health record as "the central nervous system" of their practices, and in an effort to prepare new physicians for the advent, "every family medicine residency program will implement electronic health records by 2006."
The academy's plan calls for family physicians to share data collected by EMRs with other association members to drive research efforts toward improving quality of care. The technology will be used to hook up family physicians to evidence-based practice guidelines and other decision-support services at the point of care. The AAFP also plans to crunch the data and provide members with reports on their practice styles versus quality benchmarks.
Money to buy the EMRs is a problem. The academy is trying to beat down EMR prices and obtain better financing terms for its members with its Partners for Patients alliance with tech developers. So far, 11 vendors have signed up.
But the returns on a physician's investment in an EMR accrue disproportionately--some go to the patients through better quality, lower-cost care, some to their employers (if they provide health insurance coverage) and some to the health plans--with few mechanisms in place for these beneficiaries to help offset the physician's expense in the EMR investment.
Fleming says payers often farm out disease-management activities, but physicians, who could perform the same services better and cheaper if they were compensated for them, are typically shut out.
The academy's plan is incomplete in this regard, but it has a task force looking into better ways of getting family physicians reimbursed for their EMRs and for activities associated with disease-management programs, things such as telephone and e-mail consultations and follow-up contacts by patient educators and dietitians. That addendum is due later this year.
The encouraging news about this is that payers are taking a second look at pay plans that address this inequity.
This spring, Blue Cross and Blue Shield of Tennessee announced it was piloting a bonus payment program with 1,000 physicians in four medical groups.
Steve Coulter, M.D., chief medical officer at the health plan, said it would pay physicians for phone calls, e-mails and group sessions, as well as front the cost of a year's subscription to an e-mail communication service for each of the physicians enrolled in the pilot.
All four physician-led groups chosen to receive the extra pay already have EMR systems, Coulter said. "I wanted to give it to the doctors who are spending the money and investing in their own practices," he said.
Physicians will provide the payer with clinical data about their practice styles and receive reports, funneled through their chief medical officers, on how well they are doing in adhering to practice guidelines the groups agree to follow.
Meanwhile, WellPoint Health Networks, which is in ongoing discussions with the AAFP, is shipping out $40 million worth of IT software and hardware, including desktop and hand-held computers and e-prescribing programs, to a targeted 19,000 physicians.
In its "Future of Family Medicine," the AAFP has taken a hard forward look. It sees a challenge and an opportunity.
It will take work, but it's a vision that its members can, and should, embrace.