In many, many of my previous posts, I’ve complained about the bigotry against and ignorance of family medicine by the rest of the medical establishment and the greater society. Today I will challenge my family physician colleagues to do more.
A recent survey by the AAFP found that fewer than 20% of AAFP members have hospital privileges and fewer than 42% provide office-based procedures. These numbers are pitiful.
First the hospital privileges: I understand the economic realities facing many family physicians whose offices are not near a hospital. When I ask them about seeing their hospitalized patients, they say by the time they drive 30 minutes through traffic each way, they could have seen 4 patients in the office. Allowable hospital professional fees don’t nearly match this revenue. That reality and other anti-family physician funding policies by CMS and the private insurance companies mean some family physicians lose money to see their hospitalized patients. Shared call and hospital coverage groups can lessen this burden.
But for a field that claims that continuity and long-term patient relationships are such a foundational trait of our profession, to not see our sickest patients is nearly inexcusable. Basically, these family physicians are telling their patients when they are the sickest, the most vulnerable, and the most scared, “Hope everything goes well for you in the hospital. I’ll see you later if you make it out alive.”
For the procedures, this is much more in the control of family physicians. Most patients don’t want to bounce from clinic to clinic to have different procedures performed. Family physicians generally believe the common office-based procedures are paid fairly by CMS and the insurance companies. I’m not sure why this FM procedure percentage is so low. Weak residencies that train young family physicians to be helpless combined with practice environments that discourage procedures are some of the explanations. This problem is generally easier to fix than the hospital problem. A lot of family physicians simply need to grow a spine and expand their personal basket of services.
In a few weeks I will take my turn covering the hospital for my group. It’s a wonderful diversion from day-to-day clinic life. It’s fun to teach residents how a family medicine philosophy works well in the hospital, not just the clinic. And I even get to do a few extra procedures. It’ll be fun. I wish more family physicians shared this joy.